Piriformis Syndrome Causes Butt and Leg Pain

Piriformis syndrome is one of the causes of butt and leg pain. It is most common in middle-aged women. Because it shares symptoms with a few other diagnoses, such as low back problems or hamstring injuries, it often can be misdiagnosed.

What is Piriformis Syndrome?

The piriformis muscle is located deep to your glute max muscle in your butt. It attaches your thigh bone to your sacrum (the bone just above your tailbone), and it rotates your hip outward. When irritated, this muscle causes deep, achy butt pain and can also refer pain down the back of the thigh to the knee.

piriformis syndrome

Additionally, a tight, irritated piriformis can place pressure on the sciatic nerve because of its proximity to the sciatic nerve. The sciatic nerve location varies in each person, but it is either directly above, directly below, or goes through the piriformis muscle. Sciatic nerve irritation (AKA sciatica) symptoms include numbness, tingling, or burning down the back of your leg. These symptoms can even go all the way down to your foot or toes.

Causes of Piriformis Syndrome

There are many things that can contribute to piriformis syndrome. The most accurate way to determine why your piriformis is irritated is to be evaluated by a physical therapist. Addressing all the factors that are contributing to your piriformis syndrome will ensure it does not come back in the future. Some factors that can contribute to piriformis syndrome include excessive sitting (ie, desk job), weakness in the glutes, or a leg length discrepancy.

How Do I Know If I Have Piriformis Syndrome?

These are some of the common symptoms associated with piriformis syndrome:

  • Deep, achy butt pain
  • Pain down the back of the thigh
  • Numbness, tingling, or burning down the leg – may go all the way down to the toes
  • Symptoms usually occur only in one leg
  • Increased pain with prolonged sitting
  • Increased pain with prolonged walking or running

Check out the video below for one way to test if your pain is coming from your piriformis.

Treatment for Piriformis Syndrome


Massaging your piriformis with a tennis ball or lacrosse ball like in the previous video can help reduce knots or tightness in the muscle.

Nerve Gliding

Nerve gliding moves the nerve back and forth, which increases blood flow to it and helps calm it down. This is a great sciatic nerve glide that can help reduce any numbness, tingling, or burning in your leg.


Stretching your piriformis will help improve its flexibility. This stretch is great to perform intermittently if you have to sit for a long period of time, such as while working a desk job or when on a long car ride.


Oftentimes a contributing factor to piriformis syndrome is weakness in some of the other hip muscles, which leads to the piriformis getting overworked. Here are 2 great strengthening exercises for your glutes.

Manual Techniques

Getting manual treatment in physical therapy can be very helpful in reducing the symptoms of piriformis syndrome. Dry needling is a very effective way to reduce painful knots or tightness in the piriformis. Check out this blog post to learn about what dry needling is and how it can help. Calming the piriformis will also decrease irritation of the sciatic nerve.

Eliminate Your Butt and Leg Pain

If these exercises don’t eliminate your deep, achy butt pain or sciatica, it’s time to see a physical therapist. Determining the factors that are causing irritation of your piriformis is important to making sure these symptoms won’t return. Hands-on treatment, like dry needling, and personalized exercises will get rid of this pain in your butt.

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