Piriformis Syndrome: When Sciatica Isn't From Your Spine
Piriformis syndrome is a condition where the piriformis muscle — a small but important muscle deep in the buttock — compresses or irritates the sciatic nerve, causing pain that travels down the leg. It closely mimics disc-related sciatica, which is why it's frequently missed when someone jumps straight to spinal imaging without a thorough clinical examination.
How to tell piriformis syndrome apart from disc sciatica
The key distinguishing feature is location and trigger. Piriformis syndrome tends to produce a deep ache in the buttock that worsens with sitting — particularly on hard surfaces — and with hip movements that stretch or compress the muscle, like crossing your legs. Disc sciatica more typically involves lower back symptoms alongside the leg pain, and is often aggravated by lumbar flexion (bending forward).
Athletes and people who sit for long periods are particularly susceptible. Runners, cyclists, and desk workers across South-East Melbourne are among the most common presentations we see at our Berwick clinic. A direct history of injury to the buttock — a fall, a sudden rotational force — can also trigger piriformis involvement without any disc pathology at all.
Why the piriformis gets overloaded in the first place
The piriformis is a hip external rotator, and it does a significant amount of stabilising work during walking, running, and single-leg activities. When the gluteus maximus and medius aren't contributing enough — a common finding in sedentary individuals and those with chronic lower back or hip pain — the piriformis compensates. Over time, this creates chronic tension in the muscle, which progressively impinges on the sciatic nerve running nearby.
This is why treatment that targets only the piriformis in isolation often produces temporary relief at best. If the underlying hip weakness and movement pattern aren't corrected, the muscle returns to the same overloaded state. The cycle of pain, temporary relief, and recurrence continues until the root cause is identified and addressed.
How osteopathy treats piriformis syndrome
Treatment focuses directly on releasing the piriformis and surrounding hip rotators, improving hip joint mobility, and addressing any biomechanical factors that are overloading the muscle. This typically includes deep soft tissue work, hip mobilisation, nerve desensitisation techniques, and targeted stretching and strengthening exercises.
Most people with piriformis syndrome respond well within a handful of sessions when the diagnosis is accurate and treatment is appropriately directed. If you've been treated for sciatica without improvement, it may be time to look at the hip. Book an assessment at RISE Sports & Spinal and we'll give you a clear answer.
Book an initial consultation at RISE Sports & Spinal in Berwick. Clear diagnosis, hands-on treatment, and a plan that actually gets you better.
