Piriformis syndrome occurs when the piriformis muscle, located in the buttock, compresses the sciatic nerve. This pressure often causes pain, tingling, or numbness in the buttock and thigh, typically affecting one side of the body.

The condition may result from excessive muscle tension, poor posture, or repetitive movements. Diagnosis is confirmed through specific physical tests performed by a healthcare professional, often alongside imaging exams to rule out other conditions.

Treatment for piriformis syndrome primarily includes physical therapy, medication, and rest. In more severe cases, corticosteroid injections or surgery may be considered, although most people find relief through conservative measures.

Common symptoms

The main symptoms of piriformis syndrome include:

Pain in the buttock and the back of the thigh
Burning sensation
Mild to moderate stabbing or throbbing pain
Tingling, pins-and-needles, or numbness in the buttock
Usually affects only one side of the body

Other possible symptoms include weakness or difficulty walking after sitting for long periods, pain that radiates down to the foot, and buttock muscle atrophy in long-term cases.

Symptoms of piriformis syndrome tend to worsen when sitting for extended periods, walking, running, climbing stairs, doing strenuous physical activity, or putting weight on the affected side.

Where is piriformis syndrome felt?

Piriformis syndrome causes pain mainly in the buttock, which may extend down the back of the thigh and, in some cases, all the way to the foot. Read more about glute pain and the conditions it is associated with.

Confirming a diagnosis

Diagnosis of piriformis syndrome is usually made by a physical therapist or orthopedic doctor through specific physical tests, such as:

Freiberg test: The person lies face down with knees bent, and the hip is rotated inward. Pain indicates a positive test.
FAIR test: The person lies on their side, bends the top leg at a 90° angle, moves it toward the body, and rotates it inward. Pain indicates a positive result.
Lasègue test: The person lies on their back while the hip is flexed up to 70° to stretch the sciatic nerve. If pain occurs, the test is positive.
Beatty test: The person lies on their side and lifts the top leg as if crossing it. Pain indicates a positive result.
Pace test: The person sits and spreads their knees apart. Pain in the buttock area indicates a positive result.

If four or more of these tests are positive and the person has buttock pain, piriformis syndrome is likely present.

Additional exams such as X-rays, MRI scans of the spine and pelvis, ultrasound, CT scans, or electromyography may be ordered to rule out other conditions and confirm the diagnosis.

Possible causes

Piriformis syndrome can result from issues involving the gluteal muscles, such as excessive tension, inflammation, scarring, spasms, or muscle shortening.

Certain habits and activities may also contribute to the condition, including trauma, repetitive movements, sitting for long periods, poor posture, improper lifting techniques, and lack of stretching.

In some cases, piriformis syndrome may be linked to anatomical differences between the sciatic nerve and piriformis muscle, such as abnormal nerve pathways that make compression more likely.

Treatment options

Treatment for piriformis syndrome is determined by an orthopedic doctor or physical therapist, depending on the severity of symptoms. It may include the following:

1. Rest

Treatment usually begins with a few days of rest and avoiding activities that cause pain, such as running or cycling.

It’s also important to maintain good posture when sitting, standing, or driving, get up regularly, and stretch to prevent muscle spasms.

2. Physical therapy

Physical therapy is essential and may include massage, stretching, exercises to strengthen the piriformis and surrounding muscles, posture correction, and in some cases, ultrasound therapy to improve circulation and relax the muscle.

Applying cold compresses several times a day for 15 to 20 minutes can also help reduce swelling and inflammation.

Check-out a list of sciatica stretches that can help to relieve discomfort.

3. Medication

Certain medications may be prescribed to control pain and inflammation in piriformis syndrome, including:

Anti-inflammatory drugs such as ibuprofen or naproxen to reduce swelling
Pain relievers such as acetaminophen (paracetamol) to relieve pain
Muscle relaxants such as cyclobenzaprine to reduce muscle tension
Nerve pain medications such as gabapentin to relieve neuropathic pain caused by sciatic nerve compression

For severe or persistent pain, corticosteroid or botulinum toxin injections may be used to reduce muscle spasms and provide relief.

4. Surgery

Surgery is rarely needed and is only considered when other treatments have not been effective. It may involve removing scar tissue, relieving pressure on the nerve, or releasing the piriformis muscle.

However, surgery should be carefully evaluated because it can cause scarring or adhesions in the buttock that may maintain or worsen symptoms in some cases.

Recovery time

Recovery time varies from person to person and depends on the treatment performed. Most people experience symptom relief within 1 to 3 weeks after starting physical therapy.

However, pain may return if stretching and strengthening exercises are not maintained regularly after recovery.

Can piriformis syndrome be cured?

Piriformis syndrome does not have a permanent cure, but symptoms can usually be managed and relieved with conservative treatments such as physical therapy, posture correction, medication, and activity modifications.

With these measures, most people can return to their normal daily activities, although occasional flare-ups may still occur.

Piriformis Syndrome: Symptoms, Causes, Diagnosis & Treatment