Is "Sciatica" Actually Coming From Your Piriformis? (And Why Your Low Back Might Be the Real Culprit)
- Marnie Hansen
- Jul 31
- 6 min read
Article written by Dr. Marnie Hansen, DC for Salt Lake Spine & Pelvis
Happy Friday! Let's talk about one of the biggest troublemakers I see in the clinic: the piriformis muscle.
It's tiny, and sometimes stubborn. When it's unhappy... it can make your entire leg miserable.
We often assume pain shooting into the buttock or down the back of the leg automatically means a "slipped disc" or sciatica. Yes, many times that is the case. But surprisingly often, the piriformis muscle is crashing the party.
And here's the twist...
In my experience, the piriformis is frequently target... not the archer... so to speak! Let's dive in and learn more...
Meet Your Piriformis
The piriformis is a small muscle that resides deep in your buttock (you have one on each side!), connecting your sacrum (the wedge-shaped bone at the base of your spine) to the top of your femur. It's hard at work when you walk, hike, run, and even sit... and has a big job...
What the piriformis does:
Helps you rotate your hip
Stabilizes your pelvis when you walk
Keeping your hip centered during movement
The sciatic nerve typically travels directly underneath it (in some people, actually through it). When the piriformis becomes tightened or irritated, it can compress or irritate the sciatic nerve, leading to:
Deep buttock pain
Pain while sitting
Aching into the hip
Tingling or burning down the leg
Pain with stairs, hiking, running, or getting out of the car
Welcome to the world of piriformis syndrome.
But Why Does It Flare Up?
Here's where I tend to think a little differently... Most people spend all their time stretching the piriformis. I spend time asking why it tightened up in the first place.
One of the biggest patterns I see is dysfunction coming from the low back, sacroiliac (SI) joints, or pelvis, making the piriformis tighten up and become painful.
When spinal joints stop moving well (joint dysfunction), the nervous system perks up and pays attention. Nearby muscles often respond by increasing their tone and tightness to create better spinal stability and improve movement patterning.
The piriformis is one of those muscles that loves to volunteer for this job! I like to call it a 'first responder' muscle when it comes to our posture. It's one of the first to stand and raise its hand.
Think of it like that one coworker who keeps covering everyone else's shifts until they're completely burned out. They are really great at it, and do a good job. Their intentions are good, and they just want to help. But eventually... wham!
The muscle becomes overworked, overloaded, develops trigger points, tightens around the sciatic nerve, and suddenly you're wondering why your leg hurts. Or that pain in the butt just won't quit.
This doesn't mean every case of piriformis syndrome starts in the spine. Trauma, overtraining, prolonged sitting, postural imbalance, asymmetrical loading patterns, hip weakness, pregnancy, and even changes in how you walk (gait) can all contribute to its flare-up. But I rarely look at the piriformis in isolation.
Because the body plays at this game called life as a team, I rarely look at the piriformis in isolation.
The Hip and Pelvic Floor Connection
Here's a little something that surprises many people: The piriformis sits right next door to the pelvic floor. Right there like a neighboring condo in the same HOA.
Both the pelvic floor muscles and the piriformis have attachments to the sacrum and help stabilize the pelvis. When one becomes tighter in tone, or tense... the other one often follows suit.
I've seen patients come present with:
Hip pain
Tailbone pain
Pain with sitting
Pelvic floor tension
Pain with intercourse
Persistent "tight hips"
...only to discover the piriformis has been contributing to these symptoms all along.
Everything in the pelvic region shares connective tissue, movement patterns, and nerve input. When one structure becomes overloaded, the neighboring muscles often compensate.
It's another great reminder that the body rarely works in isolated bits and pieces. It works as a whole!
What the Research Says
Trigger point researcher and pioneer Dr. Janet Travell described the piriformis as a common source of referred pain into the buttock and down the posterior thigh. While not every case involves compression of the sciatic nerve itself, trigger points within the muscle can create pain patterns that closely mimic sciatica.
Posture expert Dr. Vladimir Janda spent most of his career studying predictable muscle imbalance patterns. He observed that prolonged sitting, altered posture, and weak gluteal muscles often lead to overactive deep hip muscles, including the piriformis.
More recent research also supports looking beyond the muscle itself. Many studies suggest that improving lumbopelvic mechanics (movement at the low back and hips), hip strength, and movement quality in your posture can reduce symptoms just as effectively as stretching alone.
In other words...
Treat the root of the cause, not just the symptom.
How I Treat Piriformis Syndrome
Every patient is unique, so my approach usually involves several moving parts.
First, I assess how the spine, pelvis, SI joints, hips, and surrounding muscles are all moving together. If I find spinal or pelvic joints that aren't moving so well, I use gentle and specific chiropractic adjustments to help restore better motion and improve how the nervous system communicates with those muscles.
My goal isn't simply to "crack the back," but it's to reduce unnecessary muscle guarding and help the body move more efficiently. Improve communication at your nervous system and tissues.
Next comes soft tissue work (or sometimes I do this first... depending on preference!).
One of my favorite soft tissue techniques for the piriformis is a pin-and-stretch approach, sometimes combined with Active Release-style techniques. By applying the right amount of manual pressure directly to the piriformis while gently moving the hip through its range of motion, we can often reduce muscle tension, improve mobility, and calm down irritated trigger points.
Then we retrain movement. This is key, and sets the stage for better healing.
Because if the piriformis has been doing everyone else's job, we need to teach the rest of the team to pitch in. As we adjust the posture and calm down the soft tissues, we need to support these shifts and changes with supportive exercise.
Three Exercises You Can Start Today
1. Figure-4 Stretch
Lie on your back and cross one ankle over the opposite knee. Gently pull the supporting leg toward you until you feel a stretch deep in the buttock.
Hold 30 seconds and repeat 2–3 times.
People love this one.
2. Clamshells
Lie on your side with knees bent and feet together.
Keeping your feet touching, lift the top knee without rolling your pelvis backward.
Perform 2 sets of 10–15 repetitions.
This helps wake up the gluteus medius so the piriformis doesn't have to do all the work.
Tip: Make sure your hips are stacked up over each other, and you don't use the low back to do all the work.
YouTube this one... it's a game changer for the piriformis.
3. Bridge with a Breath
Lie on your back with knees bent.
Take a slow diaphragmatic breath, gently engage your lower abdominal wall, pushing into your heels... lift into a bridge using your glutes. Keep your feet hip-width apart and heels close to the glutes (but not so close that they touch!)
Lower slowly.
Perform 2 sets of 10 repetitions.
This teaches the hips, core, diaphragm, glutes, and pelvic floor to work together again.
Don't Forget Your Lifestyle
One of the biggest aggravators I see... is sitting.
Yup, sitting can be a big cause of the pain in the butt you might be feeling. In all honesty, the piriformis doesn't exactly love spending eight hours compressed against a chair.
If your job keeps you at a desk:
Stand every 30–60 minutes.
Take short walking breaks.
Alternate sitting and standing if possible.
Vary your positions throughout the day.
Stretch!
Movement is medicine. Even in small amounts.
The Bottom Line
No pun intended. But maybe a little...
But seriously... If you've been stretching out your piriformis for weeks and it's still flaring up, it may be time to look upstream.
Sometimes the real issue isn't the piriformis at all.
It's the way your spine, pelvis, hips, and nervous system are working together. When we restore healthy movement to the spine and pelvis, calm irritated or over-tightened muscles, and build better movement habits, that stubborn pain often starts to take a back seat and finally begins to settle down.
Your piriformis might just be asking for a little help, not punishment!
Happy Friday! And here's to moving a little better this weekend!
For more information on Dr. Marnie and Salt Lake Spine & Pelvis click here.
To claim your complementary 15 minute discovery call, and see if our care could be the right fit, click here!
Did you know that yoga can help? Learn more here!
Comments