Piriformis Syndrome is a peripheral neuritis or irritation of the sciatic nerve.
Presentation:
Patients who are experiencing Piriformis Syndrome typically present with gluteal region pain and/or pain traveling down the back of their leg. Numbness and tingling may also be present in these regions. Pressure on the piriformis muscle, from being in a seated or lying position for extended periods of time, may worsen these symptoms. Prolonged walking, squatting, sitting with crossed legs and even bowel movements may also aggravate symptoms.
Cause:
When the piriformis muscle becomes injured, spasmed, or irritated there is the potential for the muscle to then cause compression or irritation to a portion of the sciatic nerve. Women tend to experience Piriformis Syndrome at a higher rate than men do. In about 15% of cases there is an anatomical cause where the sciatic nerve pierces through the middle of the piriformis muscle which falls under the category of Primary Piriformis Syndrome. Having excessive pronation of the foot, pelvic rotation or an anatomically short leg may also predispose individuals to this condition.
How We Can Help:
By addressing the underlying cause and properly diagnosing the cause of your symptoms we can then properly treat and educate our patients about Piriformis Syndrome and its causes. Treating the injury or irritation to the piriformis muscle is one part of recovery however learning the proper stretches, exercises and activities to avoid is also another significant factor to properly treating and preventing this condition from resurfacing.
About the author
Dr. Eric Dickerson, DC, FRCms
Founder, Sports Chiropractor
As the Founder and Director of Clinical Development at Radius Physical + Sports Rehab, Dr. Eric Dickerson is a dedicated musculoskeletal provider who blends clinical experience with a patient-centered approach. He integrates functional rehabilitation, evidence-based physical rehabilitation modalities, joint manipulation, and advanced manual therapy techniques to craft a comprehensive approach to your health.
More from Dr. Eric Dickerson →Frequently Asked Questions
Common questions about piriformis syndrome.
What is piriformis syndrome?
Piriformis syndrome is a clinical condition in which the piriformis muscle—a muscle deep in the buttock—compresses or irritates the sciatic nerve, producing pain in the gluteal region that can radiate down the back of the leg. It is primarily a clinical diagnosis and is one of exclusion, meaning more common causes of sciatica are ruled out first. It is estimated to account for only about 0.3% to 6% of all cases of low back pain and/or sciatica.
What does piriformis syndrome feel like?
People with piriformis syndrome often report pain in the gluteal region described as shooting, burning, or aching down the back of the leg. Numbness in the buttocks and tingling along the path of the sciatic nerve are not uncommon. Symptoms may worsen with certain activities, such as sitting for prolonged periods, and an inability to sit comfortably for a long time is characteristic. Palpation may reveal mild to moderate tenderness around the sciatic notch.
What causes piriformis syndrome and who is at risk?
Piriformis syndrome occurs when the piriformis muscle presses on the sciatic nerve, often after inflammation, muscle spasm, or scarring in or around the muscle. The muscle can be stressed by poor body posture over time or by an acute injury involving sudden, strong internal rotation of the hip. Sitting for prolonged periods—as with taxi drivers, office workers, or cyclists—is a common contributor. Women appear to be affected more often than men, with a reported male-to-female ratio of roughly 1:6.
How is piriformis syndrome different from sciatica caused by the spine?
Piriformis syndrome and spine-related sciatica both affect the sciatic nerve but arise differently. In piriformis syndrome, the piriformis muscle presses on the nerve in the buttock, so symptoms tend to center on a more specific area. Spine-related sciatica, by contrast, can stem from a herniated disc or spinal stenosis. It can often be difficult to differentiate radicular pain from spinal stenosis versus piriformis syndrome, and conditions such as facet arthropathy, disc herniation, lumbar muscle strain, and spinal stenosis should be considered and ruled out.
How is piriformis syndrome managed?
Management of piriformis syndrome is generally conservative. It may include short-term rest (not more than 48 hours), muscle relaxants, NSAIDs, and physical therapy involving stretching of the piriformis muscle, range-of-motion exercises, and deep-tissue massage. Most people become symptom-free within 1 to 3 weeks after starting an exercise program, though the right approach depends on the individual case. Options such as steroid or botulinum toxin injections may be considered when standard measures do not provide relief.
When should someone with buttock or leg pain see a clinician?
Because piriformis syndrome is a diagnosis of exclusion, buttock or leg pain that resembles sciatica should be evaluated so that more common causes—such as a herniated disc, spinal stenosis, or other lumbar or pelvic problems—can be investigated and ruled out. A healthcare provider should be contacted for pain lasting longer than a few weeks despite following guidance, sudden severe back or leg pain, sudden weakness or numbness, trouble lifting the foot off the floor, frequent trips or falls, or any problems controlling the bowel or bladder.
Sources
- StatPearls (NCBI/PubMed Central), "Piriformis Syndrome," last updated Aug 4, 2023 — peer-reviewed condition overview; definition, diagnosis of exclusion, symptoms, causes/risk, prevalence, differential diagnosis, conservative management and recovery timeframe
- Cleveland Clinic, "Piriformis Syndrome: Symptoms, Causes and Treatment" — plain-language overview; symptom/activity list, difference from spine-related sciatica, treatment options, when-to-call-a-provider red flags
The information on this website is general education about musculoskeletal and movement-related conditions. It is not medical advice or a diagnosis, and it cannot tell you what is causing your symptoms. Reading it is not a substitute for an in-person evaluation, and booking a visit does not confirm that your condition is right for our care until a provider has examined you. This information cannot identify every condition, and some urgent problems can feel like musculoskeletal pain. If your symptoms are severe or getting worse, or you are unsure how urgent they are, contact your physician, call 911, or go to the nearest emergency room. When in doubt, seek emergency care.
