Piriformis syndrome occurs when the piriformis muscle, located deep in the buttock, irritates or compresses the sciatic nerve, leading to pain in the buttock and sometimes radiating down the leg.
The piriformis originates from the front of the sacrum and attaches to the greater trochanter of the femur.
It plays a key role in hip rotation and stabilisation of the pelvis during walking and standing.
When the piriformis becomes tight, inflamed, or in spasm — often due to postural imbalance, overuse, or pelvic dysfunction — it can entrap the sciatic nerve as it passes either beneath or through the muscle fibres.
While true nerve entrapment is relatively rare, functional irritation of the sciatic nerve from muscular tension is quite common and often presents similarly to lumbar radiculopathy (“sciatica”).
Deep, aching pain in the buttock, often one-sided.
Pain radiating into the back of the thigh, sometimes to the calf or foot.
Pain aggravated by sitting, climbing stairs, or running.
Tenderness when pressing over the piriformis muscle (mid-buttock region).
Relief when lying flat or changing posture.
Functional impact:
Piriformis-related pain can limit sitting tolerance, walking, or sports involving hip rotation.
If untreated, it may lead to compensatory tension in the lumbar spine, sacroiliac joint, or opposite hip.
Red flags:
Progressive weakness, numbness, or loss of bladder/bowel control are not typical and should be assessed for lumbar disc herniation or cauda equina syndrome.
Piriformis syndrome can develop from both local overload and global postural or biomechanical imbalance.
Common contributing factors include:
Sacroiliac joint dysfunction or pelvic asymmetry.
Prolonged sitting or sedentary work.
Overuse from running, cycling, or climbing.
Direct trauma or falls to the buttock.
Weak gluteal and core muscles, increasing piriformis strain.
Foot or ankle dysfunction altering pelvic alignment.
Previous lumbar injury, changing muscle recruitment patterns.
From an osteopathic perspective, piriformis irritation is rarely isolated — it reflects a disturbed relationship between the pelvis, spine, and lower limb, affecting how load and motion are transmitted through the body.
Osteopathic management focuses on relieving muscular tension, restoring pelvic balance, and improving neural mobility.
An osteopathic assessment may include:
Palpation of pelvic alignment, SI joint motion, and soft tissue tension.
Gentle mobilisation of the sacroiliac and hip joints.
Myofascial release and soft-tissue techniques for the piriformis, gluteals, and hip rotators.
Indirect or functional techniques to calm irritation around the sciatic nerve.
Lumbar and thoracolumbar mobilisation to restore kinetic-chain integration.
Breathing and diaphragm work to reduce pelvic tension and sympathetic tone.
Guidance on posture, ergonomic sitting, and gentle stretching or activation of gluteal muscles.
The goal is to reduce pressure on the nerve, restore smooth muscle function, and re-establish balanced movement throughout the pelvis and lower limb.
Evidence supports manual therapy, stretching, and neuromuscular re-education as conservative treatments for piriformis-related sciatic pain.
Studies highlight the benefit of addressing both the muscle and the surrounding biomechanical context, including sacroiliac and lumbar regions.
Osteopathic and physiotherapy-based approaches that combine manual therapy, postural retraining, and targeted exercise have shown meaningful improvement in pain and function.
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