Piriformis syndrome: deep buttock pain that can spread down the leg
What piriformis syndrome is, how it differs from sciatica from the spine, what usually helps, and why it can be hard to diagnose.
Piriformis syndrome describes irritation or compression of the sciatic nerve near the piriformis, a small muscle deep in the buttock. It can cause buttock pain that spreads down the back of the leg, which is why it is often confused with sciatica that starts in the spine. It is a recognised condition, but it can be difficult to diagnose, and not everyone with deep buttock pain has it.
When to get urgent help
Call 999 or go to A&E straight away if you have back pain together with any of these. They can be signs of a rare but serious condition such as cauda equina syndrome. Do not drive yourself.
- Numbness or tingling around your genitals, buttocks or inner thighs (the saddle area)
- Difficulty passing urine, loss of bladder or bowel control, or being unable to feel when you are passing urine or stool
- Pain, tingling, weakness or numbness in both legs, or sciatica on both sides, or weakness in a leg that is getting worse
- New changes to sexual sensation or function alongside back or leg pain
- Chest pain, or back pain that started after a serious accident such as a car crash
What it can feel like
- A deep ache in the buttock, often one-sided
- Pain that may spread down the back of the thigh and sometimes lower
- Pain that is worse after sitting for a long time, or with running, climbing stairs or sitting with the leg crossed
- Tingling in the buttock or leg in some people
Common contributors
- Overuse or tightness of the piriformis and nearby muscles, for example after a sudden increase in running or cycling
- Long periods of sitting, especially on a hard surface or with something in a back pocket
- A direct knock or fall onto the buttock
- Pain from the lower back or the sacroiliac joint can feel very similar, which is part of why diagnosis is not always straightforward
General self-care
These are general comfort measures many people find reasonable. They are not a treatment plan, and what suits one person may not suit another.
- Avoid sitting for long periods, and get up and walk about regularly
- Take things out of your back pockets before sitting, and use a supportive seat
- Ease back on the activity that clearly aggravates it, then build back gradually
- Gentle hip and buttock stretches and strengthening are commonly used. They should be comfortable, not painful
- If you use over-the-counter pain relief, follow the packet instructions or ask a pharmacist
When to see your GP
See your GP promptly, or call NHS 111, if you have any of the following:
- Feeling hot, cold, shivery or generally unwell, or severe pain that starts suddenly or quickly gets worse
- Unexplained weight loss, or a lump, swelling or change in the shape of your back
- Pain that is worse at night or does not ease with rest, or is worse when you cough, sneeze or open your bowels
- A history of cancer and new, persistent back pain
Consider seeing your GP if:
- Pain, numbness or weakness in both legs, numbness around the genitals, buttocks or inner thighs, or any change in bladder or bowel control. Call 999 or go to A&E
- Weakness in a leg that is getting worse
- Pain that is not improving after several weeks, or is severe or waking you at night
Where an osteopath fits in
There is limited good-quality research showing that hands-on treatment changes the course of piriformis syndrome, so I do not claim that osteopathy treats it.
What an osteopath can usefully do is work out whether your buttock and leg pain is coming from the piriformis, the lower back or the pelvis, advise on sitting, activity and graded stretching and strengthening, and refer you on if your pattern does not fit. A 2026 systematic review of surgical treatments for piriformis syndrome notes that most patients improve with conservative treatment, but that some do not and may then need specialist care. If the assessment suggests you need your GP, a physiotherapist or a specialist instead, I will tell you.
If you would like your symptoms assessed, you are welcome to book an appointment. Osteopathic care is not right for everyone, and if something needs medical attention first, I will tell you.
Common questions
What is the difference between piriformis syndrome and sciatica?
Sciatica is a symptom: pain from irritation of the sciatic nerve, most often at the spine. Piriformis syndrome is one proposed cause, where the nerve is irritated in the buttock. The two can feel alike, so an assessment is needed to tell them apart.
Does piriformis syndrome go away?
A 2026 systematic review reports that most patients with piriformis syndrome improve with conservative treatment, while some develop persistent symptoms and need specialist input. If it is not improving after several weeks, see your GP.
Sources and further reading
Links open in a new tab. Sources were checked in October 2026.
- Endoscopic vs open surgeries for piriformis syndrome: a systematic review and meta-analysis (Advances in Orthopedics, 2026)
- NHS: Sciatica
Related guides
This page is general information to help you understand common aches and pains. It is not medical advice and cannot diagnose your problem. If you are worried about your symptoms, please speak to your GP or call NHS 111.