Hip & Thigh

What It Is

Line drawing of the pelvis and leg from behind, showing the piriformis muscle crossing from the sacrum to the top of the thigh bone with the sciatic nerve passing beneath it and running down the back of the leg. — The sciatic nerve passes right by the piriformis, which is why a tight piriformis can feel so much like sciatica.

Piriformis syndrome is a relatively uncommon condition in which the piriformis muscle compresses (squeezes) the sciatic nerve (Vij et al., 2021; NHS Lothian, 2025). The piriformis is a pear-shaped muscle located deep in the buttock, near the top part of the hip joint. Piriformis literally means "pear-shaped". It is an important component of lower body movement because it helps to stabilize the hip joint and rotates the thigh outwards (NHS Lothian, 2025). It helps you walk, maintain balance and shift weight from one leg to another, and it is used frequently in sporting activities involving rotating and lifting the thighs.

The sciatic nerve is a long, thick nerve in your body. It passes near or, in some people, through the piriformis muscle, runs down the back of the leg and branches off into the smaller nerves ending in the feet (NHS Lothian, 2025). Compression of the nerve might be caused by tightness or spasm in the piriformis muscle.

Common symptoms include (NHS Lothian, 2025)

Tingling, numbness or burning in the back of the thigh, occasionally down to the foot

Tenderness in the buttock

A dull ache or burning in the hip, groin, middle of the buttock or back of the thigh

Heaviness or tiredness in the leg

Symptoms that are worse when sitting on a hard chair

Whenever you suffer with back pain, there is a chance that the piriformis can go into spasm. The buttock muscles tighten up, and this can cause referred pain into the back of the leg and down to the foot.

In some people there is a natural variation in which the sciatic nerve passes through the muscle rather than beside it, and this is thought to make piriformis syndrome more likely (Alrabai et al., 2025). However, it is not usually possible to tell whether this is the case in any particular patient.

Piriformis syndrome is difficult to diagnose. There are no agreed tests for it, so it is usually diagnosed by a doctor or therapist from your history and examination after other, more common causes of sciatica, such as a disc prolapse (slipped disc), have been ruled out (Vij et al., 2021; Alrabai et al., 2025). MRI scans do not tend to show piriformis syndrome, but they are mainly used to check for other causes, such as a trapped nerve in the spine, which may actually be causing the sciatica (Alrabai et al., 2025).

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat Piriformis Syndrome

A programme of stretches and strengthening exercises to reduce the pressure on the sciatic nerve, and massage of the buttock muscles, are part of treatment (NHS Lothian, 2025). I can guide you through these, with hands-on work for the buttock, hip and low back and a home exercise programme. See the My Approach tab for how I work.

1. Rest

Rest from the activities causing pain, whether that be sitting or actually moving around and doing something (NHS Lothian, 2025). Find a position that doesn't cause a lot of pain.

2. Ice and Heat

Apply an ice pack wrapped in a thin towel to the area for up to 20 minutes at a time, regularly, to help ease pain and inflammation. Never put ice directly on the skin. Heat may also help to improve flexibility (NHS Lothian, 2025).

3. Physical Therapy

Physiotherapy is usually the first treatment and is often effective (Alrabai et al., 2025). I can help with this too, with stretches, strengthening and hands-on work (see the My Approach tab).

NHS Lothian's exercise sheet for this condition includes massaging the buttock muscles on a tennis ball (NHS Lothian, 2025).

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Corticosteroid injection: an injection of a steroid medicine around the piriformis muscle, which occasionally helps to reduce pain and inflammation (NHS Lothian, 2025; Alrabai et al., 2025).
Botulinum toxin injection: an injection that relaxes the muscle, which is used for some people (Vij et al., 2021; Alrabai et al., 2025).
Surgery: very rarely needed (NHS Lothian, 2025).

How I can help (see the My Approach tab)

Hands-on work for the buttock, hip and low back, with your consent
Stretches and hip strengthening exercises
Advice on sitting, activity and getting back to sport

Tips

Before participating in any sporting activities, make sure you are properly warmed up.
Avoid running on any uneven surfaces or exercising on a hill unless you are more experienced. Walking up stairs or hills can increase the risk of piriformis syndrome (NHS Lothian, 2025).
Increase intensity slowly when participating in any exercise routine, as a sudden increase in activity is a common cause (NHS Lothian, 2025).
When exercising, running or walking, always use proper posture. If you are not sure, discuss with a sports coach.
If you notice pain when performing an activity, stop doing the activity until the pain has settled.
Massage to the buttock muscles may help to ease your symptoms. I can provide this with your consent (see the My Approach tab).

Treatment

My Approach

Piriformis syndrome happens when a deep buttock muscle tightens and irritates the sciatic nerve beside it. My aim is to ease that tension, take pressure off the nerve, and build the strength and habits that help stop it coming back. I treat the whole area, because the low back, pelvis and the way you sit and move usually feed into it.

I start by assessing your low back, hips and pelvis, how you move and sit, and your hip strength. I also screen the nerve (sensation, reflexes and strength), because sciatica more often comes from the back.

Hands-On Treatment

Warmth over the buttock, then work through the low back, buttock and hip before the piriformis itself, with slow, sustained pressure on tight spots, then stretching and gentle hip movement
Easing the muscles at the front of the hip if your lower back is very arched
Gentle nerve glides to help the sciatic nerve move freely
I'm careful not to press on the nerve; tell me straight away if you feel numbness or tingling below the knee
Buttock and hip work only with your informed consent and a written consent form

Exercise and Self-Care

Home stretches, such as drawing the knee toward the opposite shoulder or a gentle figure-four stretch
Showing you how to use a tennis or lacrosse ball on tight spots, stopping if it sends tingling down the leg
Hip strengthening as it settles, from side-lying work and bridges to gym-based lifts such as Romanian deadlifts
Sitting habits: knees and feet in line, changing position often, breaks on long drives, and a pillow between your knees at night
Building activity back up gradually

If you get numbness around your groin, inner thighs or buttocks, or new bladder or bowel problems, call 911 or go to the emergency room. If leg weakness is getting worse, see your family doctor or nurse practitioner.

What to Expect

Typical Course

Typical course: Most people come once or twice a week for the first few weeks, then weekly, with a reassessment at about 4 to 6 weeks, then less often as you manage more on your own. Expect improvement over those first weeks, with most people settling within a few weeks to a few months.

What I Focus On

Assessment

Deep Glute Release

Nerve-Safe Pressure

Stretching & Hip Strength

Sitting Habits

Sources

References

NHS Lothian (2025) Piriformis syndrome: patient information sheet. Available at: https://policyonline.nhslothian.scot/wp-content/uploads/2025/02/Piriformis-Syndrome.pdf (Accessed: 7 October 2026).
Vij, N., Kiernan, H., Bisht, R. et al. (2021) 'Surgical and non-surgical treatment options for piriformis syndrome: a literature review', Anesthesiology and Pain Medicine, 11(1), p. e112825. doi: 10.5812/aapm.112825
Alrabai, H.M., Alrashidi, Y., AlEtebi, R.A.A. et al. (2025) 'Piriformis syndrome is often overlooked as a cause of gluteal pain and sciatica: diagnostic challenges and the role of imaging—a narrative review', HSS Journal. doi: 10.1177/15563316251392059

Massage therapy · Kitchener–WaterlooPiriformis Syndrome

What It Is

Self-Care & Treatment

How to Treat Piriformis Syndrome

1. Rest

2. Ice and Heat

3. Physical Therapy

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

Hands-On Treatment

Exercise and Self-Care

Typical Course

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooPiriformis Syndrome

What It Is

Self-Care & Treatment

How to Treat Piriformis Syndrome

1. Rest

2. Ice and Heat

3. Physical Therapy

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

Hands-On Treatment

Exercise and Self-Care

Typical Course

References

Related Conditions

Lower Back Pain

Hyperlordosis

Greater Trochanteric Bursitis

Burning Thigh Pain

Book a session