Piriformis syndrome: is it that, or sciatica?

Based on NHS physiotherapy guidance and clinical research.

Reviewed by Harvir Ubhi, HCPC-registered physiotherapist. Last reviewed 28 September 2026.

What piriformis syndrome is

The piriformis is a muscle deep in your buttock that turns your leg outwards. The sciatic nerve, the large nerve that runs down the back of your leg, passes right next to it, and in some people through it. When the muscle tightens or gets irritated, it can squeeze the nerve at that point.

Piriformis syndrome symptoms

NHS Lothian's physio leaflet lists:

• tingling, numbness or burning in the back of your thigh, sometimes down to your foot
• tenderness in your buttock
• a dull ache or burning in your hip, groin, mid-buttock or back of the thigh
• a heavy or tired feeling in your leg
• pain that's worse sitting on a hard chair

Piriformis syndrome or sciatica from your back?

Both irritate the same nerve, so they can feel almost identical. The difference is where the nerve is being squeezed:

That's a guide, not a way to diagnose yourself. The symptoms overlap too much. Getting it wrong matters, because stretching a buttock muscle won't fix a disc problem, and treating a disc won't loosen a tight piriformis. Read more on sciatica symptoms and causes or slipped discs.

Is there a test for piriformis syndrome?

Not one that settles it. There's no accepted gold-standard test, so it's diagnosed by examination and by ruling out other causes first, especially a slipped disc or spinal stenosis in the lower back.

A clinician may use movement tests that stretch the piriformis to see if they bring on your pain. The best known is the FAIR test, where your hip is bent, turned inwards and moved across your body. A positive result points towards the piriformis, alongside everything else they find.

Scans can't reliably show piriformis syndrome. An MRI is mostly useful to rule out a problem in the spine instead.

What helps, in the order it usually happens

1. 1

   Ease off the trigger

   Rest from whatever sets it off, whether that's running, hills or long spells sitting on hard chairs.

2. 2

   Ice, then heat

   An ice pack for 20 minutes at a time to calm it down. Heat helps the muscle loosen before stretching.

3. 3

   Stretch and strengthen

   NHS Lothian's leaflet pairs hip and buttock stretches, each held for 30 seconds, with strengthening work such as bridges and side-lying leg lifts. Rolling your buttock on a tennis ball can also help.

4. 4

   Painkillers

   Paracetamol and anti-inflammatories such as ibuprofen, taken as directed. A pharmacist can tell you what's safe for you.

5. 5

   Physiotherapy

   A physio confirms whether it's the piriformis or your back, then builds your stretching and strengthening plan around what they find.

6. 6

   Injection

   Occasionally a steroid injection near the muscle helps.

7. 7

   Surgery

   Very rarely needed.

Piriformis syndrome questions

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