Piriformis Syndrome: who to see and what helps

Piriformis Syndrome · Kitchener, Waterloo & Cambridge

Piriformis syndrome is buttock pain, often with pain or tingling down the back of the leg, caused by the piriformis muscle in the buttock pressing on the sciatic nerve. It is uncommon and there is no single test for it, so the first job is to tell it apart from a problem in the spine. At CARESPACE that assessment is done by a physiotherapist or a chiropractor, who also starts treatment at the first visit.

What piriformis syndrome is

The piriformis is a muscle deep in the buttock that is involved in almost every movement of the hip and leg. The sciatic nerve runs beneath it. An injured or irritated muscle can spasm, swell or tighten and pinch the nerve. You may also see the name deep gluteal syndrome, defined as the sciatic nerve being trapped in the buttock and not by a disc.

It is a diagnosis that still divides opinion. A systematic review of 55 studies found strong support for it as a real condition, without proof, and could not settle how common it is. Its best estimate was 1% or fewer of people with sciatica seen in orthopaedic practice, taken from two older hospital reports.

Symptoms of piriformis syndrome

• A dull ache or tenderness in the buttock, usually on one side
• Pain that gets worse the longer you sit
• A tender spot deep in the buttock when it is pressed
• Pain when the hip is moved in ways that tighten the piriformis
• Pain, tingling or numbness down the back of the leg
• Pain that gets worse with activity

Long hours at a desk, as in much of the local tech sector, are the kind of sitting that can set it off.

Piriformis syndrome, sciatica or a disc?

Piriformis syndrome is a rare cause of sciatica; the usual one is a herniated disc. Symptoms alone do not separate them reliably. Buttock pain is more typical of piriformis syndrome than low back pain is, but the leg-raise test used to detect a disc problem was also limited in 42% to 62% of the piriformis cases in one systematic review, and weakness or numbness can occur in both. Leg symptoms that come on with walking and ease with sitting suggest spinal stenosis. If nobody has examined your leg pain yet, start with Sciatica.

What causes piriformis syndrome

• Overuse. Sitting for long periods, running, a lot of walking or stair climbing, lifting heavy objects, and sports.
• Injury. A fall, a car accident or a sudden twist of the hip.
• Anatomy. In some people the nerve passes through the muscle.

How piriformis syndrome is diagnosed

By history and examination: buttock pain, trouble sitting for half an hour, tenderness deep in the buttock, and pain when the muscle is stretched or made to work against resistance. No single test has been validated, and the accuracy of these signs is not known. An MRI of the spine or pelvis is used mainly to rule out other causes, and is arranged through a physician or nurse practitioner. Relief after an injection into the muscle is sometimes used as a test, although it does not prove where the problem is.

When buttock and leg pain is an emergency

Call 911 or go to an emergency department right away if you have any of these: numbness around your genitals or anus; difficulty starting to pee, not being able to pee, or loss of bladder control that is not normal for you; not noticing when you need to poo, or loss of bowel control that is not normal for you; sciatica in both legs at once; weakness or numbness in both legs that is severe or getting worse; numbness or weakness in one or both legs after an injury; or back pain that began with a serious accident, such as a car crash. These can be signs of a serious back problem that needs hospital treatment as soon as possible. Do not drive yourself, and do not wait for an appointment with us: nobody at CARESPACE can rule these out.

Go to an emergency department as well for sudden severe pain in the lower back or legs together with weakness or numbness, or if you cannot control your foot and keep tripping over it.

The emergency departments in Waterloo Region are:

• WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
• WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
• Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

See a physician or nurse practitioner if the pain has lasted more than a few weeks, or began after a fall or a lesser accident.

What the evidence says about treating piriformis syndrome

• Where this comes from. Two systematic reviews of how the condition presents and is diagnosed, one systematic review of non-surgical treatment, and MedlinePlus, the US National Library of Medicine’s health information for the public. We found no clinical guideline for it, so there are no graded recommendations to report.
• The treatment evidence is thin and old. A 2007 systematic review of non-surgical treatment found only two trials good enough to include, both of an injection. We have not found a newer systematic review.
• The usual first steps are simple. Ease off the activities that hurt, such as running or cycling, until the pain settles; use ice or heat; and do stretching and strengthening exercises as instructed. Sometimes nothing more is needed.
• Physical therapy focused on muscle and core strengthening is among the treatments a provider may add.
• Botulinum toxin is the injection those two trials tested. Both reported a benefit over placebo or a comparison treatment, one of them alongside physiotherapy, and the reviewers still called the evidence limited.
• Surgery to release the muscle is a last resort. High success rates have been reported only in small case series.

What a doctor may offer

CARESPACE does not provide these, but it helps to know where they fit.

• Medicines, such as a muscle relaxant. A pharmacist can advise on over-the-counter pain relief.
• An injection into the muscle: a steroid, or botulinum toxin.
• An MRI, to rule out the spine.
• A surgical opinion, rarely.

How each CARESPACE service treats piriformis syndrome

Physiotherapy

A physiotherapist can examine the lower back, the hip and the nerve to work out whether the buttock is the likely source, then teach the piriformis stretches and the muscle and core strengthening that MedlinePlus describes. They can also help you plan sitting, driving and a return to running.

See our physiotherapy team →

Chiropractic

A chiropractor can do the same sorting of spine from buttock, which matters because the spine is the far more common source of sciatica, and can set an exercise plan. The one treatment review we found included no trial of manipulation, so we cannot tell you it helps.

See our chiropractic team →

Other services people ask about

Massage therapy, acupuncture, dry needling and osteopathy. The two trials in that 2007 review tested an injection, not any of these, and we have not found a newer systematic review. We have nothing reliable to say about whether they work. If you try massage for comfort, treat it as an addition to the exercises.

Where most people start

Book with a physiotherapist or a chiropractor. Finding out whether the pain is coming from your buttock or your back decides everything that follows.

How your team works together

The care our sources support, assessment and exercise, can come from one practitioner: your physiotherapist or chiropractor. A physician or nurse practitioner comes in if a scan, a prescription or an injection is needed.

Browse by service: physiotherapists and chiropractors.

What to expect at your first visit

1. Where it hurts and when. How long you can sit, and whether there was a fall or a change in training.
2. Safety questions about bladder and bowel control, numbness between the legs and weakness in both legs. Those need a hospital, not a clinic.
3. An examination of the back, hip and buttock, including a leg raise, pressure over the muscle, and movements that stretch it or make it work.
4. What it looks like: the piriformis, the spine, or not yet clear.
5. Treatment that day, and a plan with your first exercises.

What you can do at home

• Ease off the activities that bring on the pain, and go back to them once it has gone.
• Put an ice pack, wrapped in a towel, on the area for 15 to 20 minutes every few hours. You can alternate with a heating pad on its low setting, for no more than 20 minutes at a time.
• Avoid sitting for long periods, and avoid sitting or lying in positions that put pressure on the hip.
• Do the stretches you have been shown.
• If you want pain relief, a pharmacist can tell you what suits you.

Outlook, and keeping it from coming back

Our sources do not give a typical recovery time. For prevention, the advice is to exercise regularly, warm up and build intensity gradually, avoid running on hills or uneven ground, and stop an activity that brings on the pain until it passes. For runners, a paved path such as the Spurline Trail fits that advice better than a hilly or rough route.

Piriformis syndrome treatment in Kitchener, Waterloo and Cambridge

Kitchener. Physiotherapy in Kitchener and chiropractic in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Physiotherapy in Waterloo and chiropractic in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Physiotherapy in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

How do I know if it is piriformis syndrome or sciatica from a disc?

Not from symptoms alone, and no single test settles it. Pain centred in the buttock that builds with sitting, with a tender spot deep in the buttock, points toward the piriformis. Disc problems are far more common, so the spine is checked as well.

Can sitting on a wallet cause it?

It has been nicknamed wallet sciatica. Long sitting is a listed cause, and the advice is to avoid positions that put pressure on the hip, so emptying your back pocket is a sensible step.

Can I keep running?

Stop while it brings on the pain, and return once the pain has gone. Then warm up, build gradually and stay off hills and uneven ground.

Do I need an MRI?

Not to diagnose piriformis syndrome: no scan has been shown to do that. An MRI is used when a spinal cause needs to be ruled out.

Is there a physiotherapist for piriformis syndrome in Cambridge?

Yes. Physiotherapy is available at CARESPACE Hespeler Road in Cambridge, as well as in Kitchener and Waterloo. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

• Hopayian K, Song F, Riera R, Sambandam S. The clinical features of the piriformis syndrome: a systematic review (full report). European Spine Journal, 2010.
• Kizaki K, Uchida S, Shanmugaraj A, et al. Deep gluteal syndrome is defined as a non-discogenic sciatic nerve disorder with entrapment in the deep gluteal space: a systematic review. Knee Surgery, Sports Traumatology, Arthroscopy, 2020. (McMaster University.)
• Cramp F, Bottrell O, Campbell H, et al. Non-surgical management of piriformis syndrome: a systematic review. Physical Therapy Reviews, 2007.
• MedlinePlus, US National Library of Medicine. Piriformis syndrome. Reviewed November 2024.
• Emergency and warning signs: NHS (UK), Sciatica and Slipped disc, both reviewed 2024; HealthLink BC (Healthwise), Lumbar Herniated Disc, current as of November 2022.

Related conditions

Sciatica · Herniated Disc · Spinal Stenosis · Back Pain

Ready to book?

Book online with a physiotherapist or chiropractor, or call 519-208-2273 and our Central Reception Team will match you with the right person and the closest location.

Online booking