Piriformis Syndrome and Deep Buttock Pain: Is It Sciatica or Something Else?

Piriformis syndrome is a diagnosis patients often come to see me with because they have pain in their buttock muscle. Usually it is self diagnosed after perhaps searching the internet for “deep buttock pain that feels like sciatica”. Something in the deep buttock is irritating the sciatic nerve or mimicking it but the cause, in this case, is not coming from the spine. Clarifying that is important, because hip and pelvic pain in the buttock has three main sources: the lumbar spine, the sacroiliac joint and the deep gluteal muscles and each is managed by a chiropractor differently.

This page is about the third group, gluteal muscles in the buttock and about how I tell conditions apart for a correct diagnosis. Deep buttock pain is common, particularly in runners and in people who sit for long hours and it responds well once the precise source of the condition has been identified.

“He explained it in terms I could easily understand”

“I had been suffering from a very painful hip for three weeks after returning to running. I tried various exercises gleaned from online videos, but none seemed to work. I made an appointment with Leslie… He is excellent. He took my medical history, carefully examined me and soon diagnosed the problem. He explained it in terms I could easily understand and gave me loads of information about how I can avoid a recurrence of the injury. I have no hesitation in recommending him – richly deserving of the 5 stars.”

William G

What is piriformis syndrome?

The piriformis muscle is a small, deep muscle running from the sacrum in the pelvis to the top of the thigh bone and the sciatic nerve passes directly beneath it or, in some people ,straight through it. When this muscle becomes tight, overworked or irritated it can produce deep buttock pain and it can sometimes irritate the sciatic nerve enough to send symptoms down the leg.

The modern literature increasingly uses the broader term deep gluteal syndrome, recognising that several structures in that same space and not only the piriformis can irritate the nerve.[1][4]

Systematic reviews note there is no single definitive test and diagnosis rests on the pattern of symptoms and careful exclusion of the spine.[1][2] This places the most importance on the chiropractic examination and why this matters more than a scan.

what causes deep gluteal pain

Two groups of people commonly experience this condition. The first is runners and cyclists, where training spikes, hill work and weak gluteal muscles overload the deep hip rotators, a pattern I often see in patients who exercise and train along our coastline and beach promenades. The second is in people who sit a lot: long hours on office chairs, car seats that compress the deep gluteal space directly or wallet kept in a back pocket that digs into the buttock. Falls onto the buttock, pregnancy and any anatomical variation in how the nerve threads the muscle all can contribute to the condition. Often it is a simple mismatch between what the deep gluteal muscles are asked to do and the condition they are in to do it.

Man in a yellow t shirt running in the sun on a hard surface of a road piriformis syndrome muscle pain a deep gluteal pain is often present in runners

Explore our hip and pelvic guides

Hip and pelvic pain: the main guide

Hip and groin

Side of the hip and buttock

Pain in the side of the hip: gluteal tendinopathy, bursitis and GTPS
Piriformis syndrome and deep buttock pain (you are here)

Pelvis and tailbone

Related guides

When hip or buttock pain starts in the back

When the problem shows up further down the leg

Wear and tear, bones and staying active

When sport or training is behind it

Piriformis Syndrome

Causes and symptoms of deep gluteal (buttock) pain

The deep buttock pain that is so often mistaken for sciatica

The piriformis is a small, deep muscle in the buttock lying right over the sciatic nerve. When it becomes tight or irritated it can cause deep buttock pain and, at times, sciatica-like symptoms down the leg. The broader clinical term is deep gluteal syndrome.³

C What causes it

Overload in runners and cyclists

Training spikes, hill work and weak gluteal muscles overwork the deep hip rotators.

Prolonged sitting

Long hours in office chairs, car seats and long drives compress the deep gluteal space.

A wallet in the back pocket

The classic and genuinely real cause, sometimes called wallet neuritis.

A fall onto the buttock

Direct injury to the muscle and the space around the nerve.

Pregnancy

Postural and load changes through the pelvis and hips.

Anatomical variation

In some people the sciatic nerve threads straight through the muscle rather than beneath it.

S How it feels

Four features define piriformis syndrome¹

Deep pain in the buttock

Pain that is worse when sitting

Tenderness deep in the buttock, near the greater sciatic notch

Pain brought on by movements that tension the muscle

Also commonly reported

Aching or burning that can travel down the back of the leg

Numbness or tingling in the buttock after sitting

Worse with driving, running or climbing stairs

This is not piriformis syndrome. Seek urgent medical care (A and E) if you notice:

Numbness in the saddle area, between the legs

Any loss of bladder or bowel control

Progressive weakness in the leg

Leslie Budzynski DC | Bournemouth Chiropractic

42 Branksome Hill Road, Bournemouth BH4 9LE | 01202 937568 | bournemouth-chiropractic.co.uk

For general information only. It is not a substitute for individual assessment by a qualified clinician.

1. Hopayian K, Danielyan A. Four symptoms define the piriformis syndrome. Eur J Orthop Surg Traumatol 2018;28(2):155-164.
2. Hopayian K, et al. The clinical features of the piriformis syndrome: a systematic review. Eur Spine J 2010;19(12):2095-2109.
3. Martin HD, Reddy M, Gomez-Hoyos J. Deep gluteal syndrome. J Hip Preserv Surg 2015;2(2):99-107.

Symptoms of piriformis syndrome

Patients with buttock pain describe a deep, specific ache in one buttock, often pointing to the exact spot where it hurts. Sitting aggravates it, especially on hard surfaces or in the car and long drives become an endurance test. Pain may travel down the back of the thigh, occasionally with tingling, which is why it is often assumed to be sciatica.

The differences are in the detail. True sciatica from the lumbar spine usually involves back symptoms. Sciatica is provoked by bending, coughing or sneezing and commonly runs below the knee into the calf or foot. Sacroiliac joint pain sits slightly higher up, over the dimple at the base of the spine and is provoked by rolling in bed and standing from sitting. Deep gluteal pain sits lower and more central in the buttock, the condition flares on sitting but the back itself usually feels fine. Getting this distinction of diagnosis between the three correct is an important part of careful and precise chiropractic diagnosis.

an atatomical image of the muscles, bones of the pelvis and the major sciatic nerve in the buttock that including the piriformis muscle and where it is in relation to the sciatic nerve, ilium and hip and how they are affected in cases of piriformis syndrome

The location of the piriformis muscle and the sciatic nerve

Pain in the sit bone when sitting: ischial tuberosity

Ischial tuberosity is a close relation of piriformis syndrome. Pain directly under the sit bone, the ischial tuberosity, that flares with sitting on hard chairs and with running, particularly uphill or at pace is usually proximal hamstring tendinopathy instead, an irritation of the hamstring tendons where they anchor to that bone.[3] Ischial tuberosity is a classic runner’s complaint and increasingly a desk worker’s one too. Management of this follows tendon rules: reduce the compression, which means cushioned sitting and temporarily avoiding aggressive hamstring stretching then progressively strengthening the hamstrings over weeks. If your buttock pain lives precisely on the bone you sit on, mention it when I see you because it changes the treatment required.

How chiropractic care may help

Chiropractic care starts with the differential examination described above. I separate the symptoms clearly to arrive at a correct diagnosis. This will often lead to effective treatment.

Where the deep gluteal muscles are the source, treatment may help through soft tissue work into the piriformis muscle and the deep rotators, mobilisation of the hip and pelvis where stiffness is contributing and advice on the sitting and training habits that started the problem. Alongside that comes a progressive programme of gluteal strengthening and controlled stretching exercises which the clinical literature consistently emphasises as the foundation of conservative management.[1][2] High-quality trial evidence specific to piriformis syndrome describes conservative care as sensible first-line management rather than waiting it out and most patients can improve steadily over four to eight weeks with that approach. Your plan is built around your examination findings, your sport and your sitting hours and lifestyle, which are personal to you.

If a pain that is deep in your piriformis muscle in your buttock is getting in the way of your sport or lifestyle, come and talk it through. I offer a free 15-minute consultation, you can come in for a short no-obligation chat with no examination or treatment.

Book a free consultation

Or call for a chat on 01202 937568

Red flags: when to seek medical attention first

Buttock and leg pain is very rarely a sign of anything serious. The exceptions need urgent attention: numbness in the saddle area between your legs, new difficulty controlling your bladder or bowels or progressive leg weakness. These suggest cauda equina syndrome and need A&E immediately. See your GP first for pain with fever or feeling unwell, pain after significant trauma, constant night pain unrelieved by any position or a history of cancer.

Everything else is appropriate for chiropractic assessment in clinic.

your first visit to Bournemouth Chiropractic

At your chiropractic first appointment visit I take a detailed history, then examine your lumbar spine, sacroiliac joints and hips in turn, using movement, palpation and specific provocation tests to establish which of the three buttock-pain sources is responsible for your pain I explain the results and we agree a plan, which includes onward referral if need be.

Frequently Asked Questions

Is my buttock pain piriformis syndrome or sciatica?

Buttock pain from piriformis syndrome typically is aggravated by sitting. It sits deep and low in one buttock and usually your back feels fine. Sciatica from the spine usually involves back symptoms and is aggravated by bending, coughing or sneezing and it often travels below the knee. An thorough examination distinguishes them from each other and os far more reliable than looking at the symptoms in isolation.

Can a chiropractor help with piriformis syndrome, the pain in my backside?

A chiropractor may help with piriformis syndrome, first by establishing that the deep gluteal muscles in your backside are the source of your pain rather than the spine or sacroiliac joint. Then treating the condition with soft tissue work, mobilisation and a graded strengthening programme. Conservative chiropractic care of this kind is the accepted first-line approach.

Why does my buttock hurt when I sit down?

Buttock pain when you sit usually means that sitting is compressing the painful structure. Deep central buttock pain points to the piriformis and deep gluteal muscles, while pain directly under the sit bone points to proximal hamstring tendinopathy. A cushion helps both in the short term, but identifying which one you have decides the best and most appropriate and effective treatment.

Is piriformis syndrome serious?

Piriformis syndrome is not serious in the medical sense. It is a persistent nuisance rather than a danger and it can improve with the right conservative management. The serious mimics of this condition have clear warning signs which are saddle numbness, bladder or bowel changes or progressive leg weakness and those symptoms need A&E rather than a clinic appointment.

Should I stretch or strengthen for piriformis syndrome?

For piriformis syndrome you should usually do both, stretch and strengthen, in the right proportion. Gentle, controlled stretching can ease the tight, irritable muscle but strengthening the gluteals is what will change the problem in the long term. If your pain is actually under the sit bone, aggressive stretching can aggravate it which is why chiropractic assessment offers help and should come first.

Whatever's behind your deep gluteal buttock pain, come and find out

Deep gluteal pain, felt in the buttock or around the sit bone is often mistaken for sciatica. Telling piriformis syndrome apart from a trapped nerve is exactly what an initial chiropractic assessment is for. I'd happily see you first for a free 15 minute consultation: a short no-obligation chat to talk through what's going on, not an examination or treatment. I'll answer your questions about whether chiropractic may help you and you can then choose whether to book a full visit for examination and treatment from there.

Deep gluteal and sit bone pain like this is a common reason people come to see me from all over Bournemouth and nearby Poole.

In many of the cases I see, chiropractic care is a very well-tolerated option worth considering and I'll explain clearly whether it's likely to help in your particular case. If I think you'd be better served by your GP, a specialist or another practitioner, I'll tell you and help point you in the right direction.

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