Disclaimer: This article provides general information and is not a substitute for professional medical advice, diagnosis or treatment. Recovery and treatment needs vary between individuals. If you have ongoing or worsening symptoms, consult a qualified healthcare professional for personalised advice.
A deep ache in one buttock that gets worse after sitting can make everyday activities uncomfortable. When the discomfort also travels into the back of your thigh, it can be difficult to tell whether the problem comes from your hip, a muscle or your lower back.
Piriformis syndrome symptoms typically involve pain deep in the buttock, sometimes with discomfort, tingling or numbness that extends along the back of the leg. Symptoms may become more noticeable after prolonged sitting, climbing stairs, running or other activities that place demand on the muscles around the hip.
However, piriformis syndrome can resemble sciatica and several other conditions. Symptoms alone cannot always identify the source.
Below, we look at what piriformis syndrome can feel like, why the sciatic nerve may become involved, how it differs from lower-back-related sciatica and what physiotherapy can do to help.
What Is Piriformis Syndrome?
The piriformis is a small muscle located deep within the buttock. It runs from the sacrum near the base of your spine to the upper part of your thigh bone.
Its role changes depending on your hip position, but it contributes to hip movement and helps provide stability when you walk or transfer weight from one leg to the other.
The sciatic nerve passes through the same general region. Its exact relationship with the piriformis varies between people.
Piriformis syndrome is used to describe symptoms thought to occur when the sciatic nerve becomes irritated or compressed around the piriformis region. It is sometimes grouped within the broader category of deep gluteal syndrome.
Because buttock and leg pain can originate from several areas, a careful assessment is important before assuming the piriformis is responsible.
What Does Piriformis Syndrome Feel Like?
The symptom pattern can differ from one person to another. However, pain centred deep within one side of the buttock is a common feature.
You may notice symptoms such as:
- A deep ache or tenderness in the buttock
- Pain after sitting for an extended period
- Discomfort that extends into the back of the thigh
- Tingling or numbness along the leg
- Pain with certain hip movements
- Symptoms during stairs, hills or running
For some people, the discomfort remains around the buttock. For others, irritation of the sciatic nerve can produce symptoms further down the leg.
Why Sitting Can Make Symptoms Worse
Prolonged sitting can aggravate piriformis-type pain, potentially because it places sustained pressure on tissues around the buttock.
You might feel relatively comfortable while standing or moving around, then notice symptoms after:
- A long car trip
- Several hours at a desk
- Sitting through a movie
- Working from a low or firm chair
The problem may become particularly noticeable when you first stand after sitting.
This pattern can provide useful information during an assessment, but it does not confirm piriformis syndrome by itself. Lumbar spine and other hip conditions can also become uncomfortable after prolonged sitting.
Can Piriformis Syndrome Cause Sciatica?
Piriformis syndrome can produce sciatic-type symptoms, but there is an important distinction between piriformis-related nerve irritation and sciatica caused by the lower back.
The sciatic nerve travels from the lower spine through the buttock and down the leg. If it becomes irritated near the piriformis, you may experience pain, tingling or altered sensation along part of that pathway.
By comparison, classic lumbar sciatica usually relates to irritation of a nerve root in the lower back. The symptoms can overlap considerably, which is why diagnosing yourself based on the location of pain can be misleading.
Piriformis Syndrome vs Lower Back Sciatica
One of the useful parts of an assessment is determining whether your symptoms appear to come primarily from the buttock or the lumbar spine.
With piriformis syndrome, you may notice:
- Buttock pain as the dominant symptom
- Symptoms that increase with prolonged sitting
- Tenderness deep in the gluteal region
- Pain linked to particular hip positions
With lumbar sciatica, symptoms may be more closely affected by:
- Lower back movement
- Bending or spinal positions
- Coughing or sneezing in some cases
- Nerve root irritation from the lumbar spine
These are patterns rather than strict diagnostic rules. You can also have more than one contributing factor at the same time.
At FlexiFit Physiotherapy, we assess both the hip and lower back when the symptom pattern warrants it rather than treating every case of buttock pain as piriformis syndrome.
What Can Trigger Piriformis-Type Symptoms?
There isn’t always one obvious cause.
Symptoms may appear after a change in how much load the hip has to tolerate. For example, you might develop pain after substantially increasing your running distance, adding more hills to your walks or returning to sport after a period of reduced activity.
Other possible contributors include:
- Repetitive hip movements
- Long periods of sitting
- A sudden increase in exercise
- Reduced hip strength or control
- Direct trauma to the buttock
- Changes in walking or running load
The relevant factor is often not the activity itself but the difference between what your body is accustomed to and what you suddenly ask it to do.
How Is Piriformis Syndrome Assessed?
There is no single symptom or simple home test that reliably confirms piriformis syndrome.
A physiotherapy assessment therefore looks at the broader clinical picture.
We may ask you:
- Where did the pain first appear?
- Does it travel below the buttock?
- What happens after you sit?
- Do lower back movements change your symptoms?
- Have you recently changed your exercise or workload?
Your physical assessment may examine hip movement, strength, nerve sensitivity and movements that reproduce or reduce your symptoms. We may also assess the lumbar spine to determine whether it could be contributing to your symptoms.
If your presentation suggests another condition or requires further investigation, we can recommend appropriate medical review.
Does Piriformis Syndrome Go Away?
Symptoms can improve, but the recovery period varies according to the cause, severity and how long the problem has been present.
Simply waiting for the pain to disappear may not address the factors that contributed to it. At the same time, aggressively stretching or exercising an already sensitive area can cause a flare-up.
Treatment often works best when it matches your current tolerance and progresses gradually. For one person, this may initially mean shorter periods of sitting and gentle movement. Someone further into recovery may need stronger hip exercises and a structured return to running or sport.
What Can You Do When Symptoms Flare?
If buttock pain becomes irritated, temporary changes to your routine may help settle symptoms without requiring complete rest.
Depending on your presentation, you may benefit from:
- Breaking up long periods of sitting
- Changing position regularly
- Temporarily reducing activities that clearly provoke symptoms
- Keeping up with comfortable walking or other gentle movement
- Avoiding forceful stretches that reproduce leg symptoms
Be particularly careful with stretches that create sharp, electric or increasingly widespread pain down the leg. That response may indicate nerve irritation rather than a useful muscle stretch.
How Physiotherapy Can Help
Physiotherapy for suspected piriformis syndrome should focus on more than simply releasing or stretching one muscle.
At FlexiFit Physiotherapy, we first work to identify which structures are most likely to contribute to your symptoms. Depending on your assessment, your treatment plan may include:
Hip Strength and Control
Exercises can help improve the capacity of your hip and gluteal muscles, particularly if weakness or poor load tolerance contributes to symptoms.
Appropriate Mobility Work
Some people benefit from mobility exercises, but we choose these based on your presentation rather than assuming the piriformis always needs stretching.
Nerve Mobility Exercises
When nerve sensitivity is present, carefully selected nerve mobility exercises may be appropriate. These differ from aggressive stretches and should not force the nerve into painful positions.
Activity and Load Modification
We can help you decide how much walking, running, gym work or other activity is appropriate while symptoms settle.
The aim is to keep you as active as possible without repeatedly provoking the problem.
When Should Buttock or Leg Pain Be Checked?
Book an assessment if pain persists, repeatedly returns or begins to interfere with sitting, walking, work, sleep or exercise.
You should also seek professional advice if you experience significant numbness or weakness rather than assuming the symptoms come from a tight piriformis.
Urgent medical assessment is important if leg symptoms occur alongside loss of bladder or bowel control, numbness around the groin or saddle region, severe or rapidly progressive weakness, significant trauma or other concerning symptoms.
Piriformis Syndrome Symptoms: Final Thoughts
Piriformis syndrome symptoms often centre around deep buttock pain and may include sciatic-type pain, tingling or numbness into the leg. Sitting and certain hip activities can aggravate symptoms for some people.
The difficulty is that several lower back, hip and nerve conditions can produce a very similar pattern.
Rather than assuming every deep gluteal ache comes from the piriformis, the more useful approach is to identify where your symptoms originate and which movements or loads contribute to them. That gives you a clearer path towards appropriate treatment.
Get Your Buttock and Leg Pain Properly Assessed
If you’re dealing with persistent buttock pain or symptoms that travel into your leg, FlexiFit Physiotherapy can help assess what may be contributing.
We’ll assess your hip, lower back, strength, movement and nerve-related symptoms where appropriate. From there, we can develop a treatment plan that fits your current symptoms and the activities you want to return to, rather than relying on generic piriformis stretches.
Whether your goal is to sit comfortably at work, return to the gym or get back to running, we’ll help you understand the next steps.
Call us on 02 8542 9507 or visit our Contact Us page to speak with our friendly team and arrange an appointment.