Piriformis Syndrome: Symptoms, Causes, and Treatment

If you have a deep ache in one buttock that flares when you sit and sometimes shoots down the leg, piriformis syndrome may be the reason. It’s often mistaken for ordinary sciatica — but the cause, and the fix, can be a little different. This guide explains what piriformis syndrome is, how to tell it apart from a spine problem, and what actually helps.

What is piriformis syndrome?

The piriformis is a small, flat muscle deep in the buttock that runs from the lower spine to the top of the thigh and helps rotate the hip. The sciatic nerve passes right next to — and in some people through — this muscle. When the piriformis becomes tight, inflamed, or spasms, it can press on the sciatic nerve and cause pain. That’s piriformis syndrome.

Piriformis syndrome vs. sciatica

This is the part that confuses people. “Sciatica” just means irritation of the sciatic nerve, and it usually comes from the spine — a pinched nerve in the lower back from a herniated disc or stenosis. Piriformis syndrome causes similar leg symptoms, but the source is the muscle in the buttock, not the spine. As Cleveland Clinic puts it, “piriformis syndrome only involves the piriformis muscle pressing on one area of the sciatic nerve in the buttock” (Cleveland Clinic). The distinction matters because it changes where treatment is aimed. Our guide on sciatica covers the spine-related version.

Symptoms of piriformis syndrome

The hallmark is pain centered in the buttock, often with symptoms that spread into the hip or down the back of the leg. People typically notice:

• A deep ache, burning, or tingling in one buttock
• Pain that shoots or radiates down the back of the thigh
• Symptoms that worsen with sitting for a long time — driving, a desk, a bike seat
• Discomfort climbing stairs, walking, or running
• Relief when you stand up and move around

What causes piriformis syndrome?

It usually comes from the piriformis being overworked or irritated. Common triggers include long hours of sitting, a sudden increase in running or activity, an injury or fall onto the buttock, and repetitive movements. Muscle tightness, weakness in the surrounding muscles, and poor movement habits all make it more likely.

How is piriformis syndrome diagnosed?

There’s no single test that confirms piriformis syndrome, so it’s largely a clinical diagnosis. A specialist examines how your hip and buttock respond to specific movements and pressure, and often orders imaging like an MRI — not to “see” the syndrome, but to rule out a spine cause such as a herniated disc. In other words, part of diagnosing it is confirming the pain isn’t coming from your back.

How is piriformis syndrome treated?

The good news: most cases improve with simple, non-surgical care, often within a few weeks.

Stretching and physical therapy

Targeted stretches for the piriformis and hip, plus exercises to strengthen the surrounding muscles, are the foundation of treatment. A physical therapist can make sure you’re stretching the right way without aggravating the nerve.

Activity changes and self-care

Breaking up long sitting, easing off the activity that flared it, and using heat or over-the-counter anti-inflammatory medicine all help calm things down.

Injections

If pain is stubborn, a targeted injection into or around the piriformis — often image-guided — can reduce the muscle irritation and inflammation pressing on the nerve. Our guide on trigger point injections explains one option for muscle-related pain.

Surgery

Surgery for piriformis syndrome is rare and reserved for the uncommon cases that don’t respond to everything else.

When should you see a doctor?

See a specialist if buttock or leg pain lasts more than a few weeks, keeps returning, or interferes with sitting, work, or sleep — especially since it’s worth confirming the pain isn’t coming from your spine.

Frequently asked questions

What does piriformis syndrome feel like?

It usually feels like a deep ache, burning, or tingling in one buttock, sometimes shooting down the back of the leg. It’s often worse after sitting for a while and eases when you stand and move.

How is piriformis syndrome different from sciatica?

Sciatica most often comes from the spine — a herniated disc or stenosis pinching the nerve. Piriformis syndrome comes from the piriformis muscle in the buttock pressing on the sciatic nerve. The leg pain can feel similar, which is why a proper evaluation matters.

How long does piriformis syndrome last?

Many cases settle within a few days to a few weeks with stretching, physical therapy, and activity changes. Stubborn cases that linger may benefit from a targeted injection.

What stretches help piriformis syndrome?

Gentle stretches that open the piriformis and hips can relieve pressure on the nerve, done slowly and without forcing. A physical therapist can tailor the right ones and make sure you’re not aggravating the sciatic nerve.

Do I need surgery for piriformis syndrome?

Almost never. The large majority of people improve with non-surgical care. Surgery is reserved for the rare cases that don’t respond to stretching, therapy, activity changes, and injections.

This article is for general education and is not a substitute for medical advice. Talk with a qualified clinician about your specific symptoms.