Piriformis syndrome why it occurs and how to treat it quickly

Piriformis syndrome — also known as “false sciatica” — is one of the causes of buttock pain and lower back pain that may radiate down the leg, and its symptoms can be very similar to true sciatica. The problem occurs when the piriformis muscle compresses the sciatic nerve, which leads to pain, numbness, tingling, and difficulty moving.In this Dalili Medical article, we will explain in detail the causes of piriformis syndrome, the key symptoms you should pay attention to, and the most effective treatment options — whether through exercises, medications, or even surgery in severe cases — so you can react properly and reduce the pain as quickly as possible.This article will help you understand everything about this condition from A to Z, and how to differentiate it from other similar problems.

What is Piriformis Syndrome?

Piriformis syndrome is a condition in which the piriformis muscle in the pelvis becomes tight or goes into spasm, causing pressure on the sciatic nerve. When the nerve gets compressed, a person may feel pain, numbness, tingling, or burning starting from the buttock and sometimes radiating down the leg, the lower back, and even the feet.

The sciatic nerve runs from the spinal cord, passes underneath the piriformis muscle, and continues all the way down the back of the leg — which is why any issue with this muscle can directly irritate the nerve.

Where is the Piriformis Muscle Located?

The piriformis muscle lies deep in the pelvis. It begins from the lower part of the spine (the sacrum) and attaches to the top of the femur (thigh bone). Its main function is to help rotate the thigh outward.

When the muscle becomes tight or strained, it can lead to pain in the buttock or lower back.

Is Piriformis Syndrome the Same as Sciatica?

No — but they are closely related.

Sciatica refers to pain caused by irritation or compression of the sciatic nerve in general.

Piriformis syndrome is specifically caused by the piriformis muscle pressing on the sciatic nerve.
So the cause is different — but the symptoms can look almost identical.

Can a Herniated Disc Be Mistaken for Piriformis Syndrome?

Yes, definitely.

Both conditions can cause similar radiating pain down the buttock and leg. That’s why proper medical evaluation is necessary to determine whether the pain is caused by a spinal disc issue or the piriformis muscle.

Does Sitting Too Long Make It Worse?

Yes.

Prolonged sitting — especially on hard surfaces — increases pressure on the piriformis muscle, which can worsen irritation of the sciatic nerve.

Can the Condition Improve on Its Own?

Sometimes mild cases can improve gradually.
But most people need stretching and strengthening exercises to speed up healing and prevent recurrence.

Is Exercise Helpful or Harmful?

The right exercises are very beneficial — especially stretching and strengthening routines.
But incorrect exercise techniques can make the problem worse.

Is Standing Better Than Sitting?

In most cases — yes.

Light walking or standing can reduce pressure on the muscle more than long periods of sitting.

Does Weight Gain Play a Role?

Yes — excess weight, especially around the pelvis and abdomen, increases the load on the piriformis muscle, which may raise the risk of developing the syndrome.

Can the Pain Come Back After Treatment?

Yes, it can — especially if the person returns to the habits that caused it, such as:

long sitting hours
no stretching
poor posture

Is Botox Injection Useful?

In selected cases — yes.
Botox helps relax the piriformis muscle, which reduces pressure on the nerve and improves pain for a period of time.

Is Every Buttock Pain Caused by Piriformis Syndrome?

No. Other causes may include:

herniated disc
hip joint inflammation
other muscular problems around the hip and lower back

This is why proper diagnosis is important.

Types of Piriformis Syndrome

Direct compression of the sciatic nerve
A tight or overactive piriformis muscle directly presses on the nerve.
Nerve irritation without direct compression
Muscle tension irritates the nerve indirectly.
Piriformis syndrome secondary to other structural problems
For example: disc herniation or hip joint issues leading to abnormal pressure on the nerve.
Piriformis syndrome caused by injury or trauma
Direct impact to the buttock or pelvis may cause inflammation and pain.
Compression from a mass or tumor (rare)
A mass in the pelvic area may compress the muscle or nerve.

Who Is at Higher Risk?

athletes (sprinters, jumpers, yoga/gymnastics)
people who lift heavy weights
individuals who sit for long periods
people with previous pelvic or lower back injuries
those with structural imbalances (leg length difference, scoliosis)
patients with hip joint problems
adults aged 30–50
women more than men (due to pelvic width)
people with excess weight
hormonal changes after menopause

Main Causes of Piriformis Syndrome

The condition occurs when the piriformis muscle compresses or irritates the sciatic nerve.

Key causes include:

Tightness / spasm of the muscle
due to:

intense exercise
training without warm-up
prolonged sitting

Sciatic nerve passing through the muscle
In some people, the sciatic nerve runs through the piriformis muscle instead of beneath it — making it easier for the muscle to irritate the nerve even with minimal tension.

3) High Physical Activity

Activities like running, weightlifting, gymnastics, and jumping can strain the piriformis muscle. Sudden or intense movements increase muscle tension and spasm.

4) Prolonged Sitting

Especially office sitting, long driving hours, or sitting on hard surfaces.
This increases pressure on the muscle and irritates the nerve.

5) Poor Posture While Sitting / Walking

Incorrect body alignment causes abnormal load on the pelvis and piriformis muscle.

6) Direct Injuries

Such as:

falling on the buttock
car accidents
severe sports trauma

These can enlarge or inflame the muscle, leading to pressure on the nerve.

7) Structural Abnormalities

Such as:

leg length discrepancy
spondylolisthesis
hip joint inflammation

These affect body balance and increase stress on the muscle.

8) Rare Pelvic Tumors or Infections

Masses or inflammatory conditions around the nerve or muscle can cause compression.

9) Psychological Stress

Chronic anxiety and tension can lead to persistent muscular tightness in the pelvic area.

10) Obesity

Excess body weight increases load on the pelvis and lower back.

11) Pregnancy

Weight gain and shifting center of gravity during pregnancy can increase pressure on the piriformis muscle.

What Are the Symptoms of Piriformis Syndrome?

The symptoms of piriformis syndrome are often similar to sciatica because they are caused by sciatic nerve compression. The main symptoms include:

1) Deep Pain in the Buttock

Pain felt deep inside the buttock
Worse with long sitting or driving
Pain may increase when pressing on the muscle area

2) Radiating Pain Down the Leg

Pain may travel from the buttock down the leg or even to the foot
Can feel like burning or intense tightness
Sometimes tightness in the back of the thigh

3) Numbness or Tingling in the Leg or Foot

Pins-and-needles sensation
Mild sensory loss due to nerve irritation

4) Weakness in the Leg Muscles

Difficulty climbing stairs
Feeling of instability during walking

5) Pain That Worsens With Movement or Sitting

Intense sports or running make the pain worse
Sitting on a hard chair or prolonged sitting increases symptoms

6) Pain When Pressing the Muscle

Direct pressure on a specific point in the buttock triggers clear pain.

7) Muscle Spasms

The piriformis muscle may go into spasm causing more pressure on the nerve.

8) Relief When Standing or Walking

Many patients report: “Pain gets better when I stand or walk.”

9) Changes in Walking Style

Patients sometimes change leg position or tilt the body to reduce pain.

Psychological Effects of Chronic Pain

Chronic pain is not only a muscular or nerve problem — it also has psychological impact.
Long-term pain often leads to anxiety, stress, frustration, reduced activity, and lower quality of life.

Medical Treatment for Piriformis Syndrome (Medications)

The main goals of medication are:

reducing pain and inflammation
relieving muscle spasm
improving sciatic nerve function

Medication is usually part of a complete treatment plan including physiotherapy and exercises.

1. Pain Relievers

A. NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

Examples: Ibuprofen – Diclofenac – Naproxen
Role: reduce inflammation and pain caused by muscle tension or nerve compression
Side effects: stomach irritation, digestive issues (especially with long-term use)

B. Paracetamol (Acetaminophen)

Useful for mild to moderate pain
Generally safer for the stomach

2. Muscle Relaxants

Examples: Tizanidine – Cyclobenzaprine
Role: decrease muscle spasm in the piriformis and improve mobility
Side effects: drowsiness – dizziness – constipation

3. Corticosteroids

A. Injections (directly into the muscle or epidural)

Reduce inflammation around the sciatic nerve
Benefits: long-lasting pain relief
Risks (rare): infection – temporary blood sugar rise – tissue weakness

B. Oral Steroids

Used in acute severe cases
Long-term use may cause weight gain, high blood pressure, and bone weakness

4. Neuropathic Pain Medications

Examples: Gabapentin – Pregabalin
Role: reduce nerve pain, numbness, and tingling
Possible side effects: dizziness – sleepiness – mild weight gain

5. Tricyclic Antidepressants (TCAs)

Example: Amitriptyline
Useful especially when pain causes sleep disturbance

6. Supplements

Glucosamine / Chondroitin → supports cartilage and tissues
Calcium + Vitamin D → supports bones and spine health
Omega-3 → reduces inflammation

Surgical Treatment for Piriformis Syndrome

If conservative treatment, physical therapy, and medication do not provide enough relief, surgery may be considered. The goal is to reduce pressure on the sciatic nerve, improve mobility, and decrease persistent pain.

Main surgical options:

1) Piriformis Release / Myectomy

A portion of the piriformis muscle is removed to reduce nerve compression.

Procedure:

small incision in the buttock
identify the tight muscle portion
remove a section of muscle

Advantages:

significant pain relief
improved ability to walk, sit, and move

Possible drawbacks:

temporary post-surgical pain
risk of infection or scar formation
recovery 4–8 weeks

2) Sciatic Nerve Decompression

The surgeon separates tissues pressing on the nerve and removes adhesions.

Benefits: improves nerve function, reduces tingling
Risks: rare nerve injury, requires physical therapy after surgery

3) Endoscopic Piriformis Release

Same concept but using small incisions and a surgical camera.

Advantages: less pain, faster recovery, tiny scars
Disadvantages: not suitable for all advanced cases, requires high surgical expertise

4) Open Conventional Surgery

Larger incision for direct exposure — used in severe or chronic cases.

Pros: clear visibility of the area
Cons: more pain, longer healing, larger scar

Most Effective Exercises for Piriformis Syndrome

Exercises are essential to reduce pain, improve flexibility of the piriformis muscle, and strengthen the hip and sciatic area. They are divided into 4 categories: stretching – strengthening – mobility – overall flexibility.