Disclaimer: This article is for general educational purposes only and does not constitute medical advice. Always consult a qualified health professional for advice specific to your condition. © 2026 Better Physiotherapy Bundoora.
Piriformis syndrome — deep buttock pain caused by piriformis muscle irritation of the sciatic nerve — is frequently misdiagnosed as lumbar sciatica. Understanding the difference matters, because the treatment is quite different. Physiotherapy is highly effective for true piriformis syndrome.
Piriformis Syndrome vs Lumbar Sciatica
Both conditions can cause buttock and leg pain, but their origins and optimal management differ significantly:
- Lumbar sciatica: Nerve root compression at L4–S1, usually from a disc bulge or herniation. Associated with low back pain, pain below the knee, and neurological signs (weakness, reflex changes). Positive straight leg raise test.
- Piriformis syndrome: Sciatic nerve irritation at the buttock level. No low back pain, buttock-localised tenderness, pain with hip internal rotation in 90° flexion (FAIR test), and pain reproduced with direct palpation of the piriformis muscle.
Physiotherapy Assessment
A thorough physiotherapy assessment differentiates piriformis syndrome from other causes of buttock and leg pain including:
- Lumbar disc herniation and nerve root compression
- Sacroiliac joint pain
- Gluteal tendinopathy
- Hip joint pathology (FAI, labral tears)
- Referred pain from facet joints or trigger points
Physiotherapy Treatment
- Manual therapy: Deep piriformis release and sciatic nerve mobilisation techniques
- Dry needling: Effective for releasing piriformis trigger points — often produces rapid symptom relief
- Stretching: Piriformis, hip external rotators, and hip flexors
- Strengthening: Gluteus medius and maximus strengthening to reduce piriformis overactivation
- Posture and sitting ergonomics: Addressing the sustained sitting that commonly perpetuates symptoms
- Neural mobilisation: Sciatic nerve gliding exercises when nerve sensitivity is a significant feature
Piriformis Syndrome Treatment at Better Physiotherapy Bundoora
We commonly see piriformis syndrome in desk workers, runners, and pregnant women. Our thorough assessment ensures you receive targeted treatment for the true source of your pain. Call (03) 9467 6900 or book online.
Frequently Asked Questions
Where is the piriformis muscle?
The piriformis is a small, pear-shaped muscle deep in the buttock, running from the sacrum (tailbone area) to the top of the femur (thighbone). Its primary function is external hip rotation. The sciatic nerve passes either beneath or directly through the piriformis in some people — this anatomical variation explains why some individuals are more prone to piriformis syndrome.
What does piriformis syndrome feel like?
Classic piriformis syndrome presents as: deep aching in the buttock (often on one side), pain aggravated by sitting for prolonged periods, pain with hip internal rotation and adduction (crossing the legs), and pain that may radiate down the posterior thigh. Unlike lumbar disc sciatica, there is typically no low back pain and the pain does not follow a dermatomal (nerve root) pattern below the knee.
What is the best stretch for piriformis syndrome?
The supine piriformis stretch (lying on your back, crossing one ankle over the opposite knee, and gently pulling the uncrossed leg toward your chest) is the most commonly used. However, stretching alone is rarely sufficient — hip strengthening (particularly gluteus medius) to reduce piriformis overactivation is equally important.
Why do I get piriformis pain from sitting?
Prolonged sitting compresses the piriformis against the sciatic nerve, and sitting with legs crossed externally rotates the hip, shortening the piriformis. Desk workers are commonly affected. Adjusting sitting posture, using a wedge cushion, and taking regular standing breaks can help alongside physiotherapy.
Ashley Haleel
Physiotherapist & Owner — Better Physiotherapy Bundoora