Piriformis syndrome (deep gluteal pain)
Why do I have deep buttock pain that gets worse when I sit?
Deep buttock pain, sometimes spreading down the leg, thought to involve the sciatic nerve in the buttock. The low back is always checked first.
What it feels like
Deep pain in the buttock, often worse with sitting, sometimes with pain, tingling or numbness spreading down the back of the leg.
What is actually happening
Piriformis syndrome, now often described as part of deep gluteal syndrome, is thought to involve irritation of the sciatic nerve as it passes through the deep muscles of the buttock. A systematic review of its clinical features found that buttock pain, tenderness over the area where the nerve exits the pelvis, pain made worse by sitting, and pain with hip movements that stretch the area are the most common findings. Because low back problems can cause very similar symptoms, they are always assessed first.
When to see a doctor urgently
Go to an emergency department straight away for numbness around the groin or genitals, bladder or bowel changes, or rapidly worsening leg weakness.
How it is assessed
Assessment includes a full screen of the lower back and hip joint, a neurological examination, tenderness in the deep buttock, and hip movement tests that reproduce the familiar pain.
How it is treated
Research on treatment is limited. A systematic review of treatments for deep gluteal syndrome found that conservative care, including exercise, stretching and manual therapy, is the usual first approach, with injections and surgery reserved for persistent cases and provided by physicians and surgeons. Treatment adjusts sitting and aggravating activities, builds hip and trunk strength, and includes nerve mobility work where appropriate.
What to do first
Break up long periods of sitting, avoid sitting on a wallet or hard edge, keep active, and have it assessed so that the low back and hip are checked.
Where this is assessed
- Athlete's Care Sports Medicine Centres Yonge & Eglinton · Mon/Wed/Fri · 8:00 AM – 2:00 PM Book at Athlete's Care
- Push Pounds Sports Medicine Downtown Toronto · Tue/Thu · 8:30 AM – 6:30 PM Call Push Pounds to book
- Country Lane Physio Home office & virtual · Sat · By appointment only Message me to book
References
This page is based on the following clinical practice guidelines and research.
- Hopayian K, Song F, Riera R, et al. The clinical features of the piriformis syndrome: a systematic review. Eur Spine J. 2010;19(12):2095-109.
- Hopayian K, Mirzaei M, Shamsi M, et al. A systematic review of conservative and surgical treatments for deep gluteal syndrome. J Bodyw Mov Ther. 2023;36:244-250.