Piriformis Syndrome

Nov 9, 2019

Piriformis syndrome is a painful neuromuscular disorder characterised by pain in the gluteal and hip area which radiates down the leg. These symptoms are very similar to those associated with Sciatica. Both Piriformis syndrome and sciatica are described as compression of the Sciatic nerve which leads to inflammation and pain.

With Piriformis syndrome, the sciatic nerve is compressed by the piriformis muscle. This muscle acts as an external rotator when the hip is extended and as an abductor when the hip is flexed. The piriformis muscle may become tight and/or hypertrophied due to biomechanically inefficient movement patterns as well as a means to compensate for weakness in the Gluteus maximus or other external rotators and abductors of the hip and femur.

Depending on an individual’s anatomical morphology, the sciatic nerve will either run underneath the piriformis muscle or pass through the muscle itself. Therefore when the piriformis muscle increases in size or becomes tight it leaves little space for the sciatic nerve which gets compressed and leads to inflammation and pain as described above.

Signs, symptoms and treatment

  • Pain, tingling, or numbness in the buttocks
  • Pain down the back of the thigh and calf
  • Pain when walking up stairs
  • Pain that is exacerbated after sitting
  • Reduced range of motion

Piriformis syndrom

  • Treatment: Ice and/or heat
  • Treatment: Deep tissue massage
  • Treatment: Stretches
  • Treatment: Rest
  • Treatment and prevention: stay fit

Causes of piriformis syndrome

Recognised causes of piriformis syndrome include:

  • Injury
  • Abnormal development or location of the piriformis muscle or sciatic nerve
  • Abnormal spine alignment (such as scoliosis)
  • Leg-length discrepancy (when the legs are of different lengths)
  • Prolonged sitting, especially if carrying a thick wallet in a pocket directly behind the piriformis muscle
  • Prior hip surgery
  • Unusually vigorous exercise
  • Foot problems, including Morton’s neuroma.

In many cases the cause cannot be identified.


While medications, such as pain relievers, muscle relaxants, and anti-inflammatory drugs may be recommended, the mainstay of treatment for piriformis syndrome is physical therapy / biokinetics, exercise, and stretching. Specific treatments may include:

  • adjustments in gait
  • improved mobility of sacroiliac joints
  • stretching to relieve tight piriformis muscles and those surrounding the hip
  • strengthening of the hip abductors (muscles that move the hips outward from the body)
  • application of heat

If these measures are not effective, more invasive treatment can be considered such as:

  • Injections of a local anaesthetic or a corticosteroid agent — these injections are generally guided by ultrasound, x-ray, or electromyogram (which detects muscle and nerve activity) to make sure the needle is in the right place.
  • Surgery — although an option of last resort and very uncommon, removing a portion of the piriformis muscle or its tendon has been reported to provide relief in refractory cases.

Exercises to improve piriformis syndrome

Below are some of the stretches and exercises that can be used as a treatment plan to treat piriformis syndrome:

Hamstring stretch:Hamstring stretch

Begin by lying on your back with your legs straight and a strap secured on one foot, holding the end in your hands.

Hold the stretch for 30 seconds, then slowly return to starting position. Aim to complete a set of three stretches.

Piriformis stretch:Piriformis stretch

Begin on all fours. Place the affected foot across and underneath the trunk of the body so that the affected knee is outside the trunk.

Extend the non‐affected leg straight back behind the trunk and keep the pelvis straight. Keeping the affected leg in place, scoot the hips backwards towards the floor and lean forward on the forearms until deep stretch is felt. Do not force body to floor.

Hold the stretch for 30 seconds, then slowly return to starting position. Aim to complete a set of three stretches.

Side lying adductor leg raise:Side lying adductor leg raise

Lying on your side tighten the muscles in the front of your thigh and lift the leg 8-10 inches off the ground. Keep your entire leg in-line with your trunk.

Complete 3 sets of 10 repetitions


Glute raises: Glute raise

Supine, keep heels close to the glutes. Keep hips level. Abdominals engaged with a neutral pelvis. Focus on stabilizing legs through the glutes instead of the hamstrings. Raise and lower hips slowly and with control.

Complete 3 sets of 10 repetitions

Running squatRunning Squat:

Keep tension on wall by pressing knee against wall. Bend knee and squeeze glutes to standing position.

Complete 4 sets of 10-20 seconds




Prepared by the Binokinetics team at the Sports Science Institute of South Africa (SSISA)

SSISA’s Biokinetics practice has a special focus on Orthopaedic & Neurological Rehabilitation, using scientific and evidence-based exercise programmes geared to improve function, performance and quality of life. The team also offer an intensive running programme for athletes of all levels to improve their abilities. Read more about SSISA Biokinetics


Please note that information found in these articles does not constitute medical advice. If you are experiencing an injury or condition of any kind, it is always advisable to contact a medical professional for advice on your specific symptoms.

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