Piriformis Syndrome: That Pain in the Butt!

What is the Piriformis?Piriformis Syndrome Diagram

The piriformis muscle is located deep in the buttock region behind the large gluteal muscle, and connects the lower spine to the top of each femur (thigh bone). The sciatic nerve (the largest nerve in the body) usually runs diagonally behind the piriformis, but in some people the sciatic nerve can actually run right through the muscle.

The piriformis allows for movement of the hip, upper leg, and foot outward from the body, and is vital to our overall balance when upright. Walking, cycling, running, dancing, and many other activities require a healthy piriformis. A problem with the piriformis can not only limit mobility and balance, but may also aggravate the sciatic nerve (sciatica), causing debilitating pain.

Symptoms of Piriformis SyndromePiriformis Muscle Sciatic Nerve

Piriformis syndrome may manifest itself as a dull ache or shooting pain in the back, hip, buttocks, and legs, and an inflamed piriformis can cause difficulty and pain while sitting and when changing positions (like when moving from sitting to standing). Sufferers may also experience numbness, tingling, and/or severe pain that radiates down the leg.

Causes of Piriformis Syndrome

While precise causes are unknown, common suspected causes include:

  • Muscle spasm in the piriformis muscle, either because of irritation in the piriformis muscle itself, or irritation of a nearby structure such as the sacroiliac joint or hip;
  • Tightening of the muscle, in response to injury or spasm;
  • Swelling of the piriformis muscle, due to injury or spasm.

Stretches for the Piriformis Muscle 1


A physical therapist will conduct a thorough evaluation to assess the condition and develop the appropriate course of therapeutic interventions, which may include:

  • Pain Relief: Ice/heat to manage inflammation, and therapeutic modalities.
  • Range of Motion and Flexibility Improvement: Soft tissue massage, stretching, passive and active range of motion techniques.
  • Mobility: Manual therapy to improve joint motion.
  • Nervous System: Nerve gliding to improve function.
  • Therapeutic Exercise: core, hip, and lower body strengthening
  • Functional Training: Whole body strengthening to support optimal posture .
  • Education: Activity modification and postural education.

Stretching to Prevent and Address Piriformis Syndrome

Exercising and stretching the piriformis takes a conscious effort, but it’s worthwhile to prevent a painful condition. If the piriformis muscle tightens, gets pulled, becomes inflamed, or spasms, an effective piriformis stretch can restore muscle function and relieve pain.

You shouldn’t stretch cold muscles. Doing so could cause unintentional injury; do at least a moderate warm-up first to loosen muscles and connective tissue before stretching the piriformis.

Stretching the Piriformis Muscle 2When exercising, it’s best to work the entire area and all connected muscles. They support each other and so they must work together.

The purpose of doing piriformis stretches is to prevent or reduce pain, not increase it. Stretch slowly and if it hurts, modify or simply don’t do it. “No pain, no gain” doesn’t apply here. If you are unable to do any of these stretches without pain, you should set up an evaluation with a physical therapist so that you do not prolong your recovery.

We Can Help

If piriformis pain is getting between you and a happy, healthy life, call today to schedule an evaluation with one of our highly trained physical therapists or to learn more about our Medically Based Personal Training program.