You feel a deep, aching pain in one side of your buttock. It might shoot down the back of your leg. Sitting for a long time makes it worse. Standing up after a long car ride can feel like agony. Your first thought: “This must be sciatica.”
But you might be dealing with something different, and that difference matters a great deal for how you treat it.
A condition called piriformis syndrome can cause pain that looks almost identical to sciatica. The two are regularly confused, even by physicians. Knowing which one you have can save you months of following the wrong treatment plan.
Research stat: A 2025 systematic review analyzed 212 documented cases of piriformis syndrome and found the average patient was 43 years old. More than one in three had a history of pelvic trauma or repetitive physical stress to the muscle. (BMC Surgery, 2025)
What Is Piriformis Syndrome?
The piriformis is a small, flat muscle deep inside your buttock. It connects the base of your spine to the top of your thighbone and helps you rotate your hip outward. Most of the time you never think about it.
Problems begin when the piriformis becomes tight, inflamed, or goes into spasm. The sciatic nerve runs very close to this muscle. In some people it runs directly through it. When the piriformis irritates the sciatic nerve, the result is pain, numbness, or tingling that travels down the back of the leg.
Because the symptoms feel so similar to spinal sciatica, piriformis syndrome is often overlooked. Imaging of the lower spine looks normal, and the real source of the problem — the piriformis muscle deep in the buttock — never gets examined.
How Is Piriformis Syndrome Different From Sciatica?
True sciatica begins at the nerve roots in the lower back. A herniated disc or bone spur compresses the sciatic nerve where it exits the spine. Piriformis syndrome compresses the same nerve much lower down, deep inside the buttock.
A few clues that suggest piriformis syndrome rather than a spinal cause:
The pain tends to stay concentrated in the buttock rather than radiating all the way to the foot. Sitting for a long stretch makes it noticeably worse. Rotating your hip inward or crossing your legs can trigger it. A lumbar MRI often comes back normal, because the disc and the nerve roots are fine.
That last point causes a lot of confusion. A clean MRI of the lower spine does not rule out piriformis syndrome. This is why a careful physical examination often reveals more than imaging. See also: back and neck pain conditions we treat.
What Causes Piriformis Syndrome?
Prolonged sitting is the top driver. A 2025 study published in BMJ Open examined a sedentary population and found a 61.1% prevalence of piriformis syndrome. Sitting duration, poor seated posture, and low physical activity were the strongest predictors of both developing and worsening the condition.2
Direct trauma is another common cause. Falling hard on the buttock, a collision during sport, or even a very long drive on rough roads can inflame the muscle. Runners and cyclists who increase their training load faster than their hips can handle are also at elevated risk.
People who sit most of the day and then push themselves hard on weekends are particularly vulnerable. The piriformis has not been conditioned for sudden demands, and it responds with tightness and pain.
Simple Stretches You Can Do Right Now
These two movements target the piriformis directly. Hold each for 30 seconds and repeat twice per day.
Figure-Four Stretch: Lie on your back with knees bent. Cross your right ankle over your left knee. Gently pull your left thigh toward your chest until you feel a deep stretch in the right buttock. Switch sides and repeat.
Seated Piriformis Stretch: Sit upright in a chair. Place your right ankle on your left knee. Sit tall and lean forward slightly. You will feel the stretch deep in the right hip and buttock. Switch sides and repeat.
A 2023 randomized controlled trial in the International Journal of Therapy and Rehabilitation compared stretching against self-myofascial release (foam rolling) in people diagnosed with piriformis syndrome. Both groups reduced pain significantly over four weeks. Consistent daily practice was the key factor for both.3
How to Stop It From Coming Back
The single most effective prevention strategy is breaking up long periods of sitting. Set a timer. Every 45 to 60 minutes, stand up and walk for two or three minutes. This simple habit reduces the sustained compression that leads to piriformis irritation. For related hip and spine conditions, read our article on SI joint pain.
Hip strengthening is the other key piece. When the glutes and hip abductors do their job effectively, they absorb more of the load during movement. A weak hip complex shifts excess demand onto the smaller piriformis, and overuse problems follow. Simple exercises like clamshells, glute bridges, and lateral band walks can make a meaningful difference.
If pain has not improved after a few weeks of consistent stretching and movement breaks, a hands-on evaluation is worth scheduling. Manual therapy aimed at restoring hip mobility and reducing sciatic nerve irritation typically produces faster results than stretching alone.
The Bottom Line
Piriformis syndrome is one of the more underdiagnosed causes of deep buttock and leg pain. Because its symptoms overlap so closely with sciatica, it often gets mislabeled and people follow treatment plans that miss the real source of their discomfort.
The good news is that most cases respond well to conservative care. Targeted stretching, regular movement breaks, and hip strengthening can resolve the pain without medication or surgery. The key is an accurate diagnosis in the first place.
Sources & Further Reading
- Systematic review of piriformis syndrome case reports. BMC Surgery, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC12512919/
- Batool N, et al. Prevalence of piriformis syndrome and its associated risk factors among university students. BMJ Open, 2025;15(1):e092383. https://pubmed.ncbi.nlm.nih.gov/39773790/
- Comparison of self-myofascial release and stretching in individuals with piriformis syndrome: a randomised controlled trial. International Journal of Therapy and Rehabilitation, 2023. https://www.magonlinelibrary.com/doi/abs/10.12968/ijtr.2023.0022
- Jankovic D, Peng P, van Zundert A. Brief review: piriformis syndrome: etiology, diagnosis, and management. Canadian Journal of Anaesthesia, 2013;60:1003–12. https://pubmed.ncbi.nlm.nih.gov/23893704/
