Physiotherapist performing leg examination at Burlington sports therapy clinic

Piriformis Syndrome

That deep, nagging ache in your buttock that flares up when you sit too long or pick up your training load is worth getting looked at. Our Burlington clinic can help you figure out what is driving it and what to do about it.

Getting to Know Your Piriformis

The piriformis is a small, deep muscle tucked underneath your gluteal muscles that plays a surprisingly important role in how your hip rotates and your pelvis stays stable when you move. Most people have never heard of it until it starts causing problems. When it becomes overloaded or goes into spasm, it can irritate the sciatic nerve running nearby and produce pain that is easy to confuse with other conditions.

The most common complaint is a deep, persistent ache right in the centre of the buttock. For some people it stays there. For others it travels down the back of the thigh and starts to feel a lot like sciatica, which is part of why piriformis syndrome gets missed or mislabelled as often as it does. Sitting for long periods, running, climbing stairs, or rotating the hip under load tend to be the main aggravators.

There is not always a dramatic event that kicks it off. Sometimes it follows a jump in training volume or a long stretch of sitting. Other times it develops gradually as surrounding hip muscles weaken and the piriformis ends up compensating for more than it was designed to handle. Either way, the pattern tends to be similar: nagging, position-dependent buttock pain that does not fully go away on its own.

Worth noting too: the piriformis rarely operates in a vacuum. How the lower back, sacroiliac joint, and hip are functioning can all influence how much strain the piriformis is absorbing. Chasing the muscle alone without looking at the broader picture often explains why some cases are slow to improve.

What Tends to Load the Piriformis

The piriformis does not usually get irritated out of nowhere. Most of the time, something has been placing more demand on it than it can comfortably handle, whether that built up gradually or arrived all at once.

Things that commonly contribute may include:

A sudden increase in running distance, cycling volume, or time on your feet that outpaced what the muscle was conditioned for
Weakness in the glutes and hip stabilizers that shifts more of the rotational workload onto the piriformis
Long periods of sitting, particularly on hard surfaces or with the legs crossed, that compress the muscle and surrounding tissue directly
Tightness or restricted mobility through the hip joint that changes how the piriformis has to work during movement

A previous lower back, sacroiliac, or hip injury that altered your movement patterns without you fully realizing it
Running or training on cambered surfaces, hills, or uneven terrain that loads the hip rotators asymmetrically
Insufficient recovery between hard training sessions, not giving the muscle adequate time to adapt
An anatomical variation where the sciatic nerve passes through the piriformis muscle rather than beneath it, making some people more susceptible to irritation regardless of load

Working Out What’s Actually Going On

Piriformis syndrome shares a lot of its symptoms with other conditions, so the first thing we need to do is make sure we are actually dealing with the piriformis and not something else. That starts with a conversation: where exactly is the pain, what brings it on, does it travel anywhere, and how does it behave with sitting versus movement. Those details go a long way toward narrowing things down before we even get to the physical exam.

From there we look at how the hip rotates, how the glutes and deep hip muscles are functioning, and whether the piriformis itself is reproducing your symptoms under specific testing positions. There are a handful of clinical tests that can help provoke or relieve the pain in a meaningful way, and combined with an assessment of hip strength and single leg control, they give us a reasonably clear picture of what is going on. Weakness through the gluteal muscles is a very common finding, and building that back up typically becomes a core part of the plan.

The lumbar spine and sacroiliac joint get looked at as well. Because piriformis syndrome and lower back referral can feel similar from the patient’s side, ruling in or out a spinal contribution matters. Sometimes both are present at once, and the treatment approach shifts accordingly.

Imaging is usually not necessary to get started. An MRI or ultrasound may occasionally be useful if the picture is genuinely unclear or if things are not moving in the right direction after a reasonable period of care, but in most cases a thorough hands-on assessment tells us what we need to know.

Sports therapist performing knee assessment on patient in Burlington clinic

Treating Piriformis Syndrome

Taking the Load Off the Muscle and Building It Back Up

A good starting point is understanding what you are trying to get back to. For some people that is running without that familiar ache kicking in around the 20 minute mark. For others it is simply making it through a workday without having to shift around constantly trying to find a comfortable position.

Piriformis syndrome tends to respond well to treatment, but it does need a two-pronged approach: settling down the irritated muscle and nerve in the short term, and addressing the underlying load and movement issues that caused the problem in the first place. Stretching alone rarely gets the job done long term. In my experience, the more reliable path is building genuine hip strength so the piriformis is not being asked to compensate for muscles that are not pulling their weight.

The temptation with something like this is to stop doing everything that aggravates it. That is understandable, but complete avoidance tends to make the muscle more sensitive over time, not less. The goal is to find the level of activity your hip can currently handle and build from there in a structured way.

Hands-on treatment can help reduce tension in the piriformis and surrounding tissue and restore hip mobility, and that early relief creates a better window for the exercise work that drives lasting improvement. Adjustments to training load, running mechanics, and how long you sit in one position can all support the process.

We also spend time making sure you understand what is driving your symptoms, because a patient who knows why their buttock aches after a long drive is in a much better position to manage their recovery sensibly than one who is just hoping it goes away on its own.

Services for Piriformis Syndrome in Burlington

Most cases of piriformis syndrome benefit from more than one angle of care. Depending on what is driving the muscle irritation and how long it has been going on, treatment may combine hands-on work to reduce tension and restore hip mobility with a progressive program to build the strength that takes pressure off the piriformis over the long term.

Chiropractic Treatment

When stiffness through the sacroiliac joint, lumbar spine, or hip is changing how the piriformis is being loaded during movement, chiropractic care may help restore more normal mechanics through those areas. Active Release Technique and Graston Technique are frequently used alongside adjustments to work directly on the piriformis and surrounding deep hip rotators, particularly where tension and tissue restriction have built up over time.

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Massage Therapy

The piriformis and the muscles around it respond well to hands-on soft tissue treatment, especially when guarding and tightness have been building for a while. Massage therapy may help reduce tension through the deep hip rotators, improve local circulation, and make the muscle more receptive to the strengthening and movement work that follows.

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Physiotherapy

Addressing the muscular imbalances that are putting excess demand on the piriformis is usually the most important piece of long-term recovery. Physiotherapy may include targeted hip and gluteal strengthening, movement retraining, and for cases that are not responding as expected, shockwave therapy or laser therapy to support tissue recovery.

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Getting Your Hip Back on Track

Recovery from piriformis syndrome tends to move in stages, and how quickly you progress through them depends on how irritated the muscle is and how well the underlying contributors get addressed. The process adapts as your tolerance for sitting, training, and daily movement improves.

Settling the Irritation

Identifying the specific positions, activities, and training habits that are currently aggravating the piriformis, and making targeted adjustments to reduce the load on the muscle while things calm down.

Building Back Gradually

Reintroducing hip loading in a controlled, progressive way, starting to rebuild gluteal strength and hip rotator capacity so the piriformis is no longer being asked to do more than its share.

Putting in the Work

Following a structured strengthening program aimed at building genuine hip capacity and correcting the movement patterns that were placing excess demand on the piriformis in the first place.

Keeping It That Way

Monitoring how symptoms respond as training volume and daily demands increase, and adjusting the program as needed to protect the progress made and reduce the likelihood of the problem coming back.

Common Questions About Piriformis Syndrome

Piriformis syndrome raises a lot of questions, especially because it can feel so similar to other conditions. Here are the ones we hear most from people trying to make sense of that stubborn ache in their buttock.

Helping Burlington patients move better since 2005.

Does piriformis syndrome ever go away on its own?

Sometimes, particularly if it was brought on by a short-term spike in activity that has since settled. But in my experience, cases that have been hanging around for more than a few weeks rarely resolve fully without some active intervention. The underlying contributors, usually a combination of muscle tightness, weakness, and movement habits, tend to persist unless they are directly addressed. The good news is that piriformis syndrome generally responds well to the right approach.

Why does sitting make piriformis syndrome worse?

When you sit, especially on a hard surface or with the hip in a flexed and internally rotated position, the piriformis muscle is placed under sustained compression. If it is already irritated, that pressure tends to aggravate things fairly quickly. It is one of the more reliable patterns we see with this condition, and adjusting how and how long you sit is often one of the first practical steps in managing symptoms day to day.

How is piriformis syndrome different from sciatica or deep gluteal syndrome?

All three can cause buttock pain that refers down the leg, which is why they get confused. The difference is in where the nerve is being irritated. With sciatica, the issue is typically at the nerve root level in the lumbar spine. With piriformis syndrome, the sciatic nerve is being compressed or irritated by the piriformis muscle itself. Deep gluteal syndrome is a broader term that covers nerve compression anywhere in the deep gluteal space, of which the piriformis is just one possible culprit. Getting the distinction right matters because the treatment approach differs meaningfully between them.

Should I stretch or strengthen for piriformis syndrome?

Both have a role, but strengthening tends to be the more important piece over the long term. Stretching can provide some short-term relief, and there is nothing wrong with using it for that. But if the piriformis is overworking because the surrounding hip muscles are not doing their job, stretching alone will not fix that. Building genuine gluteal and hip strength is what takes the excess load off the muscle and keeps it from coming back. You can’t go wrong with strong.

How long does recovery from piriformis syndrome typically take?

It varies depending on how long it has been going on and what is driving it. Milder cases that are caught early and managed well can start to feel meaningfully better within a few weeks. Cases that have been building for months, or that involve significant nerve irritation, tend to take longer. Every case is a bit different, and trying to give a precise timeline without knowing the full picture would not be particularly honest or useful.

Is it safe to keep running with piriformis syndrome?

Often yes, with some modifications. Complete rest is rarely the answer and can actually make things worse by reducing the muscle’s tolerance for load. The key is finding the volume and intensity your hip can currently handle without significantly aggravating symptoms, and building from there in a structured way. What that looks like specifically depends on where you are in the recovery process, which is something worth working through with a practitioner rather than guessing at.