Piriformis Syndrome

What is Piriformis Syndrome?

The piriformis is a small, deep muscle in the buttock that helps rotate the hip. The sciatic nerve runs right next to it, and in some people directly through it. When the piriformis becomes tight, irritated, or goes into spasm, it can press on the sciatic nerve and produce pain that feels a lot like sciatica.

For this reason it is sometimes called pseudo-sciatica or deep gluteal pain syndrome. The key difference is the source: here the problem is the muscle in the buttock, not a disc or nerve root in the spine. That distinction changes how we treat it.

Common triggers include long hours of sitting, sitting on a wallet, a lot of driving, running, stair climbing, trauma to the buttock, and muscle imbalance. A leg length difference or postural strain can also set it off.

Symptoms

• Deep aching or pain in one buttock
• Pain that radiates down the back of the thigh or leg
• Tingling, numbness, or a burning sensation in the leg
• Pain that is worse with sitting, climbing stairs, running, or squatting
• More pain in the buttock than in the back
• Tenderness when pressing on the muscle deep in the buttock

How We Treat It

Most cases settle with the right combination of targeted injection and physiotherapy. We often begin with an ultrasound-guided trigger point injection directly into the piriformis muscle to release the spasm and calm the irritation. Where the sciatic nerve itself is inflamed where it passes the muscle, a nerve block or a steroid injection around the area reduces the swelling and the radiating pain.

Injections work best when they open a window for movement, so we pair them with physiotherapy: piriformis stretching, hip and gluteal strengthening, core stability, and correcting the posture or gait pattern that caused the strain. Surgery is rarely needed and we reserve it for the few cases that do not respond to this approach.