Overview

Piriformis syndrome is a diagnosis given when buttock pain and possible leg symptoms are attributed to the piriformis muscle — a small, deep muscle in the buttock that rotates the hip outward and stabilises the pelvis — irritating or compressing the sciatic nerve nearby.

The term is debated. Many clinicians now use the broader term deep gluteal pain syndrome, and the evidence behind piriformis syndrome as a specific diagnosis is weak and inconsistent. It is a clinical diagnosis of exclusion: other causes of buttock and leg pain are ruled out first.

Typical Pattern

One-sided buttock pain, often deep, aching or cramping
Worse with prolonged sitting, especially on hard surfaces
Pain that can travel down the back of the thigh like sciatica
Tenderness when pressing on the deep buttock
Pain with movements that stretch or load the muscle — turning the leg out, squatting, lunging
Sometimes pins and needles in the leg or foot; true numbness or weakness is uncommon

Why It Develops

The cause is often unclear. Contributing factors may include prolonged sitting, high training loads, muscle tightness or trigger points, previous buttock injury, or an anatomical relationship between the muscle and the sciatic nerve that varies from person to person.

Because there is no gold-standard test, prevalence estimates vary enormously — from under 1% to around 17% of people with chronic low back pain depending on the criteria used, and a 2026 systematic review found the numbers depend heavily on how rigorously the diagnosis is made.

How It Is Diagnosed

There is no single confirming test. A clinician typically:

Takes a history of sitting-related buttock pain and leg symptoms
Rules out more common causes: disc herniation, nerve-root compression, SI joint dysfunction and hip problems
Examines the deep buttock for tenderness and checks whether stretching or resisted rotation reproduces the pain

Imaging is used mainly to exclude other causes. Injections into the muscle are sometimes used diagnostically, but their value is debated.

Treatment

Conservative care is the first line, and most people improve:

Education about sitting: break up long sits, use cushions or alternate positions
Activity and load management rather than full rest
Progressive gluteal, core and hip strengthening
Gentle stretching or manual therapy in some cases
Graduated return to running and sport

Injections (for example into the muscle under image guidance) are considered for persistent pain after a good conservative trial, usually as part of a plan that includes exercise. Surgery is extremely rare and reserved for very specific, well-documented cases.

When to Get Assessed

Arrange an assessment if buttock or leg pain persists, is worsening, or keeps returning with sitting or sport. Seek urgent care if there is new leg weakness or numbness, difficulty passing urine, loss of bladder or bowel control, or saddle numbness — those patterns need prompt medical attention.

References

StatPearls. "Piriformis Syndrome." https://pubmed.ncbi.nlm.nih.gov/38697742/
Hopayian K, Song F, Riera R, Sambandan S. "The clinical features of the piriformis syndrome: a systematic review." European Spine Journal. 2010. https://pubmed.ncbi.nlm.nih.gov/20596735/
Abeje Assefa M, et al. "Global prevalence of piriformis syndrome: a systematic review and meta-analysis." 2026. https://www.sciencedirect.com/science/article/pii/S2214751926001039

This information is for education only and is not a medical diagnosis. InjuryAtlas does not replace an assessment by a qualified health professional. If you have severe pain, visible deformity, numbness, loss of function, or symptoms that are getting worse, seek medical care promptly.

Piriformis Syndrome