Condition guide
The piriformis is a muscle deep in the buttock that turns the leg outwards; the sciatic nerve runs close to it, and sometimes through it. In piriformis syndrome, the nerve is thought to be squeezed by this muscle. It causes pain in the buttock that gets worse when sitting and can spread down the back of the leg. It is a controversial diagnosis: a slipped disc is a far more common cause of sciatica.
In a 2010 systematic review of 55 studies, most of the evidence came from case reports and reviews. The four most commonly reported signs were buttock pain, tenderness to pressure over the sciatic notch in the buttock, pain that gets worse when sitting, and pain brought on by movements that stretch the piriformis muscle.
According to an updated review in 2018, the accuracy of examination tests is not yet known; a normal straight leg raise test does not rule out the diagnosis.
Among cases of sciatica seen in orthopaedic practice, piriformis syndrome is estimated to account for 1% or fewer. The most common cause of sciatica is a slipped disc; spinal stenosis and spondylolisthesis can also cause sciatica. This is why causes in the lower back should also be considered.
You can take a break for a while from the activity that makes your symptoms worse. If you sit for long periods, getting up and moving often can help.
In stretches for the hip, you can hold each position for 30 seconds. Strengthening exercises help the hip handle load better.
Leaning against a wall or lying on the floor, you can place a tennis ball under your buttock and gently massage the tender area.
A 20-minute ice pack can help the pain, and heat can help flexibility. You can take a medicine such as paracetamol or ibuprofen as directed on the packet.
For pain spreading from the lower back down the leg, see the lumbar disc herniation guide; for pain on the outer side of the hip, see the lateral hip pain guide.
Exercises at home
Do the movements slowly and with control. If numbness or tingling in the leg gets worse, you can stop that movement and check with a doctor or physiotherapist.
Lie on your back with your knees bent. Place the ankle of your painful side over your other knee (like the number 4). Hold the lower thigh with both hands and gently pull it towards your chest; you should feel a mild stretch at the back of your painful buttock. Stop if numbness or tingling gets worse.
Hold for 30 seconds, 3 repetitionsSit up straight near the front edge of a chair. As you straighten your knee, gently tilt your head back to look up at the ceiling. As you bend your knee, tilt your head forwards. The nerve is tightened at one end as it slackens at the other, so it glides without being stretched.
10 slow reps. Stop if the numbness increasesLie on your back with your knees bent and feet flat on the floor. Squeeze your buttocks and lift your back off the floor so that your shoulders, hips and knees form a straight line. Hold for 3–5 seconds, then lower slowly.
10–15 reps, 1–2 times a dayLie on your side with the bottom knee slightly bent. Lift the top leg with the knee straight and toes pointing forwards. Your hip muscles help keep the knee stable.
10–15 reps on each sideLie on your side, facing forwards, with your elbow directly under your shoulder, your forearm on the floor and your knees bent. Lift your hips off the floor so that your body forms a straight line from your head to your knees. You can reach your top arm up towards the ceiling or rest your hand on your waist. Lower slowly, then turn onto your other side.
10–20 seconds, 3 times on each sideStand up straight, holding on to the counter. Keeping your knee straight, slowly move one leg back behind you; squeeze your buttock without arching your lower back. Slowly return to the start.
10 reps on each legNo. Sciatica is the name for pain that spreads down the leg along the sciatic nerve, and its most common cause is a slipped disc. In piriformis syndrome, the nerve is thought to be squeezed by the piriformis muscle in the buttock; it is estimated to account for about 1% or fewer of the sciatica seen in orthopaedic practice. For more on this, see our lumbar disc herniation guide.
Pain that gets worse when sitting, especially on a hard chair, is one of the typical features of this syndrome. If you have to sit for long periods, you can get up and move often, and try sitting on a softer surface rather than a hard one.
There is no single test that confirms the diagnosis. Many examination tests have been described, but how accurate they are is not yet known. The diagnosis is made by looking at symptoms and examination findings together, while also considering causes in the lower back.
Treatment usually starts with exercise and adjusting activity. In some cases a steroid injection may help; surgery is very rarely needed.
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