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Piriformis Syndrome: A Common but Often Misunderstood Cause of Buttock Pain

By Emma Glynn - The Hip & Knee Physio



piriformis syndrome

Introduction: What is Piriformis Syndrome?

If you’ve been experiencing deep buttock pain that radiates down the back of your leg, especially after sitting, running, or climbing stairs, you might have what’s commonly called piriformis syndrome.



This condition involves irritation or compression of the sciatic nerve by the piriformis muscle, a small but important muscle located deep in your buttock near the hip joint (Boyajian-O’Neill et al., 2008). Despite its popularity as a “buzzword diagnosis,” true piriformis syndrome is relatively rare and often confused with other causes of sciatic-type pain.


That’s why accurate diagnosis and individualised care are key.


What Causes Piriformis Syndrome?

The piriformis muscle helps stabilise the hip and rotate the thigh outward. It lies close to the sciatic nerve, which runs from your lower back down through your buttock and into the back of your leg. In around 15–30% of people, the sciatic nerve actually passes through or splits around the piriformis muscle, which may increase the risk of compression (Beaton & Anson, 1937; Smoll, 2010).


Common contributing factors include:

  • Direct trauma to the buttock

  • Overuse from running or repetitive hip movements

  • Prolonged sitting (e.g. desk workers, truck drivers)

  • Muscle imbalances around the pelvis and hip

  • Biomechanical issues like leg length discrepancies or poor foot control


Typical Symptoms of Piriformis Syndrome

Symptoms can range from mild to debilitating.

Key features include:

  • Deep, dull pain in the mid-buttock, often one-sided

  • Pain that worsens when sitting, climbing stairs, squatting, or running

  • Referred pain down the back of the thigh (sciatica-like), without lower back involvement

  • Tenderness over the piriformis muscle

  • Possible numbness or tingling along the sciatic nerve path


It’s crucial to rule out other causes of sciatic pain, such as lumbar disc pathology, as these often require different treatment approaches (Fishman et al., 2002).


Diagnosing Piriformis Syndrome

There’s no single gold-standard test for piriformis syndrome, which is why it’s considered a diagnosis of exclusion. Diagnosis typically includes:

  • Thorough clinical examination: assessing hip rotation strength, flexibility, palpation of the piriformis, and sciatic nerve sensitivity

  • Provocative tests like the FAIR test (Flexion, Adduction, Internal Rotation) can reproduce symptoms (Hopayian et al., 2010)

  • Exclusion of lumbar spine causes via history and neurological exam

  • Imaging (MRI, ultrasound) may be used to rule out other pathology but is often not definitive

Note: In elite athletes, overdiagnosis is common—especially in those with chronic buttock pain. Accurate assessment is key.


Evidence-Based Treatment Options

1. Activity Modification

Initial treatment may involve reducing or modifying aggravating activities like long sitting or sprinting. However, rest alone is rarely curative.

2. Exercise Therapy

Targeted rehabilitation is the cornerstone of treatment and may include:

  • Hip mobility and neural mobility drills

  • Strengthening of gluteal muscles and hip rotators

  • Load management for return to sport

Programs that improve hip control, trunk stability, and movement patterns have shown favourable outcomes (Boyajian-O’Neill et al., 2008).

3. Manual Therapy

Techniques such as soft tissue release, dry needling, or joint mobilisation may help in the short term. However, these should complement—not replace—active rehab (Michel et al., 2013).

4. Medication or Injection

In resistant cases, corticosteroid or botulinum toxin injections to the piriformis muscle may be considered under ultrasound or CT guidance (Fishman et al., 2002).


When to Seek Help

If you’ve had persistent buttock pain that’s not resolving with rest or stretching, or if your symptoms worsen when sitting or running, it’s time to get it assessed properly.


At The Hip & Knee Physio (Camberwell), we take a detailed look at your history, biomechanics, and strength to distinguish piriformis syndrome from other causes of buttock or leg pain. Your rehab plan will be tailored to your sport, training goals, and lifestyle.


Frequently Asked Questions

  1. Can piriformis syndrome be cured?

Yes, most people improve with proper diagnosis, activity modification, and exercise-based rehab. Chronic cases may take several months.


  1. Is MRI useful to diagnose piriformis syndrome?

MRI can help rule out other causes, but it’s not diagnostic on its own. Clinical assessment is essential.


  1. Should I keep stretching my piriformis?

Only if directed. Overstretching can sometimes irritate the sciatic nerve further, especially if neural sensitivity is part of your picture.


  1. What if my symptoms haven’t improved in 6+ weeks?

You may need a second opinion or a review of your loading plan and diagnosis. In some cases, other causes (e.g., referred pain from the lumbar spine) may be missed.


Next Steps

If you’re based in Camberwell, Hawthorn, Glen Iris, or surrounding suburbs, and struggling with persistent glute or hamstring pain, book an hip consultation today.


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Disclaimer

The content provided on this website is for general information and educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment.

While The Hip and Knee Physio strives to present accurate and up-to-date information, we do not guarantee results or outcomes based on the information provided. Any exercises, strategies, or recommendations featured on this site should not be considered a personalised treatment plan.

Always seek the advice of a qualified healthcare provider before starting any exercise program, particularly if you are experiencing pain, injury, or a pre-existing medical condition.

Use of this website does not create a physiotherapist–patient relationship. The Hip and Knee Physio accepts no responsibility for any injury or loss arising from reliance on or use of this information.

By using this website, you agree to these terms.


References

Beaton, L. E., & Anson, B. J. (1937). The relation of the sciatic nerve and of its subdivisions to the piriformis muscle. The Anatomical Record, 70(1), 1–5. https://doi.org/10.1002/ar.1090700102


Boyajian-O’Neill, L. A., McClain, R. L., Coleman, M. K., & Thomas, P. P. (2008). Diagnosis and management of piriformis syndrome: An osteopathic approach. The Journal of the American Osteopathic Association, 108(11), 657–664.


Fishman, L. M., Dombi, G. W., Michaelsen, C., Ringel, S., Rozbruch, J., Rosner, B., &

Weber, C. (2002). Piriformis syndrome: Diagnosis, treatment, and outcome—a 10-year study. Archives of Physical Medicine and Rehabilitation, 83(3), 295–301. https://doi.org/10.1053/apmr.2002.29675


Hopayian, K., Song, F., Riera, R., & Sambandan, S. (2010). The clinical features of the piriformis syndrome: A systematic review. European Spine Journal, 19(12), 2095–2109. https://doi.org/10.1007/s00586-010-1504-9


Michel, F., Decavel, P., Tousignant-Laflamme, Y., Girard, M., & Descatha, A. (2013). Piriformis syndrome: Diagnostic criteria and management strategies. Muscles, Ligaments and Tendons Journal, 3(4), 190–196.


Smoll, N. R. (2010). Variations of the piriformis and sciatic nerve with clinical consequence: A review. Clinical Anatomy, 23(1), 8–17. https://doi.org/10.1002/ca.20893

 
 
 

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