The Piriformis Muscle (piriformis; “pear shaped“) is a tiny muscle located deep in the buttocks underneath the much larger Gluteal (Buttocks) Muscles. This little muscle is the most well-known of a group of several muscles known as the “Hip Rotator Cuff ” and is frequently the source of one's buttocks pain.

Piriformis Syndrome is a miserable condition in which the Piriformis Muscle becomes overly tight and either compresses the Sciatic Nerve, pulls at its bony attachment points, or both. Although there are frequently underlying biomechanical/physical issues that contribute to Piriformis Syndrome (bow legs or knock knees, high or low arches, leg length discrepancy, pelvic deficiency, past trauma, obesity, sedentary lifestyle / over-training, poor posture, too much time on concrete, years of cheap and poorly constructed footwear, etc., this pathological tightness of the Piriformis Muscle is frequently the result of fascial adhesions and/or tendinosis causing a lot of pain and often mimicking the radicular pain patterns of a disc herniation.

Piriformis Syndrome can be aggravated by bending, lifting, sports, and even driving (foot on the gas pedal), but sitting tends to be the worst aggravating factor for most people. A serious inability to sit without severe buttock pain and/or Sciatica is a big red flag as far as Piriformis Syndrome is concerned. Contrary to what your M.D. might tell you, there are no drugs that effectively treat Piriformis Syndrome, and surgery often ends up with a poor outcome.


Piriformis Syndrome is an extremely common condition, and is far more likely to be found in women than men. As I stated earlier, Piriformis Syndrome is a major cause of sciatica (leg pain, numbness, tingling, or weakness, in any combination), hip pain, and / or buttock pain. Because sciatica is so often involved, it is once again often misdiagnosed as a slipped or herniated disc, or a chronic low back or sacroiliac problem.

A 2005 study by UCLA's Mount Sinai Medical School revealed that of 240 randomly picked individuals with Sciatica; the number one cause was Piriformis Syndrome. This is quite revealing considering that although I have seen many patients who have come from all over to see me specifically for "Piriformis Syndrome."

The Sciatic Nerve is both the largest (that gets smaller as it traverses down the leg) and longest nerve in the body, and at its largest point is about the thickness of one’s thumb. The sciatic nerve originates in the low back (lumbar spine region) and angles toward the middle of the buttock. It then extends down through the leg after passing underneath the Piriformis Muscle and in as much as half the population, the sciatic nerve travels through the Piriformis Muscle, passes over the Piriformis Muscle, or splits in two and passes directly around the Piriformis Muscle.


The symptoms of Piriformis Syndrome usually begin as a deep aching in the buttocks region and also in what women like to refer to as their “hip” area. This pain will be found along an imaginary line that runs from the very tip top of the gluteal fold (butt crack), to the Greater Trochanter of the femur (the bony knob on the upper portion of the outer or lateral thigh/hip). Due to mechanical stresses causing chronic tightness or outright muscle spasm, the Piriformis Muscle can actually become shortened over time. This itself can often result in microscopic scarring of the fascial sheaths that tightly surround the muscle itself, which in turn causes both local pain (pain in the butt) and compression of the Sciatic Nerve (leg pain). Piriformis Syndrome is most commonly worse at rest (sitting or lying down) and at times may not necessitate professional health care intervention. Sometimes moderate activity such as walking and/or specificity stretching can offer temporary relief. Our patients presenting with Piriformis Syndrome most often respond quite well to conservative treatment.

I pride myself on results. If I can help you I will tell you and if I can't I will at least explain what you have and point you in the right direction. Life is entirely too short for me to be wasting my time and your time. So there is no sales pitch, I frankly don't have time for it. I'm good at what I do but I am only as good as the last patient. Give us a call.