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Piriformis syndrome: symptoms, causes and remedies for «false sciatica»

Piriformis syndrome is a neuromuscular disorder in which the piriformis muscle, deep in the buttock, compresses or irritates the sciatic nerve: the result is pain that starts in the buttock and can run down the whole leg. Because it resembles sciatica, it is also known as «false sciatica»; it mainly affects middle-aged people, women more than men, and the diagnosis is a matter for a doctor.

By Mihail Crigan, sports massage practitioner in Turin · Updated on

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Anatomical illustration of the piriformis muscle and the sciatic nerve in the buttock area
The piriformis muscle and the sciatic nerve running beside it.Illustrative image generated with AI

In brief

  • Piriformis syndrome occurs when the piriformis muscle compresses or irritates the sciatic nerve: the pain starts in the buttock and can reach the foot.
  • About 50% of people who have it have had an injury to the buttock, hip or lower back; posture, a sedentary lifestyle and overload also play a part.
  • There is no quick test: diagnosis is based on symptoms and physical examination, while CT and MRI are used to rule out other causes, such as a herniated disc.
  • After the doctor's diagnosis, massage can be a support to release tension in the buttock and hip.

Massage can help if

Your doctor has already ruled out a herniated disc and other causes, and tension remains in the buttock and hip. At the studio a deep tissue massage is considered.

See your doctor first if

The pain is sudden, or there is strong tingling or loss of strength. Massage does not replace a diagnosis.

In this article

The definition

What is piriformis syndrome?

A constant, nagging, stabbing pain that starts in the buttock and can travel down the whole leg: the first thought is sciatica. It may not be. These symptoms are often confused with those of a different neuromuscular disorder, piriformis syndrome.

The problem arises when the piriformis muscle compresses or irritates the sciatic nerve. It tends to affect mainly middle-aged people, women more than men.

Where is the piriformis muscle and what does the sciatic nerve have to do with it?

The piriformis muscle

It is a small triangular muscle, located deep in the buttock, behind the gluteus maximus. It runs from the pelvic surface of the sacrum to the upper edge of the greater trochanter of the femur.

The sciatic nerve

Also called the ischiatic nerve, it is the longest and thickest nerve in the human body. It runs beside the piriformis muscle and supplies the muscles of the leg and the hip and knee joints.

This closeness explains the disorder: if the piriformis contracts, swells or becomes irritated, it can squeeze or trap the nerve that runs beside it.

The causes

What causes piriformis syndrome?

There can be various causes. About 50% of people with piriformis syndrome have had an injury to the buttock, hip or lower back. Other factors can encourage the muscle to compress or trap the sciatic nerve:

Anatomical anomalies

Particularities in the shape or course of the muscles or nerves.

Lumbar hyperlordosis

An exaggerated curve in the lower back.

Posture problems

Linked for example to a misaligned pelvis or to the lower limbs, such as small differences in leg length.

Pseudoaneurysms of the inferior gluteal artery

A change in the artery that runs in the same area as the sciatic nerve.

Prolonged sitting

This is the case for people who drive for long periods, such as taxi and lorry drivers, but also for cyclists and horse riders.

Muscle hypertrophy

The piriformis enlarges through overuse: this happens to people who do certain physical activities, during their most intense training periods.

People who work long hours at a desk also spend much of the day sitting: if this is you, read the article on the negative effects of smart working.

The symptoms

What are the symptoms of piriformis syndrome?

The symptoms easily suggest sciatica, but they can be the sign of a different problem: it is no coincidence that piriformis syndrome is also known as «false sciatica». The most common are:

The same symptoms can also have other causes, some of which need specific treatment. If you recognise them, talk to your doctor before starting any treatment, including massage.

The diagnosis

How is piriformis syndrome diagnosed?

There is no quick test. The doctor makes the diagnosis mainly on the basis of the symptoms the person reports and a physical examination.

Conventional imaging tests cannot diagnose piriformis syndrome. Computed tomography (CT) and magnetic resonance imaging (MRI) are, however, used to rule out other conditions with similar symptoms and to see whether the sciatic nerve is being compressed by something else, for example a herniated or bulging lumbar or sacral disc, or lumbosacral spondylolisthesis.

Telling piriformis syndrome apart from a lumbar disc problem can be difficult: that is why a specialist's opinion is sometimes needed.

The treatment

How is piriformis syndrome treated?

The outlook is good for most people: with proper management of symptoms, treatment and some lifestyle changes, they return to their normal activities. The possible approaches, always on your doctor's advice:

  1. 1

    Avoid what triggers the pain

    If the pain appears with certain movements or positions, it is best to avoid them for a while.

  2. 2

    Cold packs

    When the pain starts, apply a cold pack to the area several times a day, for about 15 minutes at a time, repeating every 2-4 hours if needed for as long as it helps, even for a couple of days.

  3. 3

    Personalised exercises

    A doctor or physiotherapist can suggest a tailored exercise programme to help reduce compression of the sciatic nerve.

  4. 4

    Medicines and therapies

    To control pain and inflammation the doctor may prescribe painkillers and non-steroidal anti-inflammatory drugs (NSAIDs). If the pain does not improve, they may inject a corticosteroid directly into the piriformis muscle to reduce the spasm. Transcutaneous electrical nerve stimulation (TENS) can help block the pain and reduce muscle spasm.

  5. 5

    Surgery, only in rare cases

    If conservative treatment and exercise do not work and the condition becomes disabling, the specialist may consider surgery.

Massage does not replace a visit to a doctor or a physiotherapist: if the pain is severe, started after an injury or does not improve, a clinical assessment is needed first.

Prevention

How can piriformis syndrome be prevented?

To prevent piriformis syndrome, or stop it coming back, three habits can help.

Regular exercise

Moving consistently is the first piece of advice for preventing the condition and its recurrence.

A break every hour

Avoid sitting for long periods: if your job forces you to, take a few minutes' break every hour to stretch your legs and do stretching exercises.

Correct posture

Correct bad posture habits with postural exercises and, if necessary, with aids recommended by your doctor or physiotherapist, such as insoles.

The role of massage

Can massage help with piriformis syndrome?

Massage does not cure piriformis syndrome and does not replace the doctor's diagnosis or treatment. It can, however, be a support: by working on the muscles of the buttock and hip it helps release tension and knots and can bring a feeling of relief.

The right time is after the diagnosis, when the doctor has ruled out other causes and there are no contraindications. At the Crigan Massaggi studio in Turin, Mihail Crigan works on tight muscles with the deep tissue massage and, for people who do sport, with the sports massage. When a more accurate assessment is needed, a consultation with a physiotherapist and a physiatrist is possible, thanks to his collaboration with Dr Oriano Casamenti of STUDIO RONEFOR.

Portrait of Mihail Crigan, sports massage practitioner at the Crigan Massaggi studio

Mihail Crigan's view

Sports massage practitioner, Crigan Massaggi

For Mihail Crigan, massage comes after the doctor's assessment, never in its place: targeted sessions on the buttock and hip can complement the exercises recommended by the physiotherapist.

Ask Mihail for advice

FAQ

Frequently asked questions about piriformis syndrome

What is the difference between piriformis syndrome and sciatica?

In sciatica the sciatic nerve is often compressed at the level of the spine, for example by a herniated or bulging lumbar disc. In piriformis syndrome it is the piriformis muscle, in the buttock, that compresses or irritates it: that is why it is called «false sciatica». The symptoms are very similar and telling them apart is a matter for a doctor.

Is ice or heat better for piriformis syndrome?

When the pain starts, cold is recommended: a pack on the area for about 15 minutes, repeated every 2-4 hours if needed. In general cold is suited to inflammation and injuries, heat to muscle knots: if the pain persists, ask your doctor what is best in your case.

Is massage good for people with piriformis syndrome?

Massage can be a support: it helps release tension in the muscles of the buttock and hip, but it does not replace the doctor's diagnosis or treatment. At the Crigan Massaggi studio, at Via Monginevro 76/F in Turin, a 60-minute session costs 60 € and can be booked on +39 334 858 8535.

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By appointment

Tension in your buttock and back? Book in Turin

After your doctor's assessment, a massage can help you release muscle tension: at the studio on Via Monginevro 76/F a 60-minute session costs 60 €.

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