Piriformis syndrome is buttock pain, sometimes with sciatica-like pain down the leg, caused by irritation of the sciatic nerve as it passes under or through the muscles deep in the buttock. It is typically worse when sitting. The newer term, deep gluteal syndrome, recognises that structures other than the piriformis muscle can be involved. It is diagnosed after problems in the lower back and hip have been ruled out.
Also known as deep gluteal syndrome, piriformis muscle syndrome, wallet sciatica
Anatomy: where the problem is
Front view of the pelvis and hips. Highlighted in the diagram: piriformis and deep buttock muscles and sciatic nerve.
Symptoms
- A deep ache in the buttock
- Pain that is worse with sitting, especially on hard surfaces
- Tenderness deep in the middle of the buttock
- Pain, tingling or numbness down the back of the thigh, sometimes to the calf or foot
- Pain when the hip is stretched across the body or turned inwards
- Usually little or no back pain
Causes and risk factors
- Prolonged sitting, including on a wallet in a back pocket
- A fall onto the buttock
- A sudden increase in running, cycling or rowing
- Tight or overworked deep hip muscles
- A natural variation in the route the sciatic nerve takes through the muscle
What the evidence says helps
- A systematic review identified the most consistent features: buttock pain, pain made worse by sitting, tenderness over the area deep in the buttock, and pain on movements that tension the piriformis muscle.1
- There is no definitive test, so the diagnosis is made after the lower back and the hip joint have been examined and ruled out.12
- Treatment starts conservatively, with activity changes, stretching and strengthening of the hip muscles, and hands-on treatment. Most people are managed this way.2
- An injection of local anaesthetic, steroid or botulinum toxin into the muscle is an option if symptoms persist, and surgery is rarely needed.2
Things you can try at home
- Break up long periods of sitting, and use a cushion on hard seats
- Take your wallet or phone out of your back pocket
- Keep walking and moving within comfort
- Try gentle stretches for the buttock and hip, stopping short of leg tingling
- Reduce running or cycling volume for a couple of weeks, then build up again gradually
- Strengthen the hip muscles once the pain is settling
When to get urgent help
Contact your GP urgently, call NHS 111, or call 999 in an emergency if you have:
- Severe hip or groin pain after a fall, or being unable to put weight on the leg: go to A&E
- A hot, swollen joint with a fever or feeling unwell: get same-day medical help
- Loss of bladder or bowel control, or numbness around the genitals or back passage: go to A&E
- Constant pain that is worse at night, with unexplained weight loss or a history of cancer: see your GP
- Weakness in the leg or foot, or numbness that is spreading: see a GP urgently
How Apollo can help
Because buttock and leg pain much more often comes from the lower back or the hip joint, we examine both carefully before settling on this diagnosis. If the deep buttock muscles do appear to be the source, treatment includes soft tissue techniques, hip mobility and nerve movement exercises, and a strengthening plan for the hip and trunk. We look at sitting habits, training load and running or cycling set-up. If symptoms do not settle, we write to your GP about further investigation or an injection.
No GP referral needed. Clinics in Sheringham, Coltishall and Norwich.
Related reading
Frequently asked questions
How is piriformis syndrome different from sciatica?
Sciatica describes pain travelling down the leg from an irritated nerve, most often where the nerve roots leave the lower back. Piriformis syndrome is one less common cause, in which the nerve is irritated in the buttock. Pain that is worst when sitting, with tenderness deep in the buttock and little back pain, points towards it.
How long does piriformis syndrome take to get better?
Many people improve over six to twelve weeks with changes to sitting and activity, stretching and strengthening. Long-standing cases can take longer.
Should I stretch if I have piriformis syndrome?
Gentle stretching of the buttock and hip is commonly advised and helps many people. Ease off if it brings on tingling or pain down the leg, and combine it with strengthening for a more lasting result.
References
- Hopayian K, Danielyan A (2017). Four symptoms define the piriformis syndrome: an updated systematic review of its clinical features. European Journal of Orthopaedic Surgery & Traumatology 28:155-164. View source
- Probst D, Stout A, Hunt D (2019). Piriformis Syndrome: A Narrative Review of the Anatomy, Diagnosis, and Treatment. PM&R 11. View source
This page is general information, not a diagnosis or a substitute for medical advice. If you are worried about your symptoms, speak to your GP or a registered healthcare professional. Content prepared from the sources above, November 2026.
