Is It Sciatica? Why Your Piriformis Is Trapping Your Nerve & Medically Approved Next Steps

If you're feeling sharp, shooting, or burning pain that starts in your buttock and travels down your leg, you might assume it's sciatica from a slipped disc. But that's not always the case. In some people, the real cause is piriformis syndrome — a condition where a small muscle deep in the buttock irritates or compresses the sciatic nerve.

Understanding the difference matters. The treatment for a spinal disc problem is not the same as treatment for piriformis syndrome. Let's break it down clearly and calmly so you know what could be happening — and what to do next.

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What Is Piriformis Syndrome?

The piriformis muscle is a small, pear-shaped muscle located deep in your buttock, behind the larger gluteal muscles. Its job is to:

• Help rotate your hip
• Stabilize your pelvis
• Assist with walking and shifting weight

The sciatic nerve — the largest nerve in the body — runs either underneath, through, or over this muscle depending on your anatomy. If the piriformis becomes tight, inflamed, or spasms, it can compress or irritate the sciatic nerve. That compression is called piriformis syndrome.

While it causes symptoms similar to sciatica, the source of the nerve irritation is in the buttock — not the spine.

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Piriformis Syndrome vs. True Sciatica

Many people use the term "sciatica" to describe leg pain. But medically speaking, sciatica is a symptom, not a diagnosis.

Here's the difference:

Classic Sciatica (Lumbar Radiculopathy)

• Usually caused by a herniated or bulging disc in the lower spine
• Pain often worsens with bending forward or sitting long periods
• May include numbness, tingling, or weakness in the leg or foot
• Confirmed with spinal imaging if severe

Piriformis Syndrome

• Pain starts deep in the buttock
• Often worse after sitting, climbing stairs, or running
• May improve when lying down
• Typically does not involve significant lower back pain
• Imaging of the spine is often normal

The symptoms overlap, which is why proper evaluation is important.

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Common Symptoms of Piriformis Syndrome

If your piriformis muscle is compressing your sciatic nerve, you may experience:

• Deep aching pain in one buttock
• Pain that radiates down the back of the thigh
• Tingling or numbness in the leg
• Increased pain when sitting for long periods
• Discomfort when getting up from a seated position
• Pain that worsens with running or climbing stairs
• Tenderness when pressing on the center of the buttock

The pain is often one-sided.

Unlike spinal sciatica, piriformis syndrome rarely causes severe muscle weakness or loss of reflexes. If you notice significant weakness, difficulty controlling your bladder or bowels, or progressive numbness, seek urgent medical care.

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What Causes Piriformis Syndrome?

Several factors can irritate or tighten the piriformis muscle:

• Prolonged sitting (especially on hard surfaces)
• Overuse from running or cycling
• Direct trauma (like falling on your buttock)
• Poor posture
• Muscle imbalances in the hips
• Sudden increases in exercise intensity

Athletes are at higher risk, but so are people who sit most of the day.

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How Doctors Diagnose Piriformis Syndrome

There's no single test that confirms piriformis syndrome. Diagnosis is usually clinical, meaning it's based on:

• Your symptoms
• Physical exam findings
• Ruling out spinal causes

A doctor may:

• Move your hip into specific positions to reproduce pain
• Press on the piriformis muscle to check for tenderness
• Order imaging (like MRI) to rule out a disc herniation if symptoms are severe

Because the diagnosis can be tricky, many people find it helpful to use Ubie's free AI-powered Piriformis Syndrome symptom checker before their appointment to better understand whether their symptoms align with this condition and to help prepare informed questions for their healthcare provider.

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Medically Approved Next Steps

The good news: most cases of piriformis syndrome improve without surgery.

Here are evidence-based treatments doctors commonly recommend:

1. Activity Modification

• Avoid prolonged sitting
• Take standing or walking breaks every 30–60 minutes
• Reduce high-impact activities temporarily

Rest doesn't mean complete inactivity — gentle movement is important.

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2. Targeted Stretching

Stretching the piriformis muscle can reduce pressure on the sciatic nerve.

Common examples include:

• Figure-four stretch
• Supine piriformis stretch
• Seated hip stretch

A physical therapist can ensure you're doing these correctly and safely.

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3. Physical Therapy

This is often the most effective treatment.

A physical therapist may:

• Improve hip mobility
• Strengthen gluteal muscles
• Correct posture and movement patterns
• Address muscle imbalances

Many patients see improvement within several weeks.

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4. Anti-Inflammatory Medications

Over-the-counter NSAIDs (like ibuprofen or naproxen) may reduce inflammation and pain short term. Always follow dosing instructions and check with a doctor if you have kidney, heart, or stomach conditions.

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5. Heat and Ice

• Ice can help during acute flare-ups.
• Heat can relax tight muscles before stretching.

Use whichever provides relief.

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6. Injections (If Needed)

If symptoms persist despite conservative care, a physician may recommend:

• Corticosteroid injections into the piriformis muscle
• Botox injections in select chronic cases

These reduce muscle spasm and inflammation. They're usually considered after physical therapy has been tried.

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7. Surgery (Rare)

Surgical release of the piriformis muscle is uncommon and reserved for severe, persistent cases that do not respond to other treatments.

Most people never need surgery.

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When to Speak to a Doctor Immediately

While piriformis syndrome is usually not dangerous, certain symptoms require urgent evaluation:

• Loss of bladder or bowel control
• Progressive leg weakness
• Numbness in the groin or inner thighs
• Severe, worsening pain after trauma
• Fever with back or buttock pain

These could signal a more serious condition.

Even if your symptoms seem mild, it's still wise to speak to a doctor for a proper diagnosis — especially if pain lasts more than a few weeks.

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Can Piriformis Syndrome Go Away on Its Own?

In some cases, yes. Mild muscle irritation may resolve with stretching, posture correction, and reduced sitting time.

However, if the underlying cause — such as muscle imbalance or overuse — isn't addressed, symptoms can return.

Early treatment often leads to faster recovery.

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How Long Does Recovery Take?

Recovery varies depending on:

• How long symptoms have been present
• Activity level
• Commitment to physical therapy
• Severity of nerve irritation

Many people improve within 4–8 weeks with conservative treatment. Chronic cases may take longer.

Consistency matters more than intensity.

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The Bottom Line

If you have buttock pain that radiates down your leg, it might not be a spinal disc problem. Piriformis syndrome is a real and treatable cause of sciatic nerve irritation.

Key takeaways:

• Pain often starts deep in the buttock.
• Sitting typically makes it worse.
• Most cases improve with physical therapy and stretching.
• Surgery is rarely needed.
• Severe neurological symptoms require urgent care.

If you're unsure whether your symptoms match this condition, consider checking your symptoms with Ubie's free AI-powered Piriformis Syndrome assessment tool, then bring those results to your healthcare provider for a comprehensive evaluation.

Most importantly, speak to a doctor about any persistent, worsening, or potentially serious symptoms. While piriformis syndrome is usually manageable, proper diagnosis ensures you're not missing a more serious condition.

With the right steps, relief is very possible — and often closer than you think.