The piriformis muscle is one of the deepest muscles in the buttock, and the sciatic nerve runs nearby. For some people (approximately 20% of the population), the nerve actually runs through the muscle itself – chances are you would never know if that’s the anatomy you have.
Either way, a tight muscle near or around a nerve can cause irritation.

Piriformis syndrome is described as a combination of symptoms that may include lower back or buttock pain. Pain that refers down the leg (sciatica) can be due to compression of the sciatic nerve by a tight, inflamed and tender piriformis muscle.

Sciatica is a collection of symptoms caused by irritation of the sciatic nerve. But not all sciatica is caused by the same thing.

Piriformis Syndome


As this is a form of sciatica, the symptoms are largely the same:

  • pain that may be shooting up and down the leg
  • numbness, weakness, or pins and needles
  • symptoms felt anywhere along the back of the thigh or calf, side of the calf, or sole of the foot

But there may also be local symptoms in the buttock too, namely tightness or tenderness. All of these symptoms may be worse when the muscle is engaged.
Piriformis is a stabilising muscle among other things, so there are a lot of small movements that could set it off.
If you struggle to work out exactly what actions aggravate your symptoms, your osteopath can help you work it out.

Causes of Piriformis Syndrome

It may have all started with a mild muscle strain. Picking up a new exercise or suddenly boosting your activity levels could be the trigger. But when the nerve becomes symptomatic, it gets harder to manage on your own. Irritation of the nerve encourages the body to protect itself by tightening the muscles nearby. Of course, this only makes it worse.

The muscle could also be a more secondary factor. Sitting awkwardly for a long period could put direct pressure on the nerve, leading to that protective response.
It is also possible for there to be another factor alongside piriformis upsetting the nerve. “Double crush syndrome” refers to a nerve that is irritated in two places at once. Perhaps there’s pressure from the muscle as well as a bulging disc. Your osteopath has tests they can use to determine the cause or causes.


Your osteopath will want to work on both the cause and the symptoms. Managing both is important to break the cycle.

The muscle might be the easier part to manage. Your osteopath may work directly with the gluteal muscles to encourage the whole area to relax. They may also want to work at areas that might be indirectly involved, such as the hamstrings and lower back. If this is not the first time you’ve had this problem, it might be time to look at what keeps causing it.

We may also want to calm down the nerve during treatment. Sometimes this is easier said than done, but it may be possible to gently treat the nerve to let the nervous system know it’s safe. Nerve irritation of a longer duration will typically take more time to resolve. Minimising symptoms while the rest of the problem is dealt with can help in the short term, and may give a better outlook in the long term.

If appropriate, we will also give you exercises to continue at home. These help you to continue to progress between treatments, but may also be useful as a kind of first aid for flare ups.

Book an appointment today to address your nerve pain