Written by Ansu Susan Kuriakose, BPT · Clinically reviewed by Jasmal K, BPT, MPT · Last reviewed 5 October 2026
Piriformis syndrome: deep buttock pain and sciatica-like symptoms
The piriformis is a small muscle deep in your buttock, close to the sciatic nerve. In piriformis syndrome, the muscle is thought to irritate the nerve, causing deep buttock pain that can spread down the leg. It's a debated diagnosis, and it's often confused with sciatica from the spine. A careful assessment matters, because the treatment depends on where the problem really is.
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What is piriformis syndrome?
The piriformis runs from the base of your spine to the top of your thigh bone, and helps turn your leg outward. The sciatic nerve passes right next to it. Piriformis syndrome describes sciatic-type pain thought to come from this muscle rather than from the spine.
An honest note: piriformis syndrome remains controversial among specialists. There's no accepted test that confirms it, so it's usually diagnosed by ruling out other causes, such as a slipped disc, sacroiliac joint pain or a hip problem.
Symptoms
- deep ache or pain in one buttock
- pain spreading down the back of the thigh, sometimes further
- pain that's worse when sitting for a long time, especially on hard surfaces
- pain when climbing stairs or after long walks
- tenderness deep in the buttock
When back or leg pain is an emergency
How it's diagnosed
At your Maana Spine assessment, your physiotherapist asks about your symptoms, checks your lower back, SI joints and hips, tests the nerves in your legs, and examines the buttock muscles. The aim is to rule out spinal and other causes first. Any MRI, X-ray or lab reports you bring are reviewed.
You'll get a physiotherapy diagnosis and a personalised plan. You don't need a scan to book; if one would help, your physiotherapist will recommend an MRI or X-ray.
How we treat piriformis-type pain at Maana Spine
Treatment follows Maana Spine DTX™, our personalised, non-surgical Precision Spine Care program:
Assess: we rule out the spine, SI joint and hip as the main source of your pain, and check for red flags.
Decompress: not usually needed if your pain is coming from the buttock muscles. If a disc problem in the lower back is also involved, decompression may be used where it suits your condition.
Restore: targeted muscle release, physiotherapist-led stretching, and shockwave therapy (ESWT) for tight, tender areas in the buttock muscles.
Strengthen: our four-level exercise roadmap (Level 1 Restore, Level 2 Stabilise, Level 3 Strengthen, Level 4 Maintain) for the hip, buttock and core muscles.
Empower: how to sit, drive, ride and exercise in ways that ease pressure on the buttock, with written and app-based home exercise programmes.
Maintain: in-person follow-up at 1, 3, 6 and 12 months. The 1- and 3-month follow-ups are included in your program fee; the 6- and 12-month reviews are charged separately.
A DTX program is typically 15 to 25 sessions of 60 to 75 minutes each. Your physiotherapist will tell you after your assessment how many you're likely to need.
What the research says
Diagnosis is debated. A 2010 systematic review found piriformis syndrome remains controversial, with no accepted reference test for diagnosing it.
Treatment. A 2021 literature review found that medical management and physical therapy show some promise, and that doctors may offer injections if conservative care doesn't help. Surgery is reserved for rare cases.
Our approach. We use targeted muscle release and shockwave therapy (ESWT) for piriformis-type pain based on our clinical experience. We haven't found trials of ESWT specifically for piriformis syndrome.
Practical tips
- Break up sitting, and use a cushion on hard seats.
- Stretch gently as shown by your physiotherapist; stop if stretching sends pain down your leg.
- Avoid sitting on a wallet in your back pocket.
- Build hip strength gradually.
These are general tips, not a substitute for an assessment.
When to book a spine assessment
Book an assessment if buttock or leg pain has lasted more than a couple of weeks, keeps coming back, or makes sitting difficult. Spine assessments are available at all five Maana Spine clinics in Kochi, Kozhikode, Thiruvananthapuram, Aluva and Perinthalmanna. The consultation fee is ₹250, and no doctor's referral is needed.
Book a Spine Assessment · or call or WhatsApp +91 99950 09403
Frequently asked questions
How do I know if it's piriformis syndrome or sciatica?
It can be hard to tell without an assessment. Sciatica from the spine often comes with back pain, and numbness or weakness in the leg. Piriformis-type pain is mainly deep in the buttock and worse with sitting. Because the two overlap, your physiotherapist checks the spine first.
Is piriformis syndrome real?
It's debated. Some specialists think it's underdiagnosed and others think it's overdiagnosed. There's no accepted test that confirms it, so it's diagnosed by ruling out other causes.
What's the fastest way to relieve piriformis pain?
There's no proven fastest method. Breaking up sitting, gentle stretching and a structured exercise plan help many people. Your physiotherapist will tailor treatment to you.
Does stretching help piriformis syndrome?
Gentle stretching helps many people as part of a wider plan. If stretching makes pain spread down your leg, stop and get assessed.
Can piriformis syndrome cause numbness?
It can cause tingling in the leg for some people. Numbness or weakness is more often a sign of a nerve problem in the spine, so get assessed.
How many sessions will I need?
A Maana Spine DTX™ program is typically 15 to 25 sessions of 60 to 75 minutes each. Your physiotherapist will suggest a plan after your assessment.
References
- Hopayian K, et al. European Spine Journal, 2010. pmc.ncbi.nlm.nih.gov/articles/PMC2997212
- Surgical and non-surgical treatment options for piriformis syndrome: a literature review. Anesthesiology and Pain Medicine, 2021. pmc.ncbi.nlm.nih.gov/articles/PMC8241586