A Real Pain in the Butt!

by Rachel Varga, Registered Physiotherapist

Located deep in the buttock region, underneath the gluteus maximus muscle, lies a mystery muscle called the piriformis. The piriformis muscle has attachments that run from the sacrum (a bone that is part of the pelvis) to the top of the femur (the thigh bone). Its primary function is to rotate the hip and leg outward.

I refer to this muscle as a real pain in the butt, as it can often be the source of a lot of discomfort in the area. One particular condition this muscle can lead to is Piriformis Syndrome.

Piriformis Syndrome is described as a spasm in the piriformis muscle, causing buttock pain. It can be caused by swelling or tightening of the muscle from injury, or from irritation of nearby structures, such as the sacroiliac joint or hip joint. Activities that can lead to this are sitting for prolonged periods and long-distance running.

Typical symptoms of Piriformis Syndrome include decreased range of motion at the hip and a feeling of dull aching pain in the buttock region. The pain experienced can be triggered by:

  • Walking
  • Running
  • Climbing stairs
  • Driving
  • Sitting for a long period of time

An additional problem that can arise from Piriformis Syndrome is irritation of the sciatic nerve. The sciatic nerve runs underneath the piriformis muscle. Therefore, if the piriformis muscle is in spasm, it can put additional pressure on the nerve.

This pressure can lead to more intense symptoms including:

  • Pain that refers down the back of the thigh, sometimes extending into the calf and foot
  • Pins and needles down the leg (“fallen asleep”)

Stretching the piriformis muscle can often help relieve symptoms associated with Piriformis Syndrome. Here are two variations of a piriformis stretch:

Position yourself lying down on your back. Keep the non-exercising leg straight, as you bring your exercising knee to your chest. Then, pull your foot toward your opposite hip.

Hold for 20-30 seconds. Repeat 3 times.

Position yourself lying down on your back with both knees bent. Cross your exercising leg over the non-exercising leg to rest your ankle on the opposite thigh. Then, gently push the exercising knee downward and away from your body.


Hold for 20-30 seconds. Repeat 3 times.

Piriformis Syndrome can sometimes be tricky to diagnose, as it mimics the signs and symptoms of several other neuromuscular conditions in the area, including sciatica, lumbar disc herniation, and sacroiliac joint dysfunction. It is important to have this evaluated by a healthcare professional so these other pathologies can be ruled in or out.

If you think you might have Piriformis Syndrome and would benefit from a detailed assessment and treatment plan to manage the issue, book an appointment with our Registered Physiotherapist, Rachel Varga, at Synergy Sports Medicine East on the Danforth by clicking HERE!

Rachel VargaRachel Varga

Physiotherapist – B.A. Hons (Kin), MSc.PT
Rachel Varga is a physiotherapist practicing at Synergy Sports Medicine, East End (2017 Danforth Avenue)


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