Quick Summary
Piriformis syndrome occurs when the piriformis muscle deep in your buttock becomes tight or overloaded and irritates the sciatic nerve running alongside it — causing deep buttock pain and sciatica-like symptoms down your leg. It is thought to account for a small but meaningful proportion of sciatica presentations, and it responds well to active treatment. Our HCPC-registered physiotherapists combine hands-on manual therapy, Swiss Storz Medical MASTERPULS radial shockwave therapy and a targeted exercise programme to settle your symptoms and restore normal movement. Most patients follow a course of typically 3–6 sessions, with your progress reviewed at every visit.
What Is Piriformis Syndrome?
The piriformis is a flat, pyramid-shaped muscle deep in your buttock. It runs from the front of your sacrum to the top of your thigh bone and works as an external rotator and stabiliser of the hip. The sciatic nerve — the largest nerve in the body — passes immediately alongside it, most often just beneath the muscle as it exits the pelvis. When the piriformis becomes tight, overloaded or inflamed, it can irritate this nerve, producing deep buttock pain that may radiate down the back of the leg.
The relationship between the sciatic nerve and the piriformis varies from person to person. Anatomical studies show that in approximately 87% of people the undivided nerve passes below the muscle, while the remaining 13% show variant anatomy — most commonly part of the nerve passing through a divided piriformis muscle. These variants occur at similar rates in people with and without symptoms, so anatomy alone does not explain the condition.
It is clinically useful to separate primary from secondary piriformis syndrome. Primary causes — a split muscle, an unusual nerve path or myofascial change — account for fewer than 15% of cases. The great majority are secondary, driven by a direct injury to the buttock, repetitive overuse, prolonged sitting, or altered hip and lumbopelvic biomechanics.
Current sports medicine literature increasingly describes piriformis syndrome as one subtype of deep gluteal syndrome — irritation of the sciatic nerve anywhere within the deep buttock space. Other structures in the same region can also irritate the nerve, which is why a careful assessment matters before treatment begins.
(Cass, StatPearls, 2024; Bartret et al., Tomography, 2023; Martin et al., Journal of Hip Preservation Surgery, 2015)
Do You Experience These Symptoms?
✓ Deep, aching pain in your buttock — usually the main complaint, rather than back pain
✓ Pain radiating down the back of your thigh and leg, similar to sciatica
✓ Symptoms that worsen with prolonged sitting, driving, or climbing stairs
✓ Tenderness deep in the buttock when the area is pressed
✓ Pain reproduced by hip movements that stretch or tighten the muscle, such as crossing your leg
✓ Numbness, tingling or pins and needles in your buttock or leg
✓ Discomfort that eases with gentle walking in some people, but worsens with vigorous activity in others
These symptoms can be treated.
The sooner you begin, the better your chances of a smoother recovery.
What Causes Piriformis Syndrome?
• Direct injury to the buttock
A fall onto the buttock, a road traffic accident or a direct blow can bruise and inflame the piriformis muscle.
The resulting muscle spasm, swelling or scarring can then irritate the sciatic nerve lying immediately alongside it.
• Overuse and repetitive loading
Running, cycling, hill and stair climbing, and rapid increases in training load can all overwork the muscle.
Distance runners, cyclists, skiers and racket sport players are among those most commonly affected.
• Prolonged sitting
Sustained pressure on the buttock from desk work, long drives or sitting on a wallet can compress and tighten the muscle.
This is a frequent contributor for people in sedentary occupations or with long daily commutes.
• Biomechanical imbalance
Weak hip abductor and gluteal muscles, poor pelvic control and altered movement patterns force the piriformis to overwork as a secondary stabiliser.
Over time this can produce the tightness and overload thought to underlie many cases.
• Anatomical variation
In a minority of people the sciatic nerve pierces or passes over the piriformis rather than beneath it, placing it in closer contact with the muscle.
This may increase susceptibility, but on its own it does not cause symptoms.
How We Treat Piriformis Syndrome at J&J Therapy
Hands-On Manual Therapy
Hands-on soft tissue release of the piriformis and surrounding deep gluteal muscles, combined with hip and lumbopelvic mobilisation, to reduce muscle tension and restore normal movement. Where the sciatic nerve is sensitised, we add neural mobilisation techniques to help the nerve glide more freely.
Shockwave Therapy*
Swiss Storz Medical MASTERPULS
to reduce tension in the piriformis muscle and stimulate your body’s natural healing response — applied over the muscle belly, never directly over the sciatic nerve.
Non-invasive, evidence-based. Typically 3–6 sessions.
Targeted Exercise Programme
A progressive programme of piriformis and hip external rotator stretching, gluteal and hip abductor strengthening, and lumbopelvic stability work, with graded return to running or cycling. Research shows that education combined with progressive exercise produces the strongest long-term outcomes for gluteal and deep buttock pain.
When to Seek Urgent Medical Help
While most symptoms are not serious, urgent medical attention is required if you experience any of the following:
Difficulty passing urine, or loss of bladder or bowel control
New or worsening numbness around your groin, genitals, buttocks or inner thighs
Progressive weakness, numbness or pins and needles in one or both legs
Unexplained fever, night pain, unexplained weight loss, or calf pain and swelling
FAQs About Piriformis Syndrome
Is piriformis syndrome the same as sciatica?
Not quite. Sciatica describes a set of symptoms — pain travelling along the sciatic nerve — that can have several different causes. Piriformis syndrome is one specific cause, where the muscle irritates the nerve in the buttock rather than the problem arising from your spine. A careful assessment helps us distinguish it from lumbar nerve root problems, sacroiliac joint pain, hip conditions and hamstring tendinopathy.
How long does it take to recover?
Many people improve within a few weeks of starting active treatment. Sciatica-type symptoms often settle within 4–6 weeks with conservative care, although some cases take longer, particularly if symptoms have been present for months. Consistency with your prescribed exercise programme is the single biggest factor in a lasting recovery.
Does shockwave therapy help piriformis syndrome?
Research suggests it may help. Two randomised controlled trials found that radial shockwave therapy produced pain relief comparable to a steroid injection, with one reporting faster improvement in the first week. We apply it over the muscle belly rather than the nerve itself, and always alongside manual therapy and exercise, as the direct evidence base is still developing.
Will I need a scan or an injection?
Usually not. Piriformis syndrome is diagnosed clinically through your history and examination, and most people respond well to physiotherapy. Scans are used mainly to rule out other causes of your symptoms, and injections are considered only if conservative treatment does not settle things.
What can I do at home to help?
Avoid prolonged sitting and take regular movement breaks through the day, and keep up with the stretches and strengthening exercises your physiotherapist prescribes. Building your running or cycling load up gradually rather than in sudden jumps also helps reduce the chance of symptoms returning.
This page is for general information only and does not replace professional medical advice.
Reviewed by Lavya Arigalayan, MSc, HCPC Registered Physiotherapist.
Last reviewed:
2026년 8월 20일