Piriformis Syndrome — The Hidden Cause of Buttock Pain

Sometimes pain that starts deep in the buttock radiates down the back of the thigh, mimicking sciatica, yet MRI shows no disc abnormality. In such cases, piriformis syndrome should be suspected.

Where is the piriformis muscle?

The piriformis is a deep buttock muscle that originates from the sacrum and attaches to the greater trochanter of the femur. The sciatic nerve passes directly beneath or through this muscle, so when the piriformis becomes tight or hypertrophied, it can compress the sciatic nerve and cause pain.

Symptoms of piriformis syndrome

• Deep, dull pain in the buttock
• Radiating pain down the back of the thigh
• Worsening with prolonged sitting (especially on hard chairs)
• Increased pain when climbing stairs, squatting, or sitting cross-legged
• Often only on one side

How is it different from a lumbar disc herniation?

• Symptoms start in the buttock without low-back pain
• Worse when sitting rather than when bending forward
• No disc abnormality on MRI
• Pressing deep into the buttock reproduces the pain

Causes and treatment

Prolonged sitting, lack of exercise, pelvic asymmetry, and overtraining are common causes. The key to treatment is releasing the tight piriformis.

• Acupuncture and pharmacopuncture to relax the piriformis and reduce inflammation around the nerve
• Chuna manipulation to correct pelvic alignment
• Targeted piriformis stretching (figure-4 stretch)
• Self-massage with a tennis ball or foam roller
• Improving the habit of prolonged sitting