Piriformis syndrome: what it is, causes, symptoms, and how to manage it
Learn what piriformis syndrome is, how it differs from sciatica, and how targeted exercises and simple strategies can ease discomfort and improve mobility.
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If you’ve ever felt pain deep in your glutes (butt muscles), or a tingling sensation that travels from your glute down your leg, you know firsthand how uncomfortable everyday movements like sitting, walking, or climbing stairs can become. Sometimes, this type of discomfort is labeled piriformis syndrome, which refers to sensitivity or irritation of the piriformis muscle — a small muscle that connects your sacrum (at the base of your spine) to the top of your thigh bone and helps rotate your hip.
Piriformis syndrome can be frustrating, but you can ease discomfort with simple at-home treatments like gentle, targeted exercises and movement modifications.
Read on to learn more about what causes piriformis syndrome, plus tips to manage and treat symptoms — especially with exercises recommended by Hinge Health physical therapists.
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What is piriformis syndrome?
Piriformis syndrome is a term often used to describe one-sided glute pain that may sometimes be accompanied by tingling or discomfort that is caused by muscle spasms, tightness, or inflammation in the hip. (That’s because muscle tension in your piriformis can irritate your sciatic nerve.) “Piriformis syndrome is generally used as an umbrella term for symptoms that originate around the posterior hip/glute area,” says Karla Arevalo-Alas, PT, DPT, a Hinge Health physical therapist.
Because this area helps control hip movement and stability, everyday activities like sitting for long periods, walking uphill, or climbing stairs may feel more uncomfortable when the piriformis and surrounding tissues are sensitive.
Symptoms of piriformis syndrome
Piriformis syndrome symptoms can range from mild to severe. “Some people may only feel a little discomfort that improves with movement,” Dr. Arevalo-Alas says. “For others, the discomfort can make it challenging to perform daily activities.” Not everyone will experience the same symptoms, but common ones include:
Deep buttock pain
Pain that worsens with sitting (such as driving or sitting at a desk)
Pain with climbing stairs or hills
Pain with walking in general (especially longer distances)
Discomfort when crossing your legs or rotating your hip
Butt pain, plus tingling or numbness down the back of your leg
Tenderness when applying pressure around your butt
Piriformis syndrome vs. sciatica
Sciatica refers to symptoms — like pain, numbness, or tingling — that occur when the sciatic nerve becomes irritated somewhere along its path.
Piriformis syndrome is one possible contributor to sciatica. But similar symptoms can also come from tight lower back muscles, tense hip muscles, and stiff joints. A physical therapist can help identify what’s contributing to your symptoms and design a treatment plan that works for you.
“Piriformis syndrome — and other causes of sciatica — all respond well to movement and exercise therapy,” says Dr. Arevalo-Alas.
Causes of piriformis syndrome
Piriformis-related pain is often a result of multiple factors. Prolonged sitting and doing more physical activity than your body is ready for can all contribute. Some of the most common causes of piriformis syndrome include:
Muscle tension from prolonged sitting. Sitting for extended periods, whether at a desk or while traveling on a road trip, can compress the piriformis, leading to tension in your glutes and even around your hips.
Doing more than your hip is ready for. Quickly increasing activities like running, cycling, or stair climbing can overload muscles that haven’t yet built up tolerance. “It’s great to start something new, but you have to ramp up slowly to strengthen your muscles and stretch in the process,” says Dr. Arevalo-Alas.
Hip muscle imbalances. When surrounding muscles aren’t sharing the workload efficiently, the piriformis may have to work harder during movement. “One common cause of muscle imbalances is frequent sitting, which is why strengthening and exercise in general are so important,” says Dr. Arevalo-Alas.
Changes in movement patterns. Favoring one side of your body — whether you realize it or are trying to avoid low back or hip discomfort — can increase strain on nearby muscles, including your piriformis, over time.
Repetitive hip rotation activities. Certain activities or sports, including dance and golf, may place repeated demands on the muscles that control hip rotation, such as the piriformis.
How movement can help piriformis syndrome
It may feel counterintuitive to move when you’re uncomfortable, but gentle activity is one of the best ways to manage piriformis-related symptoms. “Movement increases blood flow to muscles and joints, which supports recovery,” says Dr. Arevalo-Alas. It also helps your body gradually build tolerance to everyday demands — whether that’s walking, sitting, or exercising.
Additionally, if surrounding hip muscles are under-conditioned, targeted exercises can help improve strength and coordination so the piriformis doesn’t have to do all the work on its own. Over time, this can make everyday movements feel more comfortable and less effortful.
Exercises for piriformis syndrome relief
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- Clamshells
- Bridges
- Z sits
- Lower extremity nerve glide
Together, these movements can help improve hip strength, mobility, and coordination while reducing sensitivity in the butt region. The glute stretch and Z sits help release tight tissue and restore range of motion, clamshells and bridges strengthen the glute muscles so the piriformis doesn’t overwork, and nerve glides support healthy movement of the sciatic nerve to ease tingling or radiating discomfort down the leg. Over time, this may make activities like sitting, walking, or climbing stairs feel more comfortable.
The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.
Treatments for piriformis syndrome
Simple, at-home treatments can help ease piriformis syndrome symptoms and improve overall mobility. The following strategies, recommended by Hinge Health physical therapists, can help ease discomfort from piriformis syndrome:
Try physical therapy and targeted exercises. Targeted exercises help ease tension in and around your piriformis. They can also help strengthen neighboring muscles so the piriformis doesn’t become strained or overworked. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.
Stay active. While you may need to temporarily modify certain activities, gentle movement like walking helps maintain hip mobility and prevent stiffness. “Avoid complete rest, which can make symptoms worse by reducing muscle tolerance,” says Dr. Arevalo-Alas.
Take over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can help ease pain so you can do your targeted exercises and stay active when you have piriformis-related pain. If you have a medical condition or take other medications, check in with your provider to make sure these OTC options are safe to take.
Apply heat or ice. Heat can help ease muscle tension in the affected areas, while ice can help reduce swelling and inflammation. Try both methods, or stick to the one that works best for you.
Try massage or foam rolling. Gentle self-massage or foam rolling can help release tension in your butt and hips. “I also like to use a lacrosse or tennis ball directly on the piriformis to reduce tension,” says Dr. Arevalo-Alas. “Place the ball on the floor or against a wall, and apply pressure all around the glute, including the piriformis area.”
Consider lifestyle modifications. Factors like sleep, stress, nutrition, and certain activities can all play a role in how you feel. In fact, many people are surprised to learn that pain isn’t just about what’s happening physically — your daily habits and overall well-being can have a real impact, too. Staying curious about how your routines affect your muscles and joints can help you identify where small changes might help reduce pain. For example, you might notice your pain is less noticeable on low-stress days.
Try complementary treatments. Talk to your provider if you’re interested in trying alternative treatments for piriformis syndrome relief, such as massage, acupuncture, or chiropractic care.
Ask about TENS therapy. TENS, or transcutaneous electrical nerve stimulation, uses gentle pulses to quiet your pain response and help reduce pain associated with conditions like piriformis syndrome. One option is the wearable device Enso, available through Hinge Health. It’s small, wireless, and portable.
Tips to manage piriformis syndrome
Small adjustments to your daily routine can make a big difference in managing piriformis pain, from how you sit to how you sleep. Consider these physical therapist-backed tips for managing piriformis discomfort:
Change positions while sitting. If you sit a lot for work or school, try to shift positions or stand up periodically throughout the hour. “Changing positions, like changing which leg is crossed or adjusting how you sit, can reduce prolonged strain on the piriformis,” says Dr. Arevalo-Alas.
Switch up your sleep positions. Lying on your side with a pillow between your knees may help limit excess hip rotation overnight and improve your comfort first thing in the morning.
Adjust your driving setup. If you drive often, take breaks during longer trips when possible and adjust your seat position to stay comfortable behind the wheel. “Your seat should be close enough that you don’t have to stretch to reach the pedal, but not too close, which could put your body into a more flexed position,” says Dr. Arevalo-Alas.
Modify your activities. You may want to temporarily scale back activities that aggravate symptoms while continuing to build strength with physical therapist-recommended exercises. Finding your “movement sweet spot” can help you find the right amount of intensity so you can stay active.
Warm up before activity. Preparing your hips with gentle movement before running, cycling, or sports can help your muscles better tolerate activity.
When to see a doctor
Piriformis syndrome often improves on its own with targeted exercises and at-home treatments. But if your pain is severe, getting worse, or causing difficulty with daily activities, see a healthcare provider. It's also a good idea to get care if you have:
Severe leg weakness or numbness
Loss of bowel or bladder control
Pain following a significant injury or fall
Will piriformis syndrome go away?
Many people with piriformis syndrome see significant improvement with consistent exercise and activity modification. The exact timeline for improvement varies, but many feel better within weeks with targeted exercise. Remember: A “quick fix” isn’t necessarily the goal. “We want to help you build resilience and tolerance for activities over time so you can get back to the activities you love,” says Dr. Arevalo-Alas.
Physical therapy (PT) is for more than just recovering from surgery or injury. It’s one of the top treatments for joint and muscle pain. It helps build strength, improve mobility, and reduce pain. And it doesn't always need to be in person.
Hinge Health members can conveniently access customized plans or chat with their care team at home or on the go — and experience an average 68% reduction in pain* within the first 12 weeks of their program. Learn more*.
PT tip: Take movement snacks
Taking small, regular movement breaks (or movement snacks) throughout the day can help reduce stiffness in your hips and butt. “Try incorporating simple stretches while watching TV or sitting at work so movement becomes part of your routine,” says Dr. Arevalo-Alas.
How Hinge Health can help you
If you have pelvic pain or symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.
The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.
Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.
See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.
This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.
References
Hicks, B. L., Lam, J. C., & Varacallo, M. (2023). Piriformis Syndrome. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK448172/
Harvard Health Publishing. (2018, April 13). Ask Dr. Rob about piriformis syndrome - Harvard Health. Harvard Health; Harvard Health. https://www.health.harvard.edu/diseases-and-conditions/ask-dr-rob-about-piriformis-syndrome
Jeong, U.-C., Kim, C.-Y., Park, Y.-H., Hwang-Bo, G., & Nam, C.-W. (2016). The effects of self-mobilization techniques for the sciatic nerves on physical functions and health of low back pain patients with lower limb radiating pain. Journal of Physical Therapy Science, 28(1), 46–50. doi:10.1589/jpts.28.46
Vij, N., Kiernan, H., Bisht, R., Singleton, I., Cornett, E. M., Kaye, A. D., Imani, F., Varrassi, G., Pourbahri, M., Viswanath, O., & Urits, I. (2021). Surgical and Non-surgical Treatment Options for Piriformis Syndrome: A Literature Review. Anesthesiology and Pain Medicine, 11(1). doi:10.5812/aapm.112825