Piriformis Syndrome, Sciatica, and Buttock Pain: Causes and Relief Guide

Reviewed by: Dr. Dustin DebRoy, D.C.

By: Janett King

Buttock pain is more than a nuisance. It can interfere with sitting, walking, sleeping, and even standing still. Whether it feels like a dull ache, a sharp twinge, or a deep knot in your glutes, this type of pain is often linked to a muscle you may not have heard of: the piriformis.

Piriformis syndrome is a common but often misunderstood condition. It can mimic sciatica, cause pain in just one buttock, and create symptoms that travel down your leg. But it is not the only reason your backside might be protesting. Other conditions, including myofascial pain syndrome, ischial bursitis, and ischiofemoral impingement, can also lead to persistent discomfort.

This guide covers everything you need to know about piriformis syndrome, other causes of buttock muscle pain, and how to find lasting relief.

Understanding the Piriformis Muscle

The piriformis is a small muscle located deep in your buttocks. It connects your sacrum (the base of your spine) to the top of your femur (the thigh bone) and helps rotate your hip and stabilize your pelvis during movement. It plays a major role in activities such as walking, running, climbing stairs, and shifting your weight from side to side.

This muscle shares close quarters with the sciatic nerve, which is the largest nerve in the body. In most people, the sciatic nerve runs directly under the piriformis. In some, it passes through it. This proximity can lead to problems when the piriformis becomes irritated or inflamed.

What is piriformis syndrome and what causes it?

Piriformis syndrome occurs when the piriformis muscle compresses or irritates the sciatic nerve. This can cause a range of symptoms that feel similar to sciatica but originate in the buttock muscle instead of the lower back.

Common symptoms of piriformis syndrome include:

• Deep pain in the center of one buttock
• Pain that worsens when sitting for long periods
• Pain that radiates from the buttock into the hamstring or calf
• Tingling or numbness in the leg
• Discomfort when walking uphill or climbing stairs

These symptoms may come and go or linger depending on your posture, physical activity, and underlying muscle tension. Many people describe it as a knot in the buttocks or a dull ache that flares up with movement.

What is the difference between piriformis syndrome and sciatica?

It’s easy to confuse piriformis syndrome with sciatica. Both conditions can cause similar pain, especially when it radiates down the leg. But even though they involve the same nerve, the source of the problem is different.

Piriformis syndrome starts in the muscle deep within your buttocks. When that muscle becomes tight or inflamed, it can press against the sciatic nerve, triggering symptoms. Sciatica, on the other hand, begins in the lower spine. A herniated disc, spinal misalignment, or narrowing in the spinal canal can place pressure on the nerve at its root, leading to pain that travels through the buttock and down the leg.

The sensations may feel alike, but understanding where the pain starts is key to finding the right solution.

Key differences include:

• Piriformis syndrome typically causes buttock pain without lower back pain
• Sciatica usually begins in the lower back and radiates downward
• Piriformis pain worsens with sitting or hip rotation
• Sciatic nerve pain from the spine often worsens with bending or lifting

If you feel pain only in your buttocks without any spinal symptoms, you may be dealing with piriformis syndrome rather than traditional sciatica.

Why does sitting make the pain in my bottom worse?

If you experience sharp or throbbing pain in your buttocks while sitting, the piriformis muscle may be under stress. Sitting for long periods compresses the muscles, especially if your hips are tight or your posture is poor. This pressure can irritate the sciatic nerve, causing pain that worsens with prolonged sitting.

Sitting on hard surfaces, driving long distances, or using unsupportive chairs can all contribute to discomfort. In most cases, sitting causes butt pain on just one side, especially if you habitually lean or cross one leg.

What else causes gluteal pain?

Piriformis syndrome may be one of the most common causes of deep buttock pain, but it’s not the only one. Pain in this area can originate from a variety of sources, including muscular issues, structural imbalances, nerve irritation, and inflammation. These conditions often overlap, which makes it difficult to pinpoint the exact cause without a closer examination of your symptoms and daily habits.

Understanding what else could be contributing to that stubborn ache or sharp sting in your glutes is key to finding the right kind of relief.

Myofascial pain syndrome

If your pain feels like a deep knot in the muscle that just won’t go away, myofascial pain syndrome may be the cause. This condition involves trigger points, which are tight, irritable spots in the muscle that can refer pain to nearby areas. A trigger point in the gluteal muscles can feel like a small lump or thickened band, and pressing on it may send pain across your buttocks, lower back, or down the leg.

Myofascial pain syndrome is often associated with muscle overuse, repetitive motion, prolonged sitting, or stress that leads to muscle guarding. Poor posture, especially when seated for long hours, can also contribute. Pain may be constant or intermittent, depending on activity and position. It often worsens with physical exertion or after long periods of stillness.

Ischial Bursitis

Also known as "weaver’s bottom," ischial bursitis affects the bursa located at the base of the pelvis, right under your sit bones (ischial tuberosities). These small, fluid-filled sacs cushion the bones and reduce friction between the pelvis and surrounding muscles. When inflamed, the bursa can cause sharp or aching pain in the lower buttocks, especially when sitting on hard surfaces.

This condition is common among cyclists, rowers, and individuals who spend long periods sitting on unsupportive chairs. The pain often feels localized at the base of the buttock and may radiate slightly into the upper thigh. It’s sometimes mistaken for hamstring strain or sciatic pain, but tends to feel more centered at the point of contact between your body and the seat.

Ischiofemoral Impingement

Ischiofemoral impingement is a less common but important cause of deep gluteal pain. It occurs when the space between the ischium (part of the pelvis) and the femur (thigh bone) narrows, compressing the soft tissues between them. This condition often affects athletes, particularly runners or dancers, and may also be observed in individuals with unique pelvic or hip anatomy.

Pain usually presents as a dull, aching sensation in the deep buttock or upper hamstring area. It may worsen with hip extension, walking, or prolonged standing. Some individuals also report a snapping or catching sensation when moving the leg behind the body. Unlike piriformis syndrome, this type of pain tends to originate closer to the hip joint and may be aggravated by different types of movement.

Lower back pain radiating to buttocks

Sometimes, pain that feels like it’s in the buttocks starts in the lower back. Conditions such as lumbar disc herniation, degenerative disc disease, facet joint irritation, or spinal stenosis can all cause referred pain into the gluteal region. This type of pain often accompanies other symptoms, such as lower back stiffness, reduced mobility, or discomfort that worsens with activities like standing, bending, or lifting.

When the spinal nerves are involved, the pain may also travel down one leg or feel sharp and electrical. While piriformis syndrome causes compression of the sciatic nerve in the buttock, spinal causes involve compression of the nerve root higher up in the lower back. Differentiating between the two often requires a detailed physical exam or imaging.

Muscle strain or overuse

If your pain developed after a workout, hike, or long day of climbing stairs, you might be dealing with a simple muscle strain. Overuse of the gluteal muscles, particularly during activities that require powerful hip extension, such as sprinting, lifting, or lunging, can lead to small tears in the muscle fibers. This often results in pain, swelling, and soreness that tends to stay localized.

Unlike nerve-related pain, a strained muscle usually feels tender to the touch and may throb or tighten with contraction. The discomfort often eases with rest and responds well to ice, elevation, and gentle stretching. However, returning to activity too soon can exacerbate symptoms or delay healing.

Left buttock pain: Is it different?

Left-sided buttock pain is just as common as right-sided pain, but it may feel different depending on your body mechanics. Most people have a dominant leg that they rely on more for stability, weight shifting, or movement. This can create muscle imbalances that place extra strain on one side of the body.

Additionally, spinal curvature, leg length discrepancies, or habits like favoring one side when sitting can lead to uneven pressure in the hips and glutes. Conditions like piriformis syndrome, ischial bursitis, or referred pain from the spine can all occur on either side, but you may feel them more strongly depending on how you move, sit, or stand. If one side always hurts more than the other, it’s worth paying attention to how you use your body throughout the day.

Understanding the full range of possible causes behind buttock pain can help you make more informed decisions about your care. Whether it stems from muscle tension, inflammation, joint mechanics, or nerve irritation, the key is recognizing when discomfort becomes persistent or disruptive. Paying attention to how and when the pain appears, especially in relation to movement, posture, or sitting, can provide valuable clues. If symptoms do not improve with rest, stretching, or basic self-care, it may be time to seek guidance from a healthcare provider who can help identify the root cause and create a personalized plan for relief.

How to Relieve Muscle Knots in the Buttocks

Many people describe buttock pain as a knot or a tight band of muscle that won’t let go. These knots can come from overuse, stress, or poor posture, and they tend to linger without targeted care.

Ways to relieve muscle knots in the buttocks include:

• Gentle foam rolling of the glutes and hips
• Targeted massage using a tennis ball or a massage gun
• Stretching the piriformis and surrounding muscles
• Applying heat to relax the area
• Walking or light movement to increase circulation

Knots that don’t respond to self-care may need evaluation to rule out deeper issues like myofascial pain syndrome or nerve involvement.

Piriformis stretches to relieve buttock pain

When the piriformis muscle becomes tight or inflamed, it can press against the sciatic nerve, causing a deep ache in the buttocks or sharp pain that radiates down the leg. One of the most effective ways to ease this tension is through gentle, targeted stretching. Stretching the piriformis and surrounding muscles can reduce compression on the nerve, improve mobility, and support long-term recovery.

Regular stretching helps improve flexibility in the hips and glutes, which may relieve pain and prevent future flare-ups. These movements are especially beneficial for individuals who spend long periods sitting or engaging in repetitive motions that put stress on the lower body. Over time, consistent stretching may help rebalance muscle tension, reduce irritation, and support better posture.

Before beginning any new exercise or stretching routine, especially if you are dealing with pain, it’s important to consult a healthcare professional. A qualified provider can help determine which stretches are appropriate for your condition and ensure they are performed safely.

Here are three gentle stretches that may help release tightness in the piriformis and relieve the pain in your bottom:

Supine piriformis stretch

How to do it

Lie flat on your back with both knees bent. Cross your right ankle over your left thigh, just above the knee. Reach behind your left thigh and gently pull it toward your chest, feeling a stretch deep in the right buttock. Hold for 30 seconds, then switch to the other side.

Why it works

This stretch gently opens the hip and targets the piriformis muscle without adding pressure to the spine. It helps reduce tension in the muscle and may relieve irritation on the sciatic nerve by creating more space and mobility in the surrounding tissues.

Seated figure four stretch

How to do it

Sit upright in a sturdy chair with both feet flat on the floor. Cross one ankle over the opposite knee, creating a figure four shape with your legs. Keep your spine tall and lean forward slightly from the hips until you feel a stretch in your glutes. Hold for 30 seconds, then repeat on the other side.

Why it works

This is a simple, accessible stretch that you can do throughout the day. It gently opens the hip joint and stretches both the piriformis and gluteal muscles, helping to release tension without requiring you to get on the floor. It’s especially useful for people who spend long hours sitting.

Standing glute stretch

How to do it

Stand near a wall or sturdy surface for support. Cross your right ankle over your left knee, then slowly sit back into a shallow squat, similar to sitting in a chair. Keep your back straight and hips level. Hold for 20 to 30 seconds, then switch legs.

Why it works

This dynamic stretch not only targets the piriformis but also engages stabilizing muscles in the hips and legs. It helps build balance and body awareness while relieving tightness in the glutes. Standing variations are ideal for those who prefer not to stretch on the ground or want to incorporate movement into their daily routine.

Tips for safe and effective stretching

• Move slowly and avoid bouncing or forcing your body into position
• Focus on steady breathing to encourage muscle relaxation
• Stop if you feel sharp pain, tingling, or discomfort beyond a gentle stretch
• Try incorporating these stretches once or twice per day for best results

Stretching can be a powerful tool for managing piriformis syndrome and relieving buttock muscle pain. These gentle movements are designed to reduce tension, support mobility, and ease pressure on the sciatic nerve.

When done consistently and safely, stretching may become a valuable part of your pain management routine.

As with any exercise, talk to your doctor of chiropractic or another healthcare provider before starting, especially if you are experiencing moderate to severe pain. The right guidance ensures that your care is personalized, effective, and tailored to your body’s needs.

Lifestyle tips for preventing buttocks pain

Making small adjustments to your daily habits can go a long way in reducing the recurrence of buttock muscle pain.

• Alternate between sitting and standing throughout the day
• Use an ergonomic chair with proper lumbar and hip support
• Stay active with regular low-impact movement
• Strengthen your hips and core to reduce strain on the piriformis
• Stretch regularly, especially after prolonged sitting or exercise

How chiropractic care may help with piriformis syndrome and buttock pain

When buttock pain lingers or keeps coming back, it’s often a sign that something in the way your body moves or functions is out of balance. Chiropractic care may help alleviate pain, tension, and nerve irritation by addressing the mechanical issues that contribute to these conditions. While the focus is often on the spine, chiropractors view the body as a connected system, encompassing the hips, pelvis, and surrounding muscles.

For piriformis syndrome specifically, chiropractic care may support relief in several ways. Gentle adjustments can help improve alignment in the lower spine and pelvis, potentially reducing uneven pressure on the piriformis muscle or sciatic nerve. This may be especially helpful if the pain is associated with postural habits, leg length discrepancies, or compensation patterns resulting from a previous injury.

In addition to adjustments, many chiropractors use soft tissue techniques or targeted stretching to help release tension in the gluteal region. When muscles are overly tight or inflamed, releasing that tension can create more space around the nerve, allowing for better mobility and circulation.

Chiropractic care may also help identify movement patterns or daily habits that are contributing to your pain. Whether it’s the way you sit at your desk, your walking stride, or how you carry your weight when standing, small adjustments in how you move can make a big difference in how you feel.

While not every case of buttock pain requires chiropractic care, it may be a helpful option when conservative measures like rest and stretching are insufficient. By focusing on the body’s structure and function, chiropractic care supports healing in a non-invasive, movement-based, and personalized manner tailored to your needs.

The bottom line (pun totally intended)

Piriformis syndrome is one of several reasons you might feel persistent pain in your buttocks. Whether the source is muscular tension, nerve irritation, or inflammation, the good news is that most cases improve with time, movement, and attention to posture.

If your butt hurts when you sit, walk, or stretch, start with small steps. Stretch regularly, move often, and seek guidance if the pain sticks around. Your body is built to move, and the right care can help you feel more comfortable with every step.

Frequently asked questions about piriformis syndrome and buttock pain

What is piriformis syndrome and what causes it?

Piriformis syndrome occurs when the piriformis muscle, located deep in the buttocks, compresses or irritates the sciatic nerve. Prolonged sitting, repetitive movement, muscle imbalances, or injury often cause this condition. It can also develop gradually from poor posture or overuse.

What does piriformis syndrome feel like?

Most people describe it as deep, aching pain in one buttock, although the pain can affect both sides at the same time. The pain may feel sharp, burning, or tingling and can radiate down the back of the leg. It often worsens after prolonged sitting or during specific hip movements.

How do I know if it’s piriformis syndrome or sciatica?

Both conditions involve sciatic nerve pain, but they come from different sources. Piriformis syndrome begins in the buttock muscle, while sciatica originates in the spine due to nerve root compression. If your pain starts in your buttocks without lower back pain, piriformis syndrome is more likely. Sciatica typically begins in the lower back and can be exacerbated by activities such as bending or lifting.

Can piriformis pain switch sides?

Piriformis syndrome typically affects one side, but overcompensation, poor posture, or gait issues can cause discomfort to shift to the other side over time. This is more likely if there are movement imbalances or if the other side begins to take on extra strain.

Is buttock pain a sign of something serious?

Buttock pain is often caused by muscle tension, nerve compression, or inflammation and is typically not a sign of a serious underlying condition. However, if the pain is severe, constant, or accompanied by numbness, weakness, or loss of bowel or bladder control, you should seek medical evaluation right away.

What causes pain in the buttocks while sitting?

Pain while sitting is frequently caused by piriformis syndrome, ischial bursitis, or muscle tension. It can also result from sitting on hard surfaces, poor posture, or long periods of inactivity. These factors increase pressure on the glutes and surrounding structures.

Why does sitting make my butt hurt?

Sitting for extended periods can put pressure on the piriformis and surrounding tissues. This can irritate the sciatic nerve or increase muscle tightness, especially if you tend to slouch or lean to one side. Sitting on hard chairs, driving for hours, or using poor ergonomics can all contribute.

Why do I feel a knot in my buttocks?

A knot in the buttock is often a trigger point in the gluteal or piriformis muscles. This may result from overuse, strain, or tension. Myofascial pain syndrome is a common cause and can lead to deep aching or sharp pain when pressure is applied to the knot.

How do I relieve a knot in my buttock?

Gentle stretching, foam rolling, and massage can help release tension. Heat therapy and walking may also improve circulation and reduce pain. For stubborn knots, targeted manual therapy from a healthcare provider may be beneficial.

What helps relieve buttock muscle pain?

Movement, stretching, posture corrections, and applying heat or ice can all support relief. Foam rolling, rest, and avoiding long periods of sitting are also helpful. Some individuals benefit from a combination of chiropractic care, massage therapy, and physical therapy for long-term results.

What are the best stretches for piriformis syndrome?

Some effective stretches include the seated figure four stretch, the lying supine piriformis stretch, and a standing glute stretch. These movements help lengthen the muscle, reduce tension, and create space around the sciatic nerve. Stretching consistently is key to relief.

Can chiropractic care help with piriformis syndrome?

Chiropractic care may support relief by improving spinal and pelvic alignment, reducing nerve irritation, and addressing muscle imbalances. Many patients find relief through a combination of adjustments, stretching guidance, and soft tissue techniques.

How long does piriformis syndrome take to heal?

With early intervention, mild cases may improve in a few weeks. More persistent or chronic cases can take several months to fully resolve, especially if muscle imbalances or poor movement habits are not addressed. Consistent care and movement are essential for recovery.

Is piriformis syndrome permanent?

In most cases, no, the pain is not permanent. Most cases respond well to conservative care, including stretching, posture changes, and manual therapies. Identifying and addressing the root cause, such as muscle tightness, alignment issues, or movement habits, can help prevent recurrence.

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