Published by PMR of NY & CT
A deep ache in one buttock that flares when you sit, climb stairs or run, sometimes with tingling down the back of your thigh, can come from a small muscle called the piriformis. When that muscle irritates the sciatic nerve running next to it, the problem is often called piriformis syndrome.
Most piriformis syndrome treatment is conservative: changing how you sit and move, stretching and strengthening the hip, and hands-on care when it helps. Here is the full range of options, from home care to when a physician gets involved.
What piriformis syndrome is
The piriformis runs from the base of your spine to the top of your thighbone. It helps turn your leg outward and steadies the hip when you walk. The sciatic nerve passes just beneath it, and in some people runs through it.
When the muscle is tight, overworked or injured, it may irritate the nerve. Experts still debate how often this happens, and no single test confirms it. Common signs include:
- Deep pain in one buttock
- Pain that builds with sitting, especially on a hard seat or a wallet
- Pain with stairs, hills, running or rising from a chair
- Aching, tingling or numbness down the back of the thigh
Piriformis syndrome vs sciatica from your spine
Sciatica describes pain along the sciatic nerve, not its cause. Most often the source is the lower spine, where a disc or narrowed space presses on a nerve root. Piriformis syndrome is a less common cause, with the irritation happening in the buttock.
A few clues lean one way, though none is definitive:
- Low back pain, or leg pain that worsens with coughing or sneezing, more often points to the spine.
- Buttock pain that worsens with sitting, with little or no back pain, may point to the piriformis.
- Leg weakness, a dragging foot or reflex changes suggest a nerve root problem that needs a prompt exam.
A clinician will test your hip, spine and nerves, and may order imaging to rule out a spinal cause. Our sciatica page covers spine-related causes.
Piriformis syndrome treatment you can start at home
The first steps are simple:
- Break up sitting. Stand and move regularly, and take your wallet out of your back pocket.
- Stretch gently. For a basic piriformis stretch, lie on your back, rest the ankle of your sore side across the opposite knee, then pull the bottom leg toward your chest. Hold about 30 seconds, and stop if tingling increases.
- Try heat or ice. Heat may relax a tight muscle, and ice may calm soreness after activity.
- Keep moving. Gentle activity usually beats bed rest. Ease off long runs, hills and deep squats for now.
- Ask about pain relievers. Check with your doctor or pharmacist before using over-the-counter medicine.
Physical therapy and exercise
If home care isn't enough after a couple of weeks, a structured exercise program is usually next. Physical therapy for this problem often includes:
- Stretches for the piriformis and other hip rotators
- Strengthening for the glutes, outer hip and core, so the piriformis isn't overworking
- Nerve gliding exercises that gently move the sciatic nerve
- A review of your running form, workstation or sport mechanics
Research is limited, partly because experts disagree on how to diagnose the condition. Still, exercise is the usual starting point and carries little risk.
Chiropractic and other hands-on care
Chiropractic care for piriformis syndrome typically looks at the lower back, pelvis and hip together. A chiropractor may use joint mobilization or adjustments, soft tissue work on the piriformis and nearby muscles, and stretching, plus a home exercise plan. Medical massage may also ease muscle tension.
These approaches may reduce pain for some people, especially alongside exercise, but studies specific to this condition are few.
When to see a physician or get urgent care
If piriformis syndrome treatment hasn't helped after several weeks, a physician such as a physiatrist can recheck the diagnosis. Options may include prescription medicine or an injection into the piriformis muscle, often guided by imaging, which may ease pain for a while and help confirm the source. Results vary, and surgery is a last resort. Learn more about pain management and physiatry at Physical Medicine & Rehabilitation of NY & CT (PMR).
Call 911 or go to an emergency room if buttock or leg pain comes with loss of bladder or bowel control, numbness in your groin or inner thighs, or leg weakness that is getting worse. See a doctor the same day for pain with fever, and promptly after a hard fall or accident.
Frequently asked questions
How long does piriformis syndrome take to heal?
Many people feel better within a few weeks of consistent stretching, strengthening and changes to how they sit and train. Symptoms that built up over a long time may take a few months, and flare-ups are common if the exercises stop. If you aren't seeing progress after several weeks, ask your provider to recheck the diagnosis.
Can piriformis syndrome cause foot pain or numbness?
It can. When the piriformis irritates the sciatic nerve, pain, tingling or numbness may travel down the back of the thigh and sometimes into the calf or foot. Symptoms below the knee, especially with weakness, are also common with a pinched nerve in the lower back, so an exam is the best way to find the source.
Can sitting on a wallet cause piriformis syndrome?
It can contribute. A thick wallet or phone in a back pocket presses on the buttock and tilts the pelvis, which may irritate the piriformis and sciatic nerve over long hours, especially when driving. Moving your wallet to a front pocket is an easy change, though it is rarely the only factor.
Talk with our team
If buttock or leg pain is making it hard to sit, sleep or train, our team can help find the source and build a plan around your life. Request an appointment and we will contact you to schedule a visit at PMR of Danbury or PMR of Brewster.
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