17/12/2025
Piriformis Syndrome
(Clinically explained – Physiotherapy perspective)
What it is:
Piriformis syndrome occurs when the piriformis muscle (a deep hip external rotator) becomes tight, overactive, or inflamed and compresses the sciatic nerve, leading to buttock pain and radiating leg symptoms.
Key symptoms:
Deep buttock pain, often one-sided
Pain radiating to the posterior thigh or calf (sciatic-type pain)
Worse with sitting, driving, climbing stairs, or prolonged walking
Tenderness over the greater sciatic notch
Relief when lying supine or gentle hip mobility
Common causes:
Prolonged sitting (especially poor posture)
Repetitive hip rotation (running, cycling)
Pelvic or sacroiliac dysfunction
Postural imbalance or leg-length discrepancy
Direct trauma to the buttock
Clinical differentiation (important):
Unlike lumbar disc herniation, lumbar ROM is often pain-free
Neurological deficits are usually mild or absent
Positive FAIR test (Flexion, Adduction, Internal Rotation)
Physiotherapy management (evidence-based):
Myofascial release of piriformis & deep gluteals
Neural mobilization (sciatic nerve glides)
Hip mobility restoration (internal rotation focus)
Gluteus medius & core activation
Pelvic alignment correction
Postural and sitting-load education
Key exercises (early phase):
Piriformis stretch (supine / seated)
Figure-4 stretch
Controlled hip IR mobility
Side-lying hip abduction (low load)
When to reassess:
If symptoms persist beyond 4–6 weeks, or worsen with neurological signs, reassess for lumbar or SI joint involvement.
