Piriformis Syndrome: What It Is, Why It Hurts, and What Actually Helps
Last updated: May 2026 · Reading time: ~4 minutes
You feel a dull ache deep in your buttock. It might shoot down the back of your leg. Sitting in a car for more than 20 minutes makes it worse. Your spine X-ray came back normal, but the pain keeps coming back.
This pattern plays out constantly in chiropractic and orthopedic offices. What many patients don’t know is that a tight little muscle in the hip called the piriformis can compress the sciatic nerve and cause pain without any disc involvement at all.
A 2024 study in the British Journal of Pain evaluated 110 patients being treated for sciatica and found that 6.25% of them actually had piriformis syndrome.1 That number represents millions of people who may be receiving treatment aimed at the wrong structure.
Research finding: A 2024 study found that among patients already diagnosed with sciatica, 6.25% were actually suffering from piriformis syndrome — a hip muscle problem, not a spinal one. (British Journal of Pain, 2024)
What Is Piriformis Syndrome?
The piriformis is a pear-shaped muscle tucked deep beneath the gluteus maximus. It runs from the sacrum, the flat bone at the base of your spine, to the top of your thighbone. Its job is to rotate the hip outward and stabilize the pelvis when you walk or run.
The sciatic nerve passes directly beneath the piriformis in most people. When the piriformis tightens, spasms, or becomes inflamed, it can press on the sciatic nerve and send pain, numbness, or tingling down the back of the leg. This is why piriformis syndrome is so often mistaken for disc-related back and neck pain or lumbar radiculopathy. The core difference: in true disc-based sciatica, compression begins in the spine. In piriformis syndrome, compression begins at the hip.
How Do You Know If It’s Piriformis Syndrome?
This condition is frustratingly hard to confirm through imaging alone. Standard X-rays and most MRIs look normal. A 2024 review in the International Journal of Sports Physical Therapy noted that musculoskeletal ultrasound is becoming a useful tool because it can show the piriformis muscle and nearby sciatic nerve in real time. But diagnosis still depends heavily on your symptom pattern and a careful physical examination.2
The classic symptom picture includes deep buttock pain that worsens after sitting for 15 minutes or more, tenderness when pressing directly into the piriformis region, and discomfort when crossing the legs or climbing stairs. The same 2024 study found that the Freiberg test, a specific maneuver that rotates the hip inward, was statistically more predictive of piriformis syndrome than any imaging finding.1
A 2025 systematic review published in BMC Surgery analyzed 212 piriformis syndrome cases drawn from 97 separate studies. It found that 38.2% of patients traced their pain to a direct blow to the pelvis or to sustained stress from sports and vigorous exercise.3 Long-distance runners, cyclists, and people who sit for hours on firm surfaces are especially prone.
If you have persistent leg pain, numbness, or tingling that isn’t responding to standard back treatment, ask your provider to specifically evaluate the piriformis.
Simple Exercises You Can Do Right Now
Stretching the piriformis is one of the most consistently supported self-care interventions in the research. A 2023 randomized controlled trial compared piriformis stretching, self-myofascial release with a foam roller, and a control group. After four weeks, both the stretching and foam rolling groups showed significantly greater reductions in pain and improvements in hip range of motion.4
Figure-four stretch: Lie on your back with both knees bent. Cross your right ankle over your left thigh, just above the knee. Slowly draw your left thigh toward your chest until you feel a stretch deep in the right hip and buttock. Hold 30 seconds. Repeat on the other side. Do 2 to 3 repetitions per side, twice daily.
Seated piriformis stretch: Sit upright in a chair. Cross your right foot over your left knee. Keeping your back straight, lean forward gently until you feel a stretch in the right buttock. Hold 30 seconds. This version works well at a desk.
Stop if symptoms increase. Sharp pain or worsening nerve symptoms during stretching are signs that a hands-on evaluation is needed first.
How to Prevent Piriformis Syndrome Going Forward
Two situations consistently irritate the piriformis: prolonged sitting, which keeps the muscle locked in a shortened position, and repetitive rotational movement without adequate warm-up or recovery time.
To protect the muscle, break up long periods of sitting every 30 to 40 minutes. Even a one-minute walk or a brief hip stretch can reduce accumulated tension. Strengthening the glutes matters too: when the gluteal muscles are weak, the piriformis compensates for hip stability, doing a job it was not designed to handle for long.
Hands-on care, including spinal manipulation, deep tissue massage, and dry needling, has shown clinical benefit for piriformis-related sciatic pain. A chiropractor or physical therapist can confirm whether the piriformis is the actual pain generator and rule out spinal conditions that require a different approach entirely.
The Bottom Line
Piriformis syndrome is common, often misdiagnosed, and very treatable once identified correctly. The difficult part is that many people spend months addressing the spine when the real problem is a tight muscle deep in the hip.
If buttock pain or sciatic-like symptoms are not responding to standard back care, ask a clinician to evaluate the piriformis specifically. Getting the diagnosis right changes the entire treatment path — and for most people, that path leads to genuine, lasting relief.
Sources & Further Reading
- Yürük D, Can E, Genç Perdecio&glu GR, Yıldız G, Akkaya ÖT. Prevalence of piriformis syndrome in sciatica patients: Predictability of specific tests and radiological findings for diagnosis. British Journal of Pain. 2024. https://pubmed.ncbi.nlm.nih.gov/39372102/
- Manske RC, Wolfe C, Page P, Voight M, Bardowski B. Use of diagnostic musculoskeletal ultrasound in the evaluation of piriformis syndrome: A review for rehabilitation providers. International Journal of Sports Physical Therapy. 2024;19(6):768–772. https://pubmed.ncbi.nlm.nih.gov/38835987/
- Sorge R, et al. Piriformis syndrome: a systematic review of case reports. BMC Surgery. 2025;25:468. https://link.springer.com/article/10.1186/s12893-025-03202-2
- Comparison of self-myofascial release and stretching exercises 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
- Brochado JF, Pereira J. Behind the pain: understanding and treating piriformis syndrome. Cureus. 2024;16(10):e71118. https://pubmed.ncbi.nlm.nih.gov/39493127/
