Piriformis syndrome causes pain in the buttocks and hip. It occurs when the piriformis muscle irritates the sciatic nerve. Treatment includes stretches, exercises, and home remedies.

This irritation can cause pain, numbness, tingling, and shooting sensations in the buttocks and hip, and sometimes in the thighs and legs. Piriformis syndrome can cause occasional pain or become a chronic condition.

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The piriformis is a pear-shaped muscle in the buttocks that extends from the base of the spine to the top of the thigh. Piriformis syndrome happens when this muscle spasms and entraps the nearby sciatic nerve.

Piriformis syndrome can come on suddenly, usually following an injury, or it can appear gradually over several months.

A person can turn to different strategies to help treat symptoms of piriformis syndrome. Some strategies a person can try at home and others will need the supervision of a doctor. Strategies include:

Home remedies

When the symptoms are relatively mild, a person can try the following:

  • Using ice or heat packs
  • Massaging the entire hip and buttock area
  • Taking over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs). However, a person should not use these medications to make exercise less painful. In fact, a person should avoid activities that make the pain worse, like running.
  • Resting after an obvious injury

Stretches and exercises

People may also want to consider trying special exercises and stretches to strengthen the piriformis muscle. This may help reduce the severity of muscle spasms and relieve muscle tightness.

Some examples of stretching exercises that may help relieve symptoms include:

  • Lie on the back and bend the knees. Placing the ankle of of the injured side over the the other leg, grasp the thigh of the uninjured side, pull toward the chest, and stretch for 15 to 30 seconds.
  • Lie on the forearms with straight legs and lift the hips off the floor into a straight line, holding this position for 15 seconds.
  • Lie on the uninjured side, bending their hips and knees together, then raise the top leg toward the ceiling while keeping the heels touching for 2 seconds.

A person should repeat each stretch three to five times. If a person is unable to proceed or is experiencing pain, then they should not continue.

Other exercises that can help include hip extension and abduction exercises, which move the hips against resistance. Walking can also help relieve muscle tension throughout the body and prevent spasms from getting worse.

Clinical treatments

If the pain is intense, gets worse over several days, or is still around after a week of home management, a person should seek medical help.

There are a number of medical treatments that can help relieve severe pain from piriformis syndrome. These include:

  • Botox injections that can reduce muscle spasms and relieve pain.
  • Prescription pain medications or muscle relaxants. A person should discuss the risks and benefits of pain medication with their doctor, as these drugs can be addictive.
  • Corticosteroid or anesthetic injections.
  • Acupuncture and trigger point therapy.
  • Physical therapy to regain use of the piriformis, and to prevent wasting related to disuse and dysfunction in surrounding muscles.

As a last resort, a person may consider surgery to cut the piriformis tendon where it attaches to the hip or to cut into the piriformis to relieve pressure on the sciatic nerve.

Piriformis syndrome usually causes dull or shooting pain, tingling, or numbness in the buttocks region. The pain may radiate down the back of the leg, to the hamstrings, and sometimes to the calves and feet.

People with this condition may be unable to sit for a long time, experience more pain when moving their hips, or pain when getting out of bed. They also may experience more pain after running or walking upstairs.

Like muscle tension in other areas of the body, the causes for Piriformis syndrome vary.

They may include:

  • trauma to the hip or buttocks that leads to swelling or tightening of the piriformis muscle
  • spasm of the piriformis muscle
  • overuse of the piriformis muscle, such as frequent exercising or running
  • long periods of sitting
  • certain anatomic anomalies
  • bleeding in the area of piriformis muscle

Piriformis syndrome has been a somewhat controversial diagnosis. Researchers have argued that there are insufficient diagnostic criteria to differentiate the condition from similar conditions, mainly due to a lack of scientifically validated tests.

More recently, researchers have determined that there are different structures that can entrap the sciatic nerve, and only one of those is the piriformis muscle. For this reason, healthcare professionals now prefer to call the condition by the wider term deep gluteal syndrome.

Many doctors diagnose piriformis syndrome based on symptoms alone, which means they may be both over and underdiagnosing the condition.


Doctors will usually diagnose the condition based on the exclusion of other causes. A doctor may try a number of stretch tests to try to recreate observable irritation to the sciatic nerve by the piriformis muscle.

  • In the Freiberg test, the doctor forcefully internally rotates a person’s extended thigh.
  • In the Pace test, a doctor performs resisted abduction and externally rotates a person’s thigh
  • In the Beatty test, a person lies on their side and flexes their knee, holding it a few inches above the table
  • In the FAIR test, a person flexes the hip to stretch the piriformis and compress the sciatic nerve.

Most imaging tests will help a doctor exclude other conditions. Magnetic resonance neurography is a type of magnetic resonance imaging (MRI) test that looks for inflammation in the nerves and can show more specific irritation to the sciatic nerve. However, this test may not be available in every clinic.

The same stretches and exercises that can help relieve pain from piriformis or deep gluteal syndrome can also reduce the risk of developing it. Before doing any exercises, a person should always warm up. A person should always avoid any exercises that cause pain and avoid exercising until any injuries have healed.

Avoiding making repetitive movements, placing pressure on the hips, or spending too much time in one position may also help.

Investing in comfortable, well-fitting running shoes is important. Shoes should ensure that a person moves properly and should not pinch or hurt in other ways. Ill-fitting shoes can undermine posture and form.

If a person begins to experience discomfort, a person may need orthotics. A person can insert these into their shoes to help reduce any imbalance when walking, as well as the impact on the piriformis muscle and the sciatic nerve.

Piriformis syndrome is a condition in which the piriformis muscle entraps the sciatic nerve. It is part of a wider condition called deep gluteal syndrome. It can cause pain, tingling, and numbness, and can be temporary or chronic.

Depending on the severity of the condition, people can treat it at home or in consultation with a doctor. Exercises can help, as well as some medications. In severe cases, a person may consider surgery.