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Piriformis Syndrome

Piriformis syndromePiriformis syndrome causes pain in the buttock which may radiate down the leg. It is due to the sciatic nerve being impinged by a tight piriformis muscle deep in the buttocks.


  • Tenderness or pain in the buttock muscle.
  • The pain may radiate down the back of the leg into the hamstring muscles and sometimes even the calf muscles.
  • It is common for pain to initially be confused with a hamstring strain or hamstring origin tendinopathy. However there will be no area in the hamstrings which is tender to touch.
  • Reduced range of motion of the hip joint, especially into internal hip rotation is often seen.


The piriformis muscle is one of the small muscles deep in the buttocks that rotates the leg outwards. It runs from the sacrum bone at the bottom of the spine and attaches to the thigh bone or femur roughly near the outside crease of the buttocks.

The sciatic nerve runs very close to this muscle and in around 10% of the population it passes straight through the muscles fibers. If the piriformis muscle becomes tight it can compress the sciatic nerve and cause pain which can radiate down the leg, commonly known as sciatic pain.

It has been suggested that this condition would be better referred to as piriformis impingement due to the impingement of the sciatic nerve. A common cause of piriformis syndrome is tight adductor muscles on the inside of the thigh. This means the abductors on the outside cannot work properly and so put more strain on the piriformis muscle.

Piriformis syndrome Treatment

Treatment consists of two phases. First reducing pain by relaxing the muscle through heat, electrotherapy, massage and stretching then when pain allows strengthening exercises to help prevent the injury recurring whilst gradually returning to full training levels.


Apply heat therapy to relax the muscle. This will reduce the tension or spasm in the muscle and encourage blood flow. Heat should not be applied if an acute injury, inflammation or recent tear of the muscle is suspected as it will only increase swelling, inflammation and bleeding. Applying heat before performing exercises, particularly stretching exercises may help increase the effectiveness of the exercises.


Piriformis stretching exercisesStretching exercises for the piriformis muscle and other external rotators of the hip should be done as well as adductor muscle stretches. When pain allows exercises to strengthen the piriformis muscle can be done which should help prevent the injury returning.

See more on piriformis syndrome exercises.


Piriformis massageSports massage may be beneficial in releasing the tension in the piriformis muscle. Specific techniques to get deep into the tight muscle can help relax muscle spasm and increase blood flow to the tissues. A muscle energy technique a therapist may apply involves repeatedly contracting and relaxing the muscle whilst it is being stretched by rotating the femur bone inwards.

See more on piriformis massage.


Ultrasound, interferential and laser treatment may be used to relax the muscle. Ultrasound involves subjecting the muscle tissue to high frequency sound waves. Interferential involves passing electric current into the muscle causing it to contract and relax. Depending on the frequency used will have a pain relieving effect.