The Piriformis muscle (piriformis; “pear shaped“) is a tiny muscle located deep in the buttocks, underneath the gluteal muscles.  This little muscle is the most well-known of a group of muscles known as the “Hip Rotator Cuff” and is frequently the source of the pain in the butt and leg pain.

Piriformis Syndrome is a miserable condition in which the Piriformis Muscle becomes overly tight.  Although there are almost always underlying biomechanical issues to deal with (valgus / varus knees, high / low arches, etc) this pathological tightness of the Piriformis is 0ften the result of FASCIAL ADHESIONS, TENDINOSIS, or a nasty COMBINATION OF BOTH

Piriformis Syndrome can be aggravated by bending, lifting, sitting, sports, and even driving (foot on the gas pedal).  Contrary to what your M.D. might tell you, there are no drugs or surgeries that are effective for treating Piriformis Syndrome. I will warn you, in 20 plus years of practice I have never one time seen a person whose Piriformis Release Surgery actually worked. 

Piriformis Muscle Syndrome

Photo by Beth Ohara

Piriformis Syndrome is an extremely common condition, and is far more likely to be found in women than men (about 6-15 times more often, depending on whose studies you are looking at).  Although I can only speculate on the reason for this, I suspect that it is a child-bearing issue. It probably also has to do with the naturally wider shape of a woman’s pelvis. This is the most likely explanation for my finding it much more frequently in women than men —- even in women who have not had children. 

As I stated earlier, Piriformis Syndrome is a major cause of sciatica (leg pain, numbness, tingling, or weakness, in any combination), hip pain, and buttock pain.  Because sciatica is so often involved, Piriformis Syndrome is usually misdiagnosed as a slipped disc, herniated disc, or a chronic low back or sacroilliac problem (Hint:  HERE is a simple test to help determine the difference).

The sciatic nerve is both the largest and longest nerve in the body, and at its largest point is about the thickness of one’s thumb.  The SCIATIC NERVE originates in the low back (lumbar spine region) and angles toward the middle of the buttock.  It then extends down through the leg, passing underneath the piriformis muscle.  Be aware that in as much as half the population, the sciatic nerve travels through the Piriformis Muscle, passes over the Piriformis Muscle, or splits in two and passes directly around the Piriformis Muscle. 


Piriformis Syndrome

Piriformis Syndrome causes sciatica.  The sciatic nerve runs all the way to the foot


Piriformis Syndrome Sciatica

Note the biggest part of the sciatic nerve near the top of the picture.  The muscle that runs across the page just above the sciatic nerve is the Piriformis Muscle.

The symptoms of Piriformis Syndrome usually begin as a deep aching in what women like to refer to as their “hip” area.  This pain will be found along an imaginary line that runs from the very tip top of the butt crack, to the greater trochanter of the hip bone (the bony knob on the upper and portion of the outer or lateral thigh).

A significant predisposing factor to chronic contracture and microscopic scarring of the piriformis muscle is wearing cruddy or improper footwear for your foot type (high-arched people wearing a “stability” or “dual-density” shoe). Other people predisposed to Piriformis Syndrome includes those with faulty spinal or lower limb mechanics, being overweight, having poor posture, spending too much time sitting, spending too much time on concrete, not partaking in enough physical activity (or occasionally too much exercise — over-training).  And of course, the biggie — just being female. 

Due to mechanical stresses causing chronic tightness / contracture, the Piriformis Muscle can actually become shortened over time.  This often results in microscopic scarring of the fascial sheaths that tightly surround the muscle itself.  Piriformis Syndrome is most commonly worse at rest (sitting or lying down) and is often (but not always) relieved temporarily, by moderate activity (particularly walking or stretching).

For years, I did not really understand why I had such good clinical results with so many cases of buttock / hip pain and sciatica, while other seemingly identical cases were largely unresponsive to chiropractic adjustments.  Frequently these “problem” cases would get fantastic short-term results from their adjustment, but these results never seemed to last more than a few days at the most (and often no more than a few hours).  It was not until I started doing “TISSUE REMODELING” in 2001, that I truly began to understand what was going on in many of these cases. 

Over the past decade I have come to realize that Piriformis Syndrome is literally “epidemic” in the female portion of our society.  Although I had no intention for it to happen this way, our Piriformis Syndrome Page is Destroy Chronic Pain’s #1 webpage by far.  And despite all of the new research on the subject, the medical community remains largely mystified about what it really is, or how to treat it effectively.  Again, drugs do not constitute “effective treatment” for most cases of Piriformis Syndrome (and surgery is such a crap-shoot….).  Never assume that a “Piriformis Release Surgery” will solve your problems!



As you have read, scar tissue is normal, elastic tissue (think nicely combed hair here) that has been disrupted from its organized structure, into a balled-up and tangled wad of inflexible and hyper-sensitive, micro-gristle (think of a hair tangle that cannot be combed out — HERE).  When it comes to Piriformis Syndrome, this kind of microscopic scar tissue is not typically in the muscle belly itself, but in the Fascia.  Fascia is the thin, but very tough, yellowish white membranes that cover muscles.  In my neck of the Ozarks, deer hunters call these membranes, “Striffin“.

Fascia is arguably the single most pain-sensitive tissue in the body!  Fascial Adhesions will cause pain and dysfunction.  Destroy Fascial Adhesions and you can oftentimes Destroy Chronic Pain!

Because most of these scar tissues are in the fascia as opposed to the muscle itself, they do not image on MRI (HERE).  It is my opinion that microscopic scarring of the Piriformis Muscle is the single most common cause of chronic, long-standing, SACROILLIAC OR BUTTOCK PAIN (the Sacroilliac Joints are the bony bumps that lie just up and lateral to the top of the butt crack).  It is also the most common cause of what I was calling a “butt-based” sciatica twenty years ago.

Piriformis Syndrome

Photo by Anatomist90

Piriformis Syndrome Sciatica

Photo by Anatomist90


If you found this page beneficial, please help us reach others by liking us or sharing on FACEBOOK.  Thank you, Dr. Russ Schierling.

877 responses to “PIRIFORMIS SYNDROME (PAIN in the BUTT)

  1. michael


  2. Rose

    Are you familiar with the nerve (complications) damage associated with surgical pelvic mesh placement? *Such as obturator, pudendal, cluneal, etc…

  3. Lacey

    Hi! I am a 24 yrs old and a week ago started having pain in my ankles, legs, bones by groin area and buttocks. Also feels sore. Most painful in the morning, and when I sit or lay down for any amount of time. Gets better when I stand or walk. I have high arches and do some Pilates. Can it be PS?
    Thank you for your time!

  4. Carmen

    I’m interested in have tissue remodeling. I was shot in the buttock 10 years ago and I have all the symptoms of piriformis. Can you refer anyone in my area??

  5. Sandra

    All that you’ve said here is the problems I am having. Are you sure that there is nothing that can be done to give me some relief. I work in a day care and I’m not use to not being able to move around like I need to. Please help!!:)

  6. laura

    Hi, I’ve been having constant stomach aches and diarrhea. My diarrhea smells like crazy bad, constant pain in my right Bum cheek like aching. Can’t get comfy and when pressing my bum cheek and there’s pain in a certain part. Tired all time out of breath feel sick add it all nearly five months stomachache worse when eating. Sometimes goes away a few days and sometimes sharp stabbing pain lower right side stomach thank u so much very worried.

  7. L

    Very informative….I think I have this painful syndrome..thanks to this article I am self diagnosing my self as not having actual hip/joint issues and will certainly tell the orthopedic doctor when I make appointment of this article. However I am unsure which is worse Piriformis syndrome or a hip issue…sounds like no cure/relief for the syndrome

  8. Jordan

    I would just like to say that I have had this for over 3 years now. I started feeling the pain after starting a desk job. I have always had jobs on my feet. I started with chiropractic treatment and was going about 3 times a week for 2 years! It would temporarily relieve the pain. I then decided to see a doctor who had an MRI ordered for me! Told her my hips hurt with shooting pain. She looked at the MRI of my back and told me there was nothing wrong and that I should work out? I was in tears! I decided to get a 2nd opinion and was told I had bursitis on my hip. So I did the injections! Made the pain way worse and now I have the pain on both hips! Went to a 3rd doctor and he sent me to physical therapy, which is where they told me about this piriformis muscle! The did some great things there. I went for about 3 months, 3 times per week with temporary pain relief. I am now done with PT for about 2 weeks and I am back at square one. The doctor decided to prescribe tramadol and Mobic. I took the Mobic with no relief and I feel like taking the tramadol will just end in addiction so I decided to wait on that. I have been referred to an orthopedic doctor but am waiting for an appointment! At my whits end with this! I have a hard time working and I miss a lot due to the pain. My current primary doctor does not fill out paperwork for short term disability so I am stuck with the pain until I see the orthopedic who is out on vacation right now. I don’t know what is next!!


    • Hello Jordan,

      Either way you slice it, you have been though a lot of treatment. The problem is, this is the norm for huge numbers of people.

      Dr. Russ

      • Jordan

        Just got a call back from the orthopedic specialist… He doesn’t handle back problems and will not see me for this! Great! I didn’t realize this was a back problem? I had an MRI done that shows I have a very healthy spine!

      • Hello Jordan,

        Because PS in its variations is usually a soft tissue problem, it does not image will with standard tests and technology. Very frustrating for those suffering.

        Dr. Russ

  9. Cindie

    Dr Shierling
    I have been dealing with pain in my left buttock going down my leg for 2 1/2 months now I’ve seen the chiropractor five times he couldn’t help get rid of the pain and recommended a neurologist who tested my leg with the nerve test and found it to be normal he sent me to a pain management I have had two epidural injections which have done nothing anti-inflammatories work but have upset my stomach I have lost 15 pounds in two months is there a few stretches that I should be doing the can help stretch this muscle I am starting physical therapy next week. I’ve had two MRIs the one in the back shows no herniated disc just a slight bulge and two small posterior tears the MRI in the pelvic area done with dye was normal I don’t know what to do anymore. When this all started I also started vaginal spotting I’m a 63-year-old female went to the OB she performed a D&C for Polyps that came back normal but said that I have fibroids do you think that could be related to the pain nobody else think so. I’m was an active in shape person, now I feel like I’m withering away.

    • Hello Cindie,

      Doubtful the two are related. Make sure to read my posts on this subject over at my Doctor Schierling dot com site.

      Dr. Russ

    • Rebecca

      Candy I read your story and omg it was me , I can not believe the facts that you have put to paper. I have been to ,gynos,neuro’s, gastro’ s. Even rheumatoid specialists still no answer. If I find one I will surely pass it on
      Best wishes Bec xoxo
      Ps hopefully we find relief sooner than later xo

  10. Hege

    Dear Dr. Schierling.

    I’ve been a registered nurse for 8 years. 6 out of these years i’ve struggled with left hip pain. I’ve seen several GPs and physios and they all say it is muscular. It is a constant dull pain, becomes unabareble with repetitive movements such as cycling or work out on a rowing machine. I then immediately have to stretch, and any stretch at any time is painful and only give a short window of relief.

    How do you diagnose Piriformis syndrome and considering my symptoms is it likely that this is what I suffer from? What is the best treatment?

    Thank you in advanced.

    Kind regards,


    • Hello Hege,

      Diagnosing true PS is tough, as there are all sorts of myofasical issues that can mimic. The biggest difference is probably that true PS will have Sciatica, and the myofascial stuff probably won’t. But don’t kid yourself — the myofascial problems and Fascial Adhesions have the potential to be miserable.

      Dr. Russ

  11. Dominique

    Hello Dr. Russ,

    I lived with chronic pain in my right “hip” for a couple of years, putting it down to the hard building/ landscaping work I was doing; but when that stopped and the pain didn’t go away I started looking for other causes, and more importantly, solutions. I eventually hit gold last December with a physiotherapist who identified ‘piriformis syndrome’, gave me stretches to do and massages. Life got a lot better: i can go for hours without pain. I can sleep! BUT if I skip a day of “self-care”, the pain comes back. Which brought me to your web site this morning and perhaps the missing part of my ‘treatment’.
    I have strong/high arches; I walk at least one hour a day, often more, wearing Salomon walking shoes which i replace regularly… but you say:
    “A significant predisposing factor to chronic contracture and microscopic scarring of the piriformis muscle is wearing cruddy or improper footwear for your foot type (high-arched people wearing a “stability” or “dual-density” shoe)”
    Could you please, please expand/ explain? What should I be looking for in a walking shoe? How can I tell if they are ‘stability’ or ‘dual-density’? The shoes I have say “EVA midsoles” and “OrthoLite advanced formula insoles” which may be just proprietary jargon… but should it be avoided?
    I am determined to live without pain – and I thank you for all the information on your website that aims for the same goal. THANK YOU so much.

    • Hello Dominique,

      I don’t claim to be any sort of expert on feet. I can tell you what I’ve learned from having high arches with both foot issues and hip / buttock problems (not constant and nothing like it used to be). If you have high arches, you cannot buy a shoe that has a high enough arch to compensate for your high, rigid, foot. You will get the best information on the shoe you want by reading about it online. If you are in or near CO, go see Shawn at Xtreme Footwerks in Idaho Springs — he’s the guru.

      Dr. Russ

  12. Kari

    Hi, Dr. Schierling…I, too, was so grateful to find your page. Six weeks ago, I had a terrible sinus infection and received two antibiotic injections–one in each hip (but administered by different people on different days). Both hurt a lot and were sore for a couple of days. But three weeks after receiving them, I was at the gym and attempted a single squat with very light weights. I felt searing pain in both injection sites and immediately stopped. For a few days, I couldn’t bend or lift my legs enough to tie my shoes (though I could walk OK). It’s now been three weeks, and one side in particular keeps getting worse. I have pain from the injection site down the back of my left butt cheek. Can’t cross my legs while sitting or do several other very ordinary things (not to mention yoga, Zumba, and PiYo, which I love). Could injections in those locations cause PS? And on both sides? And it is strange that the worst of the pain came several weeks after the injections were given? Trying to figure out what’s going on with me–and what to do about it. Thank you for any insight you can provide!

    • Hello Karri,

      Let me first say that according to current peer-review, antibiotics are mostly not considered the standard of care for sinus infections any longer because the huge majority of all URI are known to be viral. Besides that, they set you up for future problems. As for your symptoms as related to antibiotics, I have a slew of articles on my blog filed under the category “Antibiotics”. Many, including a recent one, are about the degenerative nature of certain of this class of drug. Skim the titles and you will see how often antibiotics are related to chronic pain. The worst offenders, by far, are antibiotics from the Fluoroquinolone family (cipro, levo, etc).

      Dr. Russ

  13. Bonnie

    Love this site!!! You got the piriformis scar tissue pain problem right on the mark. I need you to go with me to the many doctors I have seen am still going to. LOL

  14. Himanshu D

    Hello Dr. Russ
    Firstly i really would like to thank you for writing this article.
    Secondly i’d like to ask you what might my problem be. When I first started MMA training back in august ’15 my trainer used to make us stretch our legs 180°. Which indeed was a painful thing to do. But one day he came behind me and suddenly pressed my glutes downwards in order to spread my legs more. I felt a lightning pain and heard a sound. But the pain doesn’t followed after that. But after a couple minutes while doing chest level jumps I felt the intense pain in my lower back. For almost a month I felt the pain in my lower back. Although it wasn’t that much severe back than. I felt like I could recover. But than after 3-4 months it vanished completely. And started again a couple weeks later. In January ’16 I joined the Gym. And it was after that I realised that my pain was getting down to my left buttock. I thought it might vanish in a month or so. I did leg press abductor/addctor leg curls and extensions etc. And within a week i felt that the pain was increasing. So whenever i used to walk it used to get a lot worse. It made it impossible for me to walk. Then after 1.5 months some tingling in my feet started. It was then that i consulted a physiotherapist. He used some IFT machine to provide some electrical impulses to my left buttock. It reduced my buttock’s pain by 50% as he was also engaging me into stretching. But the pain didn’t go away even after a month of therapy. And even worse. The tingling which was very little in the beginning started to radiate upto my knee. Please help me identify this problem and let me know if there is any way to cure it. The symptoms are the following :
    1. Unbearable pain in left buttock while walking.(although 20-25% while not walking)
    2. Tingling / Numbness in the area under the knee.(which started from the feet and travelled upto the knee. Also the Numbness is mostly felt in the left-back side of my left leg and all 4 fingers of the feet except the big toe. It only gets numb when I get’s up from bed or sitting position.)
    3. In the beginning pain felt while walking was only in buttock than it radiated to the right and now to the back side of the knee.
    4. Pain gets better if I stops walking and do some stretching or rests for a while.
    5. I cannot jump, run, jog, cycle. Or it gets unbearable for me.
    6. I cannot lift my leg while standing without bending the knee.
    7. Numbness started when the pain finally radiated to the knee.
    Please help me sir. I would be forever grateful for your help. Please do help me. My life has became hell due to this pain.

    • Hello Himanshu,

      Your trainer needs to be beat for his stupidity. Not sure where the tear might be. If you were in my office, I would start working and see what I could do with this, but the problem might be too deep to access. Hard to say. I would pay to have this pain relieved for you if I could do so. It’s just too hard to say exactly what is going on.

      Dr. Russ

      PS; please let me know if you find a solution to this.

  15. Kathryn

    I found this helpful. I started with knee pain in the back of my knee then pain and tightness in my hamstrings. I had physio and massage and deep heat treatment on my thigh. But all my symptoms are back im fed up. I will go to dr and tell him this us what I think it is. Will massage help over the area to release adhesions. I am very sensitive n tense in my mid buttock area and hip pain

  16. Ruben

    it’s possible in guys as well correct?

    im embarrassed if its only a lady thing. but im feeling those kinda things also

    • You are correct Ruben,

      It is certainly possible in males. It’s just that it is much more common in females.

      Dr. Russ

      • Ruben

        how can i figure out for sure if it is this or something else?? everyone i talk to thinks it might be early signs of diabetes or nerve damage. how do i narrow it down and eliminate false suspects?

        i feel it around the knees, from my right knee up to the hip, shins, calves, bottom and tops of feet, hamstrings – my lower half basically sucks right now. and because of that – every single day sucks because i dont feel normal. like you said in your description sitting is what affects it the most – in fact sitting for too long is probably what caused it i think. along with years of poor posture, lack of exercise, like traditional exercise (i always thought going to work and working hard was exercise enough) now i cant even go to work.

        any help you could provide would be very much appreciated – i thank you for your time

      • The whole Diabetes / Inflammation thing is why I am such a stickler for Paleo. Have you seen a doctor to be evaluated for Peripheral Neuropathy? I just put up an article on it on my blog last week or the week before. Also make sure to look at the “test” I link to numerous times on this page (it is also in the body of the article).

        Dr. Russ

  17. Antoinette

    So how do I treat piriformis syndrome now?

  18. Danielle

    Thank you so much for the amazing article! For almost a year this pain is driving me crazy no metter what I do. It gets way worse when I lay down. You described my symptoms and it feels good to finally find out what is bothering me since my doctor and chiropractor could not help. I’ll do more researches to find out what could i do to get better. Thank you!!!

  19. Lora

    Is there anything I can do to help it. I only have the problem if on a long trip in car or sit to long on couch. I do streching it helps. Get up and walk helps. Just tired of it it’s been 2 years.

  20. Naomi

    Have had constant hip and back pain issues for years on my outer right hip and tailbone area of back. Had an mri done of spine 12 years ago and had a hymangioma and swelling at l4/l5. Have had my ribs dislocate at c2/c3 with no obvious cause. Have had pelvic/pubic separation during last pregnancy making walking nearly impossible. I also have Instertitial Cystitis with severe detrusors every 3 minutes or so and Pelvic Floor Dysfunction. Now my sacroilliac joint keeps popping out of place on my right side. I have had bad bouts of sciatica in the past as well. I now have small fiber neuropathy for which I take gabapentin. I have bouts of cramps in my feet that nearly cripple me as it shoots up from the arch into my pelvis area. Now my left side butt cheek has a deep aching pressure that hurts worse if I lean forward or sit. I also get extremely bad cramps in my calve hip and pubic area that radiate down my leg to my knee. My right knee locks and pops. I also get symptoms of raynauds when exposed to cold and by cold I mean anything below 80 degrees causes my hands feet face and butt to go ice cold and white and then when I warm back up they get bright red and flushed like I was playing in the snow. something as simple as walking in the refrigerated isle at grocery store induces this. I am starting to worry that there is something really wrong.Is this all related to a pinched sciatia?

    • The fact that you have at least two Autoimmune Diseases (Raynaud’s & Interstitial Cystitis) not to mention the PN (a hallmark of both Fibromyalgia and blood sugar dysregulation) tells me that you have Inflammation running rampant in your body. This is the first thing you need to deal with. Fortunately for you, today’s blog post is on Peripheral Neuropathy. Take a look at it because I will show you some tricks to help you potentially deal with all of these problems.

      Dr. Russ

  21. Anita Grace

    Thank you so very much, I can’t believe that this hits the nail on the head perfectly this is exactly what is wrong with me and I had no idea I thought I had bone cancer or something! Thank you very much!

  22. Christine

    I’m a 57yr. old female with no children. My job involves labor as I am a product merchandiser. This pain started about 3months ago and doesn’t usually bother me at work. Yes, concrete floors. Right side, stops at knee from the right butt cheek. Hard to walk at times at home. Some creams help….thought it was arthritis or old hamstring pull from 30yrs. back. Try diabetic shoes?

    • No idea where you live, but if I saw you in my clinic with this, I would automatically think of Scar Tissue / Fibrosis in the buttock / hamstring area. I would treat you, and probably not even make a follow up appointment. Best guess, it would dramatically improve almost instantly.

      Dr. Russ

  23. Brenda

    hi dr. Russ,
    back in january i fell directly on my buttocks onto a stoop stool. Could this have triggered the pain in my piriformis? i have never had this pain before. My masseuse told me it is possible. Can this be true?

    Thank you

  24. Marie

    I have previously had a slipped disc removed on left side .for the last week I have pain on right side buttock area that goes to my hip and groin area worse when walking or sitting .thebpajn is constant I feel like when I am walking I’m walking strange as if my body is pushing to one side .please help

  25. Breyana

    I have been having this problem for about a year and it is getting worst. I haven’t seen a doctor and I don’t know what it is that’s giving me unbearable pain. You actually described every problem my leg hurts my upper but area and my hip. It’s so hard for me to work let alone drive I am only 21 is this common for younger females?

  26. Kim

    I have been having a battle with this for over 25 years now. Sometimes does cause sciatica pain down my leg but most the time DOES NOT! I had a pain specialist tell me that the chance of it being in that tiny muscle was so rare…well, he laughed at me! Sometimes, the pain is to the point my leg gives out and I’m down in an instant. I’ve had problems with my back for years. Two years ago I had a steel rod put in my cervical neck and I do have some bulging discs in lumbar and sacral sprine. Have lots of arthritis in lower back too which dr. tells me is causing all the pain and not to worry but I’m sick of this!

  27. Derek

    I am a 27 year old male. My back issue comes and goes. Have been good for 2 years but the last 3 months it’s been back and as bad as ever. I am told I have a pinched nerve in my lower spine. My pain initially was right in my tail bone. I have been doing physio twice a week, being put on a traction table. Feel like that pain has gotten better but now have sever pain from my butt to the back of my knee. What can I do to fix this?

  28. Christina

    On January 17th, I developed a sore back from taking down decorations (this is nothing new and I thought very little of it) On the 20th, I experienced extreme pain, tingling, and weakness in both legs. Within an hour, I was incapable of walking and my husband and to carry me just to get me into a wheelchair. MRI was done ASAP to r/o Cauda Equina. I had also developed difficulty voiding. MRI shows some degeneration at L4-5, DJD, and mild to moderate cord compression, lumbar stenosis. I was treated with anti-inflammatories and sent home with a walker. When I was discharged I was unable to bear any weight on my right foot and minimally on my left foot. I strained with all my might to void because straight cath was something I was desperately trying to avoid. I remained out of work until the 23rd, use a cane, and still go to PT 2/wk. I’ve gained back much of feeling in my right foot. However numbness and tingling persist across the buttocks and I have pressure at the bottom of my spine. I have strained to pee SO much, I feel as though my urethra opening has stretched as well. I’ve been told nerve damage can take a very long time to heal, but i am getting frustrated and do hope and pray that the “tennis ball” I feel I’m sitting on goes away sooner rather than later. I’m still uncertain as to whether or not to use ice and/or heat. ANY advice would be so appreciated.

    • Hello Christina,

      I have actually had a case of Cauda Equina Syndrome in my clinic that the ER had sent home with Tylenol (we sent him to a different ER with a hand-written note explaining what his problem was). This would have definitely been at the top of my list concerning you. However, cord compression can do very similar things. This is not PS. I have a post on my Doctor Schierling site called CHRONIC LOW BACK PAIN AND THE THORACOLUMBAR FASCIA that has a ‘Top Ten’ list of DIY for your back. I would probably at least talk to someone in your area about Spinal Decompression Therapy. “Moderate Cord Compression” will sooner rather than later lead to some sort of surgery.

      I wish you well,
      Dr. Russ

  29. Willette

    So what does a person do to release the fascia? I have had butt pain and lower back pain for about 5 months. Lately I find the most relief from the tightness by massaging with a lacrosse ball. It seems when my butt hurts then it causes my lower back to hurt.

  30. Taly

    Hello Dr. ! I am 33 years old , mom of 2 kids. I am suffering from buttocks pain two sided already 6 months. All my MRI’s are ok. I feel a preassure pain when lying on sides. When sitting i feel like sit bones pain. My pain was worse and i also had hips pain and feeling of instability. Anti inflammation drugs didnt help and my doc gave me the prednisone for a month. The pain got better in hips but buttocks pain is still there and another strange thing is jumping of muscles in buttocks and hamstring and feeling tightness in hamstrings. I had no injuries . I have seen a lot of doctors and noone can tell me what it can be. Some doctors tell that may be PS . Is there any test i can do to make sure the problem is PS ? Ultrasound maybe ?

    • Although the newest diagnostic ultrasounds are far better than they used to be, I still don’t believe they do a good job of imaging PS. There are very special sorts of EMG’s that can sometimes tell you something. Be sure to read my article called “Imaging the Piriformis” over at Doctor Schierling dot com.

      Dr. Russ

  31. Solange

    The content of the article reveal of what happening to my son. I would love to discuss more.This feel like a huge relief for him. Hopefully he will be diagnosed properly

  32. Jeanette

    So you have educated me on the differences of PS and Herniated Disc. I believe I have PS any treatments available

  33. Gloria

    Help!!!! I have had 6 back surgeries. Lumbar spine almost all fused. I am 63. Osteoporosis and numerous autoimmune dx. T10 compression fracture and vertebroplasty and recently RF. Told I have bursitis, bilateral SI joint issues and petiformis… Tried PT numerous times. No relief. 4’10” was 5′. Pain is all the time ! Walking or lying in bed. It awakens me. Is there ANY hope for help? I can hardly stand it!!! I Cannot sleep on my back because of surgeries and can only lie on right side which is my worst side. I NEVER can sleep for more than an hour or two before I have to sit up for awhile. I am DESPERATE!!!! And in tears often. I try to keep active but am told because of back surgeries and the way I walk it compounds the sciatica, bursitis and PI. I cannot have injections or take steroids becsuse of side affects and have numerous medication allergies and side affects. Is there ANY HOPE left for me? Doctors keep saying more back surgety and I refuse!!! No more !!!! Please help me!!! Now I have pain in feet, and lots of chsrlie horse type of spasms all over my body, buttocks, hips, stomach, legs, feet, hands. I have numerous (hundreds) of small and medium size lumps all over my body that are very tender. They come and go. Fibromyalgia? I have that too ! Ct scans shoe numetous calcifications all over my body is this related to my pain?

    • Hello Gloria,

      It certainly sounds bad. And while I do not have an “Easy Button” like they do on TV, if you go to my Doctor Schierling dot com site and type the words “Exit Strategy” into the search bar, there’s something that may help you.

      Dr. Russ

  34. Raymond

    I have a swollen L4L5 that my physician tells me it is cracked and is leaking fluid on my L5 root nerve. Have had 1 sac injection and 2 epidurals in my swollen disc. With not much relief. I only get relief by laying flat. It hurts to walk and to rise from sitting. Most of my pain is in my butt cheeks. But have some in my lower back area. Have been this way since having knee surgery. One leg is an inch longer then the other and one foot stick out 10 degrees to the outside than the other. Exercise doesn’t help. Stretching very little comfort when I sit butt and groin numb up. Any suggestions.

    • Make sure to read my post on Doctor Schierling dot com called “Chronic Low Back Pain and the Thoracolumbar Fascia”. I do not believe your problem is Fascia-related from what you are telling me, but I have a “Top Ten” list for healing your own back.

      Best wishes,
      Dr. Russ

  35. Sharon

    This pain is unbareable it is so bad that it wakes me up My pain medication is not helping me at all just wanting to know what else I can do to sibsize my pain in having other obtions

  36. Marc

    I believe i have periformis syndrome. Is physical therapy a good way to go for getting rid of it? I have had it now for about five weeks. Stretching seems to help the most. The most constant thing is not having full sensation on the outer bottom of the affected leg, as well as the out part of the calf on the same side.

  37. Mikayla

    For about 5 and a half years i have had terrible pain in my upper glut area. It definitely feels like a deep charlie horse in my muscle like it is always tensing and won’t relax. I get spasms in glut muscles and done my leg and my low back. I think it through me out of alignment so I have really bad tightness in my shoulder with the same numbness down my arm. In the last two months I’ve had numbness with no pain on my face. All on the left side of my body. Right side feels fine, normal. This pain is constant and I feel that I’ve tried everything. I stretch and stretch and do yoga. I tried muscle relaxers for a short time, no relief what so ever. I’ve tried electro pulse therapy. I use a heating pad. I was visiting a chiropractor regularly. Massages seem to make it worse. I just started a doctoral program for oriental medicine and I receive acupuncture regularly. It seems like nothing truly brings relief. I have had either no insurance or state insurance, so it’s been hard to get help. No MRI, don’t know if I should. The pain reaches a ten often and sometimes I wonder if I should go to the emergency room. Is there any hope? Can the muscle or nerves die if the pain continues for years? I just turned 24, I had no injury to cause this. Tall and thin, no kids. Always been very active in sports, outdoor stuff, yoga. Desperate for help.
    Thank you, Mikayla

    • Hello Mikayla,

      Not completely sure what this could be. Doubtful MRI will show anything. The fact that massages make it worse is interesting. I have several articles about Central Sensitization, but it is impossible for me to even speculate on something like this.

      Dr. Russ

  38. I have been suffering night spasms in my legs for years never really knowing what it was. Always around the time I get a bad bout of sciatica. I wake with both legs in spasms and can hardly stand. I have to struggle out of bed leaning my hands on the wall in front and try to get my feet down as they are contorted. My lower legs then crack and it leaves my legs pulsating…I can never seem to get answers from doctors or osteopaths that I have seen in the past. I have been told I could have surgery to try and help but it is not recommended due to the risks involved.Is this being caused by the piriformis muscle and how can I get a diagnosis

  39. Sandy

    I have most of the symptoms you described, but no butt pain. My pain ranges from my hip to my knee to my lower leg to my feet. It started out worse in my hip area and is now worse in my knee area. I have had slight back pain a few times. My pain is at its worst when I sit very long or when I sleep. It is better when I am active. I have lupus and my doctor brushes it off as arthritis. This pain is different though and only when I’m not active. Any thoughts?

    • Almost impossible to say Sandy. Make sure you take a look at the Autoimmunity Protocols over at DoctorSchierling dot com.

      Dr. Russ

    • Not the Dr.

      That sounds like my sciatica pain. Don’t look at auto immunity info. See if your doctor can check you out for sciatica.

      • Hello ND,

        The problem with a physician “diagnosing” sciatica is that sciatica is a symptom, not a diagnosis. If, in fact, the doc happened to puncture both Sciatic Nerves with the injections, they will hopefully get better on their own as there is no treatment for this sort of thing that I am aware of. However, if you take a look at my blog, it is replete with letters from people who have had terrible reactions (mostly various forms of autoimmune) to antibiotic injections (mostly but not limited to fluoroquinalones such as Cipro). The web itself is full of sites dedicated to this very thing.

        Dr Russ

  40. Tatenda

    Hi. I have this big lump for the past 5 days. It is on my right butt and very painful. It’s getting bigger than it was the first day. First day it had a small portion with puss and I squeezed it out. I’m 35 weeks pregnant and I can’t even lay facing upwards because of the pain on butt. If I touch the lump, its temperature is hot compared to rest of my body. It’s about 4-5cm wide. Now the lump is just hard and no sign of puss. What could it be?

    • Hello Tatenda,

      This is about as far out of my league as something can be. Could be a pilonidal cyst depending on where it is (or even MRSA). Not sure, but whatever it is, you need to see a doctor ASAP as this is not even remotely related to Piriformis Syndrome.

      Dr. Russ

  41. Jim

    Wow!!! I’ve been dealing with this unbelievable pain!!! AND I MEAN PAIN!!! I USED TO BE A PERSONAL TRAINER, I totally understand the importance of having a strong core, and continued to work for 10 yrs. Trying to keep my muscles strong around my back to keep to support my spine. Until, I am no longer able to do so, I continue to move,move ,move!!! As painful as it is,, but I’m afraid I’m only doing more damage at this point

    • Hello Jim,

      I would have to have more information to give you my opinion on your last sentence.

      Dr. Russ

      • Jim

        Hi, about 10 yrs ago. I had to hold down a consumer, or better known as a Handycapped Adult. 2 xs. In doing so, I herniated and bulged 7 discs, I used my left leg to hold his core down. I was literally holding him down with every Oz of strenght I had.
        It has never gotten better. I’ve had 1 lazer surgery, over the yrs.on my lower back, I’ve also, ripped my pec. (Another surgery) after the pec tear, at a ER they injected me in my left butt, with morfion, hit my siadica! Almost, couldn’t walk.had the pec surgery also, fell on my butt 2 xs at another job. In doing so. Fell on my right hand 2x causeing on going nerve damage. In my right hand. However, my main concern is, the question,,,, did I rip that muscle??? Holding down that consumer 10 yrs ago???? I’ve never been the same since. I exercise, at least try 2. My hip, groin pain, siadica, and left leg giving out without warning. Is too much! I stretch every morning, very lightly exercise, and keep moving, In doing so,, costently fall!! Help,,_plz!

      • Sounds like you are asking me a legal question. All I have is the information on my site.

        Russ S

      • Jim

        Plz… No I am not asking you a legal question, plz is all,,, I want to know is could I possibly have ripped that muscle? Back 10 yrs. Ago? I have worked , continueusly…….. In doing so ………stretching ,, and very light exercise, but trying to keep moving……… Pretty much non stop. The pain is the same, feels like hipps are broken, unbaleavabile groin pain and ofcorse, Siadica down the back of my left leg. It won’t ease up, I can’t drive 4 any distance,, and quite often my leg has no feeling, and I go down unexpectedly,, just value youre opinion.
        Again thanks for any input
        J Herbert

      • Hello again Jim,

        You certainly could have ripped the muscle. Bear in mind that most of the time, what people refer to as “torn” or “ripped” muscles (or for that matter, “pulled” muscles) are actually injured Fascia, which will not show up with standard advanced imaging.

        Dr. Russ

      • Jim

        Thanks soooo much,, words can not express my gratitude. And yed, I’ve found out after many yrs. Modern imaging doesn’t pick up my problem. It has been a very miserable to say the least 10 yrs. For myself. My symptoms have not changed, and have exepted the fact, I have to live with this. I’ve tried everything from operations, acupuncture, injections, P.T. and the list goes on. I had continued to work,, threw out the yrs. Only to find, I reinjure my back, again and again. Ppl.watch my left leg give out. And I fall literally on my face! Last dpring, my left leg, touched a hot motorcycle pipe, never even noticed it till 4 days later. At which time it had turned into a spider infection.
        My leg goes numb and I never felt it. But the hip, butt, groin, and constant siadica I do notice!!! I can’t begin to express my gratitude for ure help.. I do stretch, everymorning and continue to try and exercise. Adprin, Aleive, and everything gover the counter doesn’t touch the pain!! The only releive I get comes from my pain management Doctor, I ice, I heat, in stsfting to learn self psin control.Our Brains r very powerful !! I’m trying to teach myself, mind over matter. And pray to God for some releif. Stay as stress free as possibile. And keep my mind active.. If u don’t mind, it dont matter. ( Kinda )
        God bless

      • Jim

        Good morning,
        In reference to our past conversation, I HONESTLY. Beleive. This is my main issue. And with that being said, I am stretching, very light exercise, I move nostop beause of the pain. I woud not allow another surgery! I used to be personal trainer. I know my body better than anyone ! I know what it takes to change my body, no matter what age I am, (54) however, nothinghelps. It feels as though, its hopeless. No one believes me. I’m a Christan and I don’t lie. I take it 1 day @ a time. It excuse the expressionbut it SUCKS. To say the least. Ppl watch my leg give out. I m constently falling hitting myhead, urning my leg, as it is numb most 80% of the time. Pain medicine works, but only 4 a small period of time. I do not, allow myself to become addicted to any medicine. So I purge my self off all medicines before I require a stroger dose. You are a godsent, this form is very helpful ! My heart goes out 2 all, that have 2 deal with this nasty Symdrone. I think I screwed my self in thinking I was invinsabile! ? No 1 person is invinsabile!! We r what we eat, r bodys r like machine, take care of ure body and it will take care of u! Abuse it,,,,,,, and we’ll….. Hear we r. Trying to figure out what’s wrong.. Any feedback is greatly appreciated.
        Sincerely Appreciated

  42. sophia

    Hi, I think I may be a victim of Piriformis Syndrome. I am crushed. I have always live a very active lifestyle. I am now 40 years old and have been in and out of the gym for 23 years. In the past, I would consider myself an athlete and even have had people asked me in the gym, if I am an athlete. I use to Hit the gym 5 days a week. About 2 years ago, I probably took my workout a little too far. I was trying to really focus on my butt and I began to dedicate 2 days per week on legs and glutes. My butt used to be my best asset and now it is a pain in my A** (no pun intended. ok maybe). Seriously. I had no clue. about a year and a half in and I started to feel burning pain on my gluteus muscles, but I ignored it. I then started to notice my butt began to sag. I thought maybe I needed to up my protein and increase my weights. Fast forward, by the time I realized something was wrong, I was too late. I first tried cutting my leg days to 1 day per week, then quit working legs all together for a couple of months. Nothing worked. Now, when I sit down, I feel my butt burning. I am so sad. I don’t know what to do… All of my muscles are gone. Now my butt is flat with no shape to them what so ever. I wished I had done more research earlier when I noticed the pain, I wonder if I could have prevented it. If there is anything I can do to alleviate the pain, please let me know. Thanks so much !

    • Hello Sophia,

      If you start looking at the blog posts on PS on my other site (doctor schierling dot com) you will see I have tons of self-help information. Beyond that, have you tried any sort of body work?

      Dr. Russ

      • jim

        Hi ,, Not exactly sure what u are reffering to by body work? However if You mean Exercise? Yes,, I have exercised most of my life. Since age 18, I have always been active. Diet and exercise have been apart of my life since my wife past 18 yrs ago. However when I was at a job, 10 yrs. ago and was asked to restrain a consumer whom, belonged behind bars, instead of in a home for the slow, or other mental disorders. I herniated and bulged 7 discs. The male weighed in at about 350lbs was 6’3″ and I was 160 lbs, but fit. He Head bucked me, Smashed my head with a fire extinguisher. I performed my job and had to hold him on the ground for 20 min. twice. In doing so, I held both his arms down and used my left leg to hold the rest of his body down. I was honestly fighting for my life!! I had to do so without hurting him. Not easy! Trust me, when someone like this is, told they cant do something they had in the past they get crazy STRONG!! After…. I have had crazy Crazy! Pain. I have had ! laser spine surgery, ( No Relief ) my leg goes numb, ( the leg I used to hold him down,) it feels as if Ive been kicked in the groin, the only way i can explain it is, it feels as if my Hips are broken…Ive gotten out of my truck before to have my leg numb, ( nothing there ) grab a tree to keep from hitting the ground and ripped my pec. from my bicep. While at another job, I was checking the parking lots to see if they needed to be salted, and slipped and had my hand with my clipboard crunched by my rear to brake my fall. which left me with nerve damage in my hand. At any rate have I tried exirecise? Yes ! stretching, massage. injections, aqupuncture. I wonder if while at the ER, for my pec tear, a P.A. shot me in the syadica with some kinda pain killer would do damage, I wasnt able to use that leg for 45 min.?

      • By “bodywork” I mean any of the myriad of massage-like techniques used to break up adhesed tissue.

        Dr. Russ

    • Lori

      Dr. Russ,
      I unfortunately did have the Release surgery that promised to cure the pain I’d been having for 20+ years. I was told by the Surgeon that my Sciatic Nerve was wrapped around my Piriformis muscle from birth… Needless to say, I was heart broken when my pain is the same on good days and worse most days. This was after 20 years of tests, Specialists, being called a hypochondriac and a “Pill Seeker”. When they gave my Piriformis Syndrome a name I was so relieved to know I wasn’t crazy! I put all my hope in the surgery being “the answer” and was assured it was. After 5 years and still in pain, the Surgeon tells me that it’s how it’s going to be and I knew that the Surgery had risks. He refuses to see me. SO… I am back to square one… Any thoughts, ideas, or encouraging words?😉
      Lori in Minnesota

  43. Anna

    I can’t find anything on what is causing my pain only when I stand up after bending over or squatting down. When I am about to be upright I get these horrible pains in my back upper thigh where my leg and butt meet and what I think is pain in both hips but it all feels like its in the back (not my back) . I don’t have any radiating to my leg pains . It started yesterday out of nowhere when I stood up after bending over. Do you have any idea to what this is?

  44. Tresia

    You are correct, no relief lying down or sitting. The pain initially midway my buttocks and horizontal pain it radiates my back thighs down to the knee. Extreme pain! It wakes me every night Have to get out of bed to walk my heated car seat appears to offer some relief. I fell in a clients home in May 2015., my doctor has ignored my reporting of pain. I stepped into client’s family room one step uncarpet floor.. Fell flat in buttocks! Still in much pain!

  45. Matt

    Good morning,

    I’m 33, and I’ve had what I believe to be Piriformis Syndrome for 12 years now. Some days it’s worse than others. Lately it’s been worse than usual.

    I’ve seen countless doctors, chiropractors, acupuncturists, massage therapists (including ones that do Active Release Therapy), etc. I’ve done months of physical therapy 3 different times. I’ve tried stretching programs, exercising, not exercising, have had MRIs, trigger point injections, dropped thousands of dollars on a nice new bed, new chairs, foam pads, etc and the list goes on. Nothing has been able to give me consistent, long-term relief. I just manage the symptoms day to day the best I can, and try to move forward.

    I’m intrigued by your website and the idea that you can make this go away. However, given all of the different things I’ve already tried that have failed, and the distance / cost it would take to fly from New England to Missouri, I’m skeptical that it will just be another addition to my list.

    Do you think you can you help me?

    Thank you.

    • Hello Matt,

      No idea with a case history like yours as to whether or not I can help (HERE). Wish I could do better than that, but I never really know beforehand. If you ever decide to vacation in the area or are traveling through, be sure to stop by.

      Dr. Russ

  46. Diana

    Thanks for the info..helped me understand better..I’m going to look into it more..I’m in so much pain and doing pt at the moment but have had it for years..nothing work’s. .I’m hoping to find out more about this when I go to my dr. Appt on thursday. …thanks,again

  47. Denise

    Hello Dr. Russ,

    I have had piriformis syndrome for over a year and a half and it has significantly reduced my quality of life at only age 31. I have undergone 3 rounds of PT, had acupuncture, massage, saw two different chiropractors (one who did active release on my piriformis twice per week for months), and had two lidocaine/steroid injections into my piriformis, which did absolutely nothing. I have also had injections in my SI joint, s1 nerve root, and hip joint, all which did nothing as well. All of my MRIs have been clear, and I’ve had 5 (hip and low back). It seems that everything that is supposed to help PS has made it worse. Massage activates the pain for days, I experience no relief. The pain also goes to my lateral hip, and sometimes the front of my hip and low back. Out of desperation, I finally allowed a hip surgeon to go in and take a look. He found a labral tear and repaired it, but said my sciatic nerve looked good. He said I did have a small band near the nerve that he cut (it was very small) just in case it was pressing on the nerve. Needless to say, my hip and butt pain have been even worse after surgery. I’m very interested to research the technique you discuss here regarding the fascist adhesions, I just can’t help but be nervous that it would aggravate my pain in the same way massage and active release did. I can handle a lot of pain, but both of those things caused increased pain for days, and then a return to my normal pain level, never an improvement. Should I still look into the technique? Are there practitioners in various areas that practice it? I’m very committed to feeling better but fear that I will be on prescription pain killers for the rest of my life. Any advice/guidance is appreciated.

    • Hello Denise,

      Not surprised the MRI’s have been clear as it does not show up on this test. As to whether or not what I do would aggravate it, it’s tough to say. If you start reading through my blog posts on PS over at Doctor Schierling dot com, you’ll notice that a couple of patients have stirred their problem by overstretching post-treatment. I have helped lots of people with this problem — some who have had it for as long as 40+ years (see our testimonials). I have also had people who did not respond at all. I’ve even had several people who responded beautifully for a week or so; then their problem came back. The only promise I make people is that you will know in one treatment if it is going to work. Believe me when I say that I wish I could promise better. Unfortunately, I have not yet determined a way to know beforehand.

      Dr. Russ

  48. Stephanie

    I have a pain it’s almost like a fatigued muscle pain right UNDER my butt check, right where your leg bends. Right now the left side has been hurting for the last week. It switched from side to side, but isn’t usually on both sides at the same time. I think it’s weak muscle. How do I isolate which muscle it is to try to work on it. I can’t do any kind of lunges they make my knees HURT!!!

    • Hello Stephanie,

      This is not PS. Have you been adjusted? Being out of adjustment subtly affects nerves without necessarily causing full blown sciatica. I will say that anytime someone starts talking about problems like this that are switching sides and moving around, the potential for autoimmunity enters my mind. Most of the time, isolating muscles is the last thing you want to do, as it is better to work on complex movements that involve lots of muscles. One more thing, I am a fan of lunges but if not done exactly right, they can cause knee problems (you were probably already aware of this).

      Dr. Russ

  49. paula martin

    Can the pain travel upwards causing a feeling of severe angina?

  50. paula martin

    Can the effects of piriformis syndrome travel upwards in the body causing a pain in the chest (heart) that seems to be angina?

  51. Tina

    How do I fix it? Every night arround 9ish I am in pain!! I fell on my porch steps last winter and ever since then I am in so much pain…. I don’t know what to do..

    • There are any number of things you can do — most are over on my Doctor Schierling dot com site.

      Dr. Russ

    • linda

      Out of curiosity, have you had the pain since your fall or were you pain free for awhile? I fell 18 months ago but have only been in pain for 9 months or so. I thought everything was fine for awhile now I’m in pain everyday.

  52. Bobbie

    Dear Dr. Russ,
    I was told eight years ago by Pain management Dr that there wasn’t too much he could do for my pain, yet I was able to get a referral for a spinal cord implant. That didn’t cover my pain. He did give me two shots in upper buttox that kept me pain free for a month. Also was told if I continue to be so persistent I would get myself fixed. I’ve had a fusion done and been told I need one more surgery. Yet I moved out of state and can’t find any surgeon that agrees.I’m confused. Is it really hopeless?

  53. prosperoussite

    I have had left buttock pain for the past year not been able to sleep on left side at all. Sustained an injury while sitting in a chair something stuck me in my left buttocks went to ER and csplinters were removed, what is my issue?

  54. Patricia

    Thank you so much Dr. Russ for this informative article. I sustained an injury on my job in 2002; 2005 became permanently disabled (L3-S2) herniated, bulging disc among other things and for 3 years I’ve been given epidural with some relief. However, for the pass two years I have endured this nagging rt. hip pain and the butt pain that’s often not quite sciatica. I also have a severe left foot valgus, which I wear a knee high brace which is somewhat helpful but still often painful. So your article certainly helped put things in perspective for this nurse of 40 years now disabled. Thank- you. There IS power in being informed.

  55. Catherine

    Dear Dr Russ,

    I know I have a herniated disc at L5/S1 from an MRI scan that appears in contact with my sciatic nerve. However, I am not convinced that it is the cause of my pain, I have had two spinal injections which have not helped at all.

    I have not been able to sit down for 12 weeks. If I don’t sit my pain is minimal or gone, except when I lie on my right side in bed which can also be uncomfortable.

    When sitting if I slide my buttocks to the very edge of my chair and lean right back I can sit for an extended period – maybe one hour. However, if I sit in a normal upright position after 5-10 minutes I am in great pain in the right hip region and back of thigh and have to stand, and then the pain eventually eases.

    Do you think I could have PS? I have been doing pilates and find that this relieves my symptoms temporarily. I have also been doing some piriformis stretching just recently when I read your site, which feels good.

    Osteopathy has not helped.

    Any suggestions would be gratefully received. I can’t sit at work, I can’t travel in the car – it’s very disabling.

    Many thanks and regards

  56. Staci

    Hi Dr.Schierling.
    I am a 46 yo woman, w/several autoimmune diseases, who has been living in chronic pain hell for the past 4 yrs. I had a myomectomy in Jan if 2012 & since maybe 4mos after, I have developed chronic, debilitating pain. I hv been diagnosed w/ Hashimoto’s thyroiditis, Hypothyroidism, IBS, Raynaud’s, UC, and RA. And most recently, my pain management dr want me to be tested for Adrenal disease.
    And I have sciatica pain EVERY time I walk or stand for more than afew minutes. I try to push thru it but my hips freeze up first , then my legs, and it feels as though I can’t take another step. I am on opioid pain meds, muscle relaxers for spasms (which feel like a spinning, flat sawblade in my low back/butt cheek). I can’t work, I can’t do much of anything, my life has become just trying to remember to take meds, and dealing with the different levels of pain. My life has been robbed from me, I used to go to the gym in the early evening for 2 hours at a shot, 6 days a week and pilates 5 days a week in the am. I was fit and pain free, then suddenly all the above happened. I want my life back….do you have any suggestions on wht doctors to see, tests to ask for, anything?
    I thank you in advance for any help or guidance you can provide.

  57. Nick

    Hi Doctor

    Great article. I have been experience pain in left buttock which travels down to my calf muscles. The Pain is worsen in the mornings and while sitting and standing as I am unable to put any pressure on my butt muscles. It’s seems to go away once I have been in a sitting position for good time i.e. driving. I do do a lot of running. Could you please advise what steps I need to take for the pain to go away and for me to exercise again. I am 27 and fairly fit. Is this piriformis and do I need to concerned about my lower back?
    Thanks again:)

  58. Penny Vann

    I have been to so many doctors….then when I decide to Google why my back and bottom still hurts…..these are answers! I am going to your blog/page to read more! Doctors don’t take the time to care. Thank you for taking that time to help.
    We need more doctors like you.


    Penny Vann

  59. Michele

    I’ve had 2 failed fusions L5-S1 then L4-S1. I get what can only be described as a hot ice pick in the area where my right sacroilliac joint is with nerve pain down my but to my calf….or so I’ve been told by 3 specialists. Could this be piriformis misdiagnosed???

  60. Jenn

    Dr. Russ,

    I’m a 23 year old female and have been experiencing sharp constant pain in the inner of my right buttock going down to my knee for the past month. I am a long distance runner and have been training for a 50k over the past 6 months (thus increasing my normal distance training) I’ve now reached the point that the standing, sitting, and even laying down the pain will still exist. It has gotten so bad that I’m having trouble sleeping at night and get constantly woken up from it. The only time I have some relief is after I’ve done some stretching and muscle massaging. Before any of my runs I do a short warm up jog and lightly stretch. After that I do my long run followed up with 20 minutes of stretching. I also notice that my hips/lower back pops/grinds whenever I do any kind of leg lifts. Is PS a possibility? And should I see a specialist and what kind of doctor? I afraid if I go in, they’ll just prescribe me pain killers and muscle relaxers instead of really treating the problem. Running is my passion and I would hate for this injury to stop me from doing that. Any advice would be great. Thanks!

    • Hello Jenn,

      Not sure I have any earth-shattering solutions for you, but I would suggest that you get this figured out before you continue to train so hard. You could potentially end up causing yourself irreversible damage. Don’t ask me how I know about this (the story can be found on my blog).

      Dr. Russ

  61. Amy

    Hi Dr. Russell,

    I have been experiencing occasional pain in my lower back and right buttock and i was having difficulty picking things up and even looking down without it hurting. My doctor believes it is sciatica and she gave e flexiril, which has helped. I haven’t taken it often because, as I said, it’s intermittent.

    This week, the pain has worsened immensely. I don’t know if it’s even a related issue or the same one, but I have been having pain when walking in my buttock. It sometimes causes discomfort on my hip and my thigh. Sometimes, it feels “dead” or numb. Other times, it actually hurts and i find myself limping and overcompensating for the painful side (right) without realizing it.

    Just this weekend, the pain hit a 10. It was horrendous and I found myself in tears and on my knees unable to move because any movement only caused more pain. The pain seems to cover the entire right buttock area (middle part up to the top) and it feels like my muscle is locking up or cramping up. i can’t tell. I just know i can’t make a small move with causing it to hurt and feeling like I can’t move because I’d make it worse. Hoping you can please help.

    • Hello Amy,

      Firstly, Because there are so many different causes, sciatica is not so much a diagnosis as a symptom. So ‘diagnosing’ you with Sciatica is really not a diagnosis at all. Secondly, I would suggest that you go to my Doctor Schierling site and look up the “Piriformis Test,” which will help you differentiate between two very forms of sciatica — from a disc or from Piriformis Syndrome.

      Dr. Russ

  62. Linda

    I had a laminectomy at L5S1 in the mid 80’s. Several months after that surgery I developed agonizing pain and was forced to walk with a very bad limp and totally “lop-sided” due to scar tissue formation. I went into a chronic pain clinic at a local hospital for 8 weeks and several types of treatment were tried until I was able to loosen things up so that I could walk correctly again. In the intervening years I have had some troubles with my lower back and more than one doctor has done tests and told me that I have other disks that are narrowing.

    Last March I flew from Florida to Illinois for a program for one of my grandchildren. Before I left I experienced this pain in my bottom and by the time I navigated through the airport, flew for 2.5 hours I was in so much pain I couldn’t do anything but cry. My chiropractor was able to help me get through the weekend and attend the program by using electrical stimulation and deep massage. When I returned to Florida I was fine for several months.

    In August I experienced the same thing and when my Ortho Doctor did some tests and examined me he said it was bursitis and gave me a steroid shot. The shot hurt like 60 but it seemed to take care of the issue. He did inform me that it was not a cure and the condition could indeed come back.

    Last week on Wednesday the situation came back with a vengeance. I again went to my chiropractor this time because I had the wedding of a very close family member on Saturday and was willing to try whatever might get me the best and quickest results. She used the same techniques but as we spoke and she did her examination, she said she thought I could have PS, which I had never heard of. I did make it to the wedding but only by taking pain meds.

    So on Wednesday when I had had no sleep to speak of for 2 nights, I contacted my ortho and he is doing an MRI on Monday and then I will see the specialist in the practice who deals with backs. He said it sounded much more like I was experiencing disk issues again.

    I’m still not convinced it is not PS and I plan to ask this new doctor about it when I see him after the MRI on Tuesday. I have been managing these last few days only by staying filled up with pain meds and steroids and I hate feeling so out of it on these drugs.

    Any advice on how to address this to get the best conclusion would be greatly appreciated.


  63. Stephanie

    I had a pretty traumatic fall about 3 years ago, the pain was excruciating…… Anytime I moved it felt like my right back and leg was being shocked, at one point I passed out from pain. An MRI showed 2 herniated discs. I quit working out for about 3 months and returned as normal with minimal pain. Over the past year the pain has gradually grown, and is bothering me on a daily basis. It hurts when I use the restroom, it hurts when I sit in the bath, it hurt when I drive, it throbs sometimes for no reason. I’ve noticed my left leg is also slightly longer than my right, which is the side my pain is on. I’m wondering if maybe my hip is broke, fractured??? It is starting to affect my daily life. Just standing still will hurt me. The main form of exercise I do is running….when I run it doesn’t hurt. Recently I’ve began feeling the pain in the front side of my hip as well, actually it’s slightly above my hip, but in the front. What would you think this sounds like? Thank you so much for the informative article.

  64. Cheryl

    Dr. Russ,

    I’m 52 and have been at a desk job for 22 years. Several months ago, I began to have deep left buttocks pain ONLY when sitting at work. Sitting anywhere else caused no pain, and the pain was immediately relieved by standing. I tried different chairs and using various types of cushions. (Also, I have had left hip pain, back pain, and radiating leg pain for many years – don’t know if there is a correlation.) Recently, the pain in my buttock (still just the one side) happens no matter where I sit, and is still immediately relieved by standing. Do you think this is PS?

    Thank you!

  65. Steve

    Can the irritation cause twitching of the muscle in your experience? I have had ongoing twitching for a week or so. But had the pain first. I do a mixture of a lot of sitting and then very hard cycling!

  66. Leah


    I am 24 years old and 15 weeks pregnant. I’ve had chronic lower back pain for roughly 10 years now, however, over this past 2-3 weeks, now and again, when I wake up I can barely sit up and standing is worse! My whole lower back area and both sides of my bum are in excruciating pain. I stand up to stretch it out and it is relieved maybe 5-10 minutes after. I can barely walk in that space of time. I’ve never felt anything like it. Do you think it could be Piriformis Syndrome?

    Kind regards,

  67. Mary

    Hi. I got my right knee injected with kenolog and lidocaine s/p meniscus repair. I developed by his right buttock tingling and pain. If I have weight on my right leg it catches. Painful. I walk and it is better. I can lie down on the right side and it feels better with pressure on it. Sounds crazy huh? It does run down my leg but the pain is butt cheek and calf mostly. Is this PS. Do all chiropractors know how to remodel?? Thanks

    • Hello Mary,

      I have seen occasions where injections fire off PS-like symptoms. However, not sure if I have ever seen a knee injection cause this in the pelvis area. As to the remodeling, some do and some don’t. You’ll just have to ask.

      Dr. Russ

  68. Kelly

    Hi Dr. Shierling~

    Wow! Great article. After reading it, I too am convinced this is what has been driving me batty for about 26 years. I remember when it started. While I was pregnant with my first child laying on my back an annoying aching pain in my lower back, deep in my hip came on me and ever since then I have had this pain that radiates into my buttocks left side and only a few times has that radiated down in my leg so I don’t believe it’s actually sciatica I do however believe it is the Piriformis syndrome.

    There is one thing though that I’ve noticed that wasn’t mentioned. For me, I have a very strange way of relieving the pressure temporarily and it has become a habit if you will. The pain is in my left hip and butt muscle. Deep in there, so I lean over bearing weight on my left leg. I raise my right leg as high as I can and then POP goes that whatever it is. It feels like my hip is popping back into alignment, but I could be wrong. Maybe you can comment on that. Like I said it seems to relieve things for a while. I have to perform this weird ritual at least 5 times a day.

    Feels like there might be arthritis in my hips too. I also am AMAZED at the stiffness in the muscle. It’s seems as though deep stretching would be just what the dr ordered but no. The muscle refuses to give. Not sure what that is about. Ex ballet, gymnastics, dance so stretching is huge and now that I am older (45) it is no longer relieving to stretch.

    But, I was recently diagnosed with Fibromialgia which has been a living nightmare in itself so stretching my muscles creates more intense pain.

    It would be wonderful to have some relief. Thank you for your research and sharing your knowledge with us.



    • Hello Kelly,

      Thank you for the kind words. Best guess is that this is not actually PS, but some sort of Fascial Adhesion causing a bony restriction and subsequent crepitus that is relieved by you “popping” it. Figure out where that adhesion is, and you’ve gone a long way toward solving your problem. By the way, make sure you check out my posts on FIBROMYALGIA as well.

      Dr. Russ

  69. asherrozil

    Hi Doctor,
    I have a 18year old sister who experience a pain in her waist,and it extends to her leg and sometimes vertebrae column.It started 9years ago when she was given an injection on her buttock.
    Later on,she fell down and the pain has been excruciating anytime she feels it.
    Visit to several doctors indicate there is nothing wrong with her.
    Please can i know what is wrong and some remedies?

    • Hello Asherrozil,

      Tough to say exactly what is going on, but I have seen similar problems before. This is not PS, but likely some sort of nerve injury from hitting the sciatic nerve. As to whether or not Tissue Remodeling or anything else for that matter would help her, I really don’t know.

      Dr. Russ

  70. Joseph

    Dr Schierling,
    I’m in my Junior year of college and I’ve been dealing with pelvic problems since the summer after senior year football. I was working out and I dont remember ever getting injured, but I slowly got this nagging pain in my left glute and it got worse and worse until I saw a doctor. He sent me to a chiropractor who said i had sciatica and who I went to several times for adjustments and electrical stimulation, and I would leave feeling slightly better but the pain would come back soon after. This was about a year or two ago, now I dont have as much consistent pain, but anytime I bend over or try to stretch I get this terrible pain in my glute and cant stretch. I have essentially no flexibility now in my left side only because of this, and when I squat or try to stretch my hips tilt really badly to accommodate that side. Do you think it’s piriformis syndrome? I try to roll on it with a lacrosse ball sometimes and it helps a little but stretching just seems like a lost cause because I’ve tried a lot and I can’t really do it and it doesnt help when I try. Is there anything I can do?

    • Hello Joseph,

      When simple stretching and exercises don’t work, I usually suggest trying Tissue Remodeling — something that sounds like it might help you. I do have tons of self-help stuff on my DoctorSchierling site.

      Dr. Russ

    • Dwayne

      Great Article!
      My life has been taken away (I will get it back) by a literal pain in the but. I had ongoing pain in my back for the last 5yrs. In the beginning I would only experience pain every so often. This pain would last for a week and than it would be gone. Over time (a few accidents, being sedentary in office environments) the issue has developed into a serious problem that has effected almost every facet of my life.

      For the past year I am experiencing pain in my piriformis (have you noticed spell check doesn’t even recognize the word) that causes sciatica like conditions down my leg into my foot. When I awake in the morning I look like the Leaning Tower of Pisa. My entire body is slanted and I have to adjust most of my weight to the “good side” of my body in order to make it to the bathroom. Once there everything is done in a slanted position. It is hard to walk and very painful. I force myself to get up and make it downstairs to the kitchen. I eat, take some anti inflammatory medication and try to walk around as best as possible. After a few hours I start to come around. The periformis stays painful but somewhat bearable (funny how you get used to pain and treat it like normal) but I am not as much on a slant. I can not sit down for long periods of time. Driving in the car is a whole new experience and usually takes me some time to get moving after getting out of the car which is a task in itself. I am in some kind of pain all the time.

      I have been scheduled for an MRI and I hope this will show more. No one has been able to tell me what is wrong and its bad to say but I feel that due to the lack of knowledge in these areas it is easy to give a person the run around. I just want to know what is wrong so I can work to heal it. It is essential that I find a solution. I am 36 years old and have a family to take care of. Why is it so hard to find out what is wrong with you? Can you offer a better strategy to determine the root of this problem?


      • Thanks for the kudos Dwayne,

        Sounds like it is PS. Make sure to check out my article on Doctor Schierling dot com about “Imaging the Pirifomris”. If that is in fact what this is, MRI will prove worthless. I have about 20-25 articles on PS over on that site.

        Dr. Russ

    • Francisca

      Dr. Schierling, I have been dealing with a radiating pain that starts at the left side of my lower back and radiates through my left buttocks and thigh. It started out as something that would flare up every so often. It is now something that happens whenever I sit down for more than 10 min. I will literally get up from a sitting position and be limping. I cannot sleep at all at night because my left side will radiate with pain no matter what side or position I try to get in. Pain relief medicine does absolutely nothing for it now. It takes about a good hour of moving around in the morning before the pain finally subsides. I am a makeup artist so I am on my feet all day. Oddly it is the only time I am not feeling the pain. Suggestions????

  71. Olene

    My buttock aches also going around top of leg feels achy burning foot aches so does knee at times what is this dr says hip joint xray showed cartilage worn down i’m tired of aching

  72. tanya

    Good Evening
    Interested to see this article . 15 years ago shortly after giving birth to my daughter i was laying down when i started getting pain that would radiate from my mid lower back into my buttock and down my leg only while lying or sitting for long periods of time. Im still suffering to this day. Everytime i lay down ,without fail, i get radiating pain that goes from my buttock/hip area down my leg and draws my leg up every 30-40 seconds and leaves me without sleep. The nerves in my hip and leg are so sensative that ( if i am not taking medication) i can get something as simple as a itch on my arm ( or anywhere) and it sends that nerve/muscle into drawing up and reacting. I’ve recently also started getting a hot tingling burning feeling deep in my hip area (where the leg joint connects to the hip) on both sides..worse in the right. If pressed it burns and radiates pain in that area as well as the upper part of my leg and upper butt area..my right hip is always sore. Also it tends to be more irratated when im ovulating or on my menstral cycle.

  73. Diane

    Dr. Schierling…
    I was so thrilled to find your webpage…. I am a 65 year old female and have been having lower back problems for several years putting me on disability. I have seen several doctors with diagnoses such as sciatica, sacrolilliac, bulging disks, disk degeneration, etc. and have undergone pain management, physical therapy, cortisone / epidural injections, and RFA’s for nerve burnings. I’ve had 2 MRI’s (the last one being 2 yrs ago) and they both showed the things mentioned above plus more.
    My LATEST problem is a scale of 10 for “butt pain”… It’s intense and I ice it about 5-6 times a day which gives me a little relief but not long lasting… I just went through another 6 weeksof Phys. Ther. and the PT said she didn’t know what else she could do…I take plavix (due to a stroke a few yrs back) so I can’t take anti-inflammatory drugs… i am at my wit’s end. I haven’t slept in the bed but probably 4 times in 2 months. Most nights consist of 2 hrs sleep…pain & up for hours… then maybe another 2 hrs sleep (if I’m lucky).
    The dr. is ordering something called a tens unit to see if that helps. He has also suggested pain management again….
    I noticed in an above post that ayoung lady said her pain travelled from one side of her butt and then would hurt on the other side (but never at the same time). That’s exactly what I’m going through. I have to sit completely straight (and not for a long period)…am having trouble walking and last night I fell down…
    Can you offer ANYTHING to get me going in a direction where I can have a decent life? Surgery was suggested a few years back…but it scares me since I’ve had so many “different” diagnoses ….they don’t really know what they are treating… One dr wanted to place some kind of pain control unit inside my body where I can control the pain (He never even went over any of my history …just spent 7 minutes with me and determined I needed this “implant”… needless to say.. I didn’t go back to him.
    HELP ME…. Please…. Once again it is 2 am and I am still up….

  74. Genny

    Dear Dr. Schierling,
    I am 27 yrs old and have been experiencing these painful electric sting in the upper part of my right butt for almost 3 yrs. The pain does not radiate anywhere. It usually comes with prolonged bending or if I lift or work with heavy things for longtime(more than 20 min). Then I cant sit, walk or sleep in certain positions coz it triggers the sting which is extremely painful to bear and I can feel the muscles sore at that area. It usually used to diminish on application of hot water bag on my back but it doesn’t seem to work these days.
    I would like to make a point that in other days I am extremely fine and long hours of walking, sitting and standing does NOT trigger the pain. it only comes back when I do bending or lifting jobs for more than 20min.
    Do u think it could be PS? would it get any worse?

    • It could certainly be a piriformis issue (myofascial) but sounds like there is no sciatic nerve issues — at least not yet. Have you been to a competent chiro yet? That is one thing I would consider trying first, along with the piriformis and gluteal stretches.

      Dr. Russ

  75. Dana

    I was recently told I have a slipped disc, L5, S1 and could barely move the pain was so bad. Some lower back but more the entire length of my left leg. I have been going for acupuncture for a week and a half and my acupuncturist told me my piriformis was pressing down on my static nerve causing the pain in my leg. Acupuncture has greatly increased my mobility in just a week and a half and would recommend it to anyone with a similar problem. It will take several visits and they will be painful but you’ll heal quicker then doing nothing in my opinion. Best if luck.

  76. sara

    I’m a 35 year old female carrying my second child. Just got the pain in the butt that is so sharp and awkward, I can’t stand on that leg or put pressure on it. Unfortunately I also struggle with Pubic Symphisis, both issues I developed with my first pregnancy. The public symphysis never went away 16 months post partum and I’ve seen many people and done many exercises and nothing helped. I am wondering if the two could be related? I use to be a runner and much more active before these issues arose and I would do anything to get there again. Will massage help the sciatic issue in the butt?

  77. Heather

    In April, I discussed my aching glute muscle with a yoga instructor as she also does deep tissue massage. I thought, perhaps, that would help with my problem.

    After probing the area, she felt it was my Piriformis muscle. She mentioned to me how she could feel a “void” in the area and suggested I do strengthening exercises.

    Since then, my pain has progressed. I now have, and what I assume to be, symptoms of sciatica. There is tingling in my left leg all the way to my toes. I also get a burning sensations and a feeling of creepy crawlies in my shin. Plus, the pain in my glute still exists. I am miserable.

    As I am an avid yogi (hot vinyasa), and a very active person, this has put a real damper on things I love in my life. Day to day living is painful. I currently take 12 Advil daily, and alternate between ice and heat.

    I am considering acupuncture.

    What I’m wondering is whether or not it’s Piriformis or related to Sciatica? Perhaps a disc issue? It’s hard for me to do the “test” as I always have pain in the areas, with the exception of my back. I really do not have any pain in my back. Just a little tightness when I wake up.

    Four years ago, I suffered from a herniated disc in my neck – between C5/C6. I was the worst pain imaginable. I was in PT for a large portion of the summer. Looking back, what I can say I learned from that experience was it just takes time to heal. Maybe the same applies to this injury.

    Any advice you can give would be greatly appreciated.

  78. Valareé

    Dr. Schierling,
    You do not know how excited I was to find your website!! I have been researching for awhile now why I am having the pain I am having! I am an OT by profession so I had some idea of what was going on and had narrowed it down to something going on with my L5-S1 (sciatic) but just could not pinpoint the problem ! After reading this info on Piriformis Syndrome I am convinced that is exactly what is going on with me! I got so excited reading this but then it just ended……… You stated get rid of fascia adhesions and you get rid of chronic pain but didn’t say how to do this : (. Where can I find out how to heal myself ? How do I get rid of these fascial adhesions? Thank you for a reply.

  79. Angela

    Dear Dr. Russell Schierling,
    I am in desperate need of answers and or help. I am now 18 years old and have been experienceing the same excruciating pain on the very top of my buttox, for the past three years of my life. I was forced to quit volleyball my sophomore year of highschool because I could physically not do the exercises, let alone walk to practice without an obvious limp. The pain starts in the top of my buttox and shoots all the way down my entire leg, causing me to struggle greatly when walking. Over the course of these three years I have tried working out in a gym five times and was forced to stop each time because the pain was almost unbearable. When sitting for extended periods of time, I can almost not walk at all once I get up, and more times than not my leg has actually given out. I am in fairly good shape, and only weigh 135 pounds and am 5’8. Before I had to quit volleyball I was one of the fittest on the team. I have gone to over 7 appointments with doctors, physical therapists and even a chiropractor once. I have gotten two Mri’s of my back and they didn’t show anything. I did physical therapy for about 3 months the first year that I was feeling pain and they diagnosed it as sciatica. I would do stretches that seemed to help for a little over an hour and the pain would come right back. Frustrated, I gave up and tried to deal with the pain. However, it proved to be too difficult and I went back to physical therapy about 6 months later and tried once more, but again, nothing was resolved. Some nights the pain is so bad that I cry myself to sleep because it is the most painful thing to lay down flat. At this point I am desperate, and frustrated beyond belief. I am 18 years old and all I want is to be able to go for a morning jog without having to drop out after 5 minutes and limp home because I cannot take the pain. Something also weird is that over the course of these three years the pain (exact same) has moved from my right to my left side and back again. It’s been on both sides at different times but never at the same time. I stretch every morning, and it does barely anything. Please help me, or at least guide me in the right direction because I am desperate beyond belief. Thank you.

    • Hello Angela,

      I hate what you are going through. Other than the fact that her problem started with a severe injury, ‘JANE’S STORY‘ reminds me of you. The first thing you need to do is to see if Tissue Remodeling is going to work for you (any Fascial Adhesions need to be addressed). If that does not work, I would consider seeing a Carrick-trained Functional Neurologist. The part of your history that is somewhat perplexing is the fact that, “over the course of these three years the pain (exact same) has moved from my right to my left side and back again.” Although I have see this a few times over the years, it’s an odd finding that sends up a red flag. A pinching in the right buttock should not cause pain on the left, and visa versa.

      Please keep me in the loop and let me know what you find out.
      Dr. Russ

  80. Trina

    I’m only 15 and I have pain in my butt and it’s traveling up to my lower back. I play a lot of sports and I lift a lot of heavy things which might be the cause of my problem. I just want to know what can I do to make the pain go away faster? Could I ever get this pain again?

  81. lANCE

    I have the aching pain in my glutes and sometimes in the front hip area. I also get a numbness somewhat aching pain in the side of my thighs. I have worked a desk job for years and have not seriously worked out besides walking occasionally. Now I am trying to get into shape after all these years but when running I get a pain in each of knees on the outside. Just wondering what you thought that might be?

  82. Carmen

    Hello Dr Schierling, I’m a 59 year old female and I had 2 discs replaced in my neck in 2011. When I awoke from surgery, my whole body was jerking violently. I have RLS and believe that it may have been a reaction to the anesthesia. I was very active before the surgery. To make a long story a bit shorter, I believe the violent jerking of my body could have caused my problems. I have been in so much pain. Lower back, buttocks ( sometimes it feels like I’m sitting on a rock). The pain travels all the way down to the bottom of my foot. Pain, burning, numbness. The pain is relentless. I have been on every med you can name and have had so many tests run, I can’t list them all. I tried PT 3 times. It left me in so much pain I couldn’t walk. I’ve tried Chiro, acupuncture, you name it I’ve tried it. I had a laminectomy/formanectomy 6 months after cervical surgery. Dr thought that would be the answer to my pain. I got no relief. I’m at my wits end. It’s been over 4 years, this changed my life, I had to retire as I can’t sit, walk or stand but a few minutes. The pain causes intense fatigue and keeps me unable to do very much in a day. I try hard and push myself but pay for it in the end. No dr has ever mentioned PS to me. After 4 years will I ever get any relief?

  83. Abe

    Hi, I’ve been in pain for about 2 yrs now…I’m a 39 yr old male that is normally in good shape. I’ve had a low back and right hip pain for about 2 yrs but in the past yr it has really seemed to ground me. The pain in consistently in low back and sacrum area. When I bend over I have no sharp pain in my low back, glutes, and thighs. It’s a constant dull nag that never goes away. The pain also wraps around to the front of my hip on my right side and sometimes on my left near the greater trocanter area. I also have a terrible internal snapping hip on my right side. I’ve been to at least 10 chiros, two doctors, a rolfer, and I am currently doing a M.A.T. program but nothing seems to be helping the actual pain. 3 of the chiros have told me I have arthritis in my low back ( l5 l4 s1 facet) and this has been seen on xray. I have a mild curve in my spine and a small pelvic tilt. I know this a lot but if I can’t get past the pain I feel I will never get better. I’ve been wanting to use an inversion table but I am not sure how wise it will be considering the arthrosis. Any thoughts on any of this? It really has destroyed my life. I have had a very hard time finding a good therapist that can really analyze my situation accurately.

    • Hello Abe,

      I am a huge fan of Inversion. Before doing it, make sure you read my blog post on how to do it correctly over at my DoctorSchierling.com site. Doubtful that the degeneration is the cause of your pain. Arthritis or DJD is a common scapegoat because it is one of the few things which can actually be seen with imaging. Are the rolfers being intense — i.e bruising you or making you feel like you are going to cry?

      Dr. Russ

  84. Stella

    Hi Dr. Russell
    early last month I sat at e edge of a motorcycle for a short trip on reaching my destination my butt started aching me seriously that I had to take a pain reliever, this persisted for some weeks, I later noticed any time I sit in a vehicle for more than 30mins my butt aches, just 2days ago I travelled in a bus for 4 hrs and on getting home I had very extreme pain in my butt, am scared is it a condition in which may medication is required, i am quite chubby, I hardly exercise could that also be the cause?

    • This certainly sounds like it’s possible you caused some (hopefully minor) PS. As far as the chubby, sedentary part; take the bull by the horns and do something about this. By exercising wisely and eating healthy foods, you can largely control the amount of Systemic Inflammation in your body.

      Dr. Russ

  85. danielle

    Hi. I’ve been having some trouble in 2013 I was in a bad car accident. I was the driver. I seen it coming and braced really hard. I was told it was a torn tendon and would heal itself. I never had pain before the accident. I believe this to be foot trauma but I’m uncertain. I will now describe were the pain originates from. The last two toes on my right foot. Where it looks like it forms a y shape there is severe pain in that area it runs up my leg on the side up into my hip butt area. I am now pregnant and my legs/feet are swelling causing pain to the area in my toes. Its gotten really bad to were if I walk any amount of time it causes severe discomfort. All the way from my foot to my butt

  86. Irene

    I use to have thick tissue on my buttocks and now I notice my butt has gotten flatter and I can feel the bones it’s like the muscle has gotten thinner or something on my buttocks, I’m also having a lot of pain on my left cheek on my buttock that is makes uncomfortable to sit or lay down. I had sciatica nerve problems before but they went away now I have this problem. What can this be?

  87. Chad

    Hi Dr. Shierling,
    I was deadlifting 2 months ago and awkwardly put the weight down. Now I have a sharp pain just above my glutes. This happens if I go down stairs or pick something off the ground. I was told I have glute amnesia as well if that means anything.

    Thanks and much appreciated

    • Hello Chad,

      Even though I used to be a relatively serious powerlifter, I had not idea what “Glute Amnesia” was, so I looked it up. For those who are like me and have never heard of this, it is basically a deconditioning due to too much sitting. Interestingly enough, there are studies that have come out very recently claiming you cannot overcome a lifestyle of sitting — no matter how much exercise you do. Make sure to watch my blog as I am going to address this issue and others with a post on the multitudes of problems associated with sitting.

      Dr. Russ

  88. Kelly

    Hi, I run XC and track so basically I’m running all year round. Recently I’ve had pain when walking/running in my hip and when I put pressure on my butt when I roll it out, there’s a sore spot right in the middle of my cheek. I can still run but after practice today, it was extremely hard to even walk normally because that butt/hip area hurts so much. I tried icing and doing a few stretches I found online which helped for a while but it came back. It especially hurts when I go from practice to my job (I’m a hostess at a local restaurant) and I have to speed walk around for 5+ hours. Does this sound like the injury described in this article, something else, or just soreness from 1000 meter repeats I did yesterday on a gravel trail?

    • Hello Kelly,

      I would not be too worried after just one day. If the problem persists, lay off because believe me when I tell you that you do not want to aggravate this problem if that is what it is.

      Dr. Russ

  89. Francisco

    Dear Dr Schierling,
    My name is Francisco and I am a 21 year old male who is experiencing symptoms such as these. 2 years ago I was on the treadmill , and I did the mistake of not warming up and just pushing through fast paced intensity on it when I felt like a snap in my buttock/leg and felt a cold rush of blood. Keep in mind that this was 2 years ago and wet since I have limited mobility on this leg. I’m extremely active always working out or running/biking. I haven’t had any complications until recently this summer in which the pain has become excrutiating especially when I wake up. It is a hassle to get out of bed and the only brief comfort I get is by sitting down, biking or running. I just don’t know what to do, as it is becoming an irritating problem and a painful one to say the least. I can’t stand for too long because my glute/leg starts to hurt and bending down is extremely hard to perform. I still exercise my legs , regularly squatting and can push through the pain but after my workout is complete an a good hour passes by the pain comes back. If you could please advice me any exercises or stretches to perform it would be greatly appreciated.

  90. Deb

    I came off my horse November last year and have been experiencing the pain across my butt crack and tingling in both my legs ever since. Sitting for long periods of time (1hr) is a nightmare of pain. The doctor put me on nerve blockers but I took myself of them as I didn’t like the way they affected my head. Thanks for the article and thank heavens I stumbled across it, as it describes my pain and areas of pain exactly. I’m going to book mark this page and show it to my chiropractor. Do you have any advice on what I can do to help myself heal or relieve some of the pain. I have a fairly high pain tolerance but there are days when it gets a bit much. Thanks you Deb

    • Hello Deb,

      Although not unheard of, bilateral PS is not very common. I would try some inversion and see what that does. Usually Inversion (done per instructions on my Doctor Schierling dot com site) is quite beneficial for disc issues. However, it tends to aggravate PS. Try just a little bit and see what happens.

      Dr. Russ

  91. Kevin Buttner

    Dear Dr Schierling,

    After a second L4L5 disc operation, I suffered from a nerve inflammation in my right shoulder. It took my quite a while to get back into some sort of shape, but I got there. Then I made the mistake of overdoing my workout on my hometrainer – I put the resistance too high and trained far too often. The result is a tight and overworked Piriformis muscle.

    I’ve worked hard with the physical therapist for five months now. I’m quite strong and have a lot of control over the muscles. However, the tightness remains. I have faith I’ll get there. There’s one question that keeps popping up in my head, though. Perhaps you could answer it? Sitting for a while increases the tightness a bit. But does sitting for like an hour actually aggravate the condition? Does it make it worse? Or does it just feel worse? I’m curious, because I have to do some sitting for my job and wonder whether this hampers my progress.

    • Hello Kevin,

      I am not really sure. What I am sure about is that prolonged sitting is being tied to virtually every health problem you can name. I also know that an inability to sit is probably the most classic sign of PS. I would guess that it aggravates it. Thanks for your question.

      Dr. Russ

  92. The Freckled Runner

    I started to get the pain earlier in the year. I was training for a few marathons and upping my mileage. Once it got to a bad point, I didn’t run much for a week and it seemed lessen greatly and eventually go away. I’m training for another marathon now and this pain came back on Sunday. It starts at the top of my left butt, goes into the middle of my butt, down the back of my leg, and to the outside of my left calf. I haven’t ran since Sunday because it’s hurting so bad! I work an office job so I sit a majority of the day and can tell it’s aggravated by that. Also, when driving I will get shooting pains. Help!!!! My marathon is in 10 weeks and I’m very scared a PT will tell me to stop running. What do you think?

    • As an athlete myself, I’m no different than you. The thought of giving up, changing, or ratcheting back on my training regimen is not an appealing thought (although I have had to do it several times). However, whatever this is, you risk making it permanent by continuing to train on the same schedule. Try something else, like training in the water for a week. Or maybe do some upper body resistance training. I see lots of people whose lives are destroyed by this stuff — it’s not something to mess around with.

      Dr. Russ

  93. KM

    Hello Dr. Schierling,
    Approximately 14 years ago I was diagnosed with permanent sciatic nerve damage from being in a car accident. A lady “T-Boned” me. It was tolerable for the last years, but as of lately, I have continual, constant pain in my hip that on occasion, wraps around to the front of my thigh and travels down my leg. I picked up something heavy recently and the hip pain ceased but now I have been experiencing deep “butt” pain. It hurts to stand, walk, or to try to change positions in the bed. Sitting isn’t too terrible. I have been sitting a a desk that isn’t really a desk for awhile now (months), because I am a novelist (or rather, aspiring novelist). There is no way for me to put my legs under the desk, as there is a shelf there. Oftentimes I find myself resting one or both feet on the shelf so I can get closer to the desk. So, my question is – is this pain due to the way I am sitting? Or is it what you’ve spoken of here? I am to the point that I just cannot take it anymore.

    All the best,

  94. Trish

    I started with left groin, buttock and thigh pain back in April after doing yard work. I was doing a lot of bending and squatting for several hours. The next day I woke up with this pain. I have not been able to sit or lie flat on my back due to the pain. I have done PT for 3 months, saws chiropractor once and just started Active Release. I have also alternated between ice and heat. I had 3 steroid injections: left hip, ligament in buttocks and pirformis each about 2 weeks apart. Post pirformis injection seemed to increase my pain. Any other suggestions or do you know of anyone physician wise who can help me in my area. I live outside of Philadelphia,PA. I am a Nurse Practioner, former ER nurse for 10 years and started running in 5 TV grade long distance competitively all through grade school, high school and college. Stopped running after that and I also played soccer in grade school and high school. This is worst pain of my life. Please help.

    • Hello Trish,

      Wish I had something to offer you beyond what’s on my sites. Do you have the sciatica with it?

      Dr. Russ

      • Trish

        EMG normal today with no signs of nerve damage. I cannot sit or lie flat on my buttocks as I get intense pain. I have seen so many specialists and still no answers on cause of pain or how to fix it. I have been walking twice a day, active release twice a week and PT twice a week. Not sure if any of these aggravate condition. Need answers. I still think it is pirformis, but no one will confirm for sure. Any suggestions would be appreciated.

      • No great answers for you. Just be aware that it takes a certain kind of EMG to see PS, and it does not image will with most tests. Take a look at my post called “Imaging the Piriformis”. It’s over at my http://www.DoctorSchierling site

        Dr. Russ

  95. stoney

    I have been having pains every day that I wake up in pain my butt area and the back of my thighs…I don’t Work out…and I thought it was from me sleeping on my Couch..but even in my bed I’m having the same problem!!!.. it hurts threw out the day..this has been going on for months…what can I do? I also been having leg cramps in my calf’s from time to time…in my sleep I wake up crying!! Please help me..I’m 30 yrs old

  96. Melissa

    I have had this for so long. It has taken years to get answers. I’ve been diagnosed with different issues but when I realized I had joint hypermobility and chronic saccro illiac joint pain I realized I also had piriformis syndrome as well. My ortho briefly mentioned it but then he changed the subject. I believe most Doctors dont like to tell you they really can’t fix your problem. I have tried physical therapy, injection and they never worked. I have a small TENS unit at home that does help briefly, not long term. My pain is constant and has changed my life drastically. In your article I noticed you mentioned the Ozarks and I am from Arkansas. Any information or help/advice would be greatly appreciated.

    • Hello Melissa,

      Go over to my Doctor Schierling dot com site and take a look around. Much more information than this site. BTW, I am in a county that borders Arkansas (I am north of Mountain Home, close to West Plains). Not sure where you are, but as close as you are, it might be worth a trip.

      Dr. Russ

  97. myecco glover

    This really describes what i feel it feels like a permanent charlie horse or a muscule that cant stretch im a 27 yr old male i thought it was due to my broken toe but im not sure what it is but its the worst pain ever im 6’6 and it brings me to my knees

  98. Kathryn

    Thank you for this, as an active person it is disheartening to get to the point where your body doesn’t cooperate anymore. Sitting all day makes me want to stand but then standing for awhile hurts too. I just finished a PT of 2 mos and I feel like I’m back to square 1. I cannot go to the doctor twice a week forever. Diagnosed with bulging disk and hip that is ‘sticky’ but trying to get fit again and it is hard, so sore today after a measly workout last night. I used to be an avid road cyclist too and the long rides (70 miles) are what put me over the edge with this. And, previous doctors had treated me solely for the hip as this article mentions. An anti inflammatory diet helps a little but not 100%.

    • Hello Kathryn,

      Your timing is amazing as I responded to Jay’s post this morning (it may be just above or below this one) about their progressively worsening buttock / leg pain. This person started training for a 100 mile bike ride back in February. They are two weeks out and my guess is they will go ahead with this race. Chronic Pain is simply not worth it. Thank you for your post.

      Dr. Russ

  99. shine

    Hello Doc! I’m female 28 yrs old. Last month when my monthly period ends I felt something warm and like throbbing tightening feeling in my left pelvis area just above my left thigh. The nextday I felt numbness, very warm tingling pain on my hips down to my buttocks and sometimes down to my left legs. But there is no problem on my walking the next week I’m feeling better but the numbness and discomfort feeling still there. I decided to see a doctor and he said I had sprain in ligaments and gave me mefenamic. The pain was gone not until I finished my meds. It came back but now the pain is more on my left hips lower back,thighs and below the belt line ,down to my buttocks and sometimes the back of my left thigh and legs felt like something is vibrating but will gone soon. There’s no problem on my walking or setting but the discomfort feeling won’t go away. As if it felt like something is gripping tightly on left side of my hips,pelvis thighs and occasionally pain at my buttocks area. I’m so confused now if its just this or there’s something else.

  100. Jay

    Started training for a century bike ride in Feb. (This is my first time riding road bikes) My ride is in 2 weeks. Two days ago started with pain in the right ankle and back of thigh. It’s very sore in my right buttocks and I am fine once I’m up and about walking, it’s the sitting that is very painful. Applying any slight pressure along the back of the leg hurts too. I find that 600mg of Ibuprofen does nothing. I have a history of rheumatoid arthritis and a few years ago had a MRI on my spine that found nothing significant. Does this sound like Piriformis Syndrome? Stretching the muscles feels great, and I almost don’t notice any problems one I am walking. I have a 50-mi commute (one way) so it’s especially worse when I get out the car. I don’t think I’ll be able to get into the doctors before the ride. Just wondering what I can do to improve my situation but I don’t want to try something if it’s not piriformis.

    • Hello Jay,

      Sounds like it certainly could be PS. Bikers are prone to PS, Pudendal Nerve Entrapment, and other similar problems. Not sure I would advise you to go through with your bike ride — particularly due to the fact that you’ll be doing 100 miles.

      Dr. Russ

  101. mike

    This is really helpful and educating and even more precise to other diagnostic comments being posted. I actually have difficulty standing upright and walking properly due to a very painful feeling in my butt and hips. I can’t even sit properly after I use the toilet and I feel so weak and tired after I use the toilet. And after I use the toilet, I get painful swelling around my anus I believe is hemorrhoid but just can’t tell the cause of all this pain and its making my life miserable and its like it wants to cripple my life and activities. Bt with this, info on piriformis, I believe its exactly what is wrong with me because I try to stretch to feel good and the stretching is just around my hips and to exercise my leg to align my body.

  102. Kathleen

    Hi – I am getting to be a bit depressed about my condition. I have been running since I was 10 years old and am now 45. I ran competitively and my last half marathon was a 1:40. Have never had any severe injuries, ever. In July 2014 I went running one day and had no problems. They next day I tried to go and couldn’t pick up my right leg with a severe pain and lack of strength in the hamstring area. I did not run for several months hoping it would go away, but I sit here a year later with the same pain and inability to run. The pain seemed to move to my buttock and now I think it is piriformus syndrome. I have had acupuncture treatment and massage but no relief. Any suggestions?

  103. Christine

    Dr. Russ,

    I really need your help. My fiance already had 2 pinched nerves from accidents. He had 9 mm disc bulge before, got laser surgery, which went down to 7 mm, got into another accident and ended up with 2 pinched nerves. He was living with 2 pinched nerves for 3 years but was able to walk, do normal daily activities. One day, (by the way, he is in the roofing business) he was lifting something heavy and he said he felt something pop. He said his back was hurting so we took him to an acupuncture. After acupuncture right when he got off the table while i was trying to help him out of the office his legs looked like they were shaking and jello-like and he was in so much more pain than before the acupuncture treatment. His leg wasn’t hurting before the acupuncture treatment but was in excruciating pain right when he got off the acupuncture table. The acupuncturist said sometimes it takes more pain to get better, but it’s been a month since his last acupuncture visit and his pain centralized to his back and his leg was feeling better a week ago. Suddenly this week his leg AND his back is hurting and it’s like he just took 2 steps backwards and I don’t know what to do. This Friday will be the 4th week. He just felt a whole new type of pain few days ago when he got up too fast from sitting down which scared him. He thought he was getting better but after he got up too fast now he’s not so sure. We are both very scared. He’s been trying to walk around but he’s in pain when he walks so he lays down but when he’s laying down he feels like it hurts more so he sits up, but I told him sitting up isn’t good for him either so, we’re both stuck not knowing what to do and not sure how to handle this. He doesn’t have health insurance.

    Can you help? What’s going on?? I cry everyday. I don’t know what to do I just cry and cry every day while im driving, in the shower. I’m about to lose my job because I’m so nervous and scared.

  104. suzi

    Hi…I am 24 years old and for the past one year i have had severe pain on my right side. Pain feels like it coming from the inside of my bone it’s that deep. I find it hard to get up when I’m sitting or lying down. Pain gets worse when I’m on my feet for a long time. I find it hard to turn around from one side to the other when I’m sleeping. The next day pain is usually less but I can’t walk as fast as I used to. What could it be?

  105. Dylan Johnson

    im an 18 year old male, and about a week ago i was moving some furniture around and the next morning my right butt hurt really bad. the pain then went to my thigh, now its hurting my lower leg and foot. its been a week and the pain seems to be going away, idk though. what could be wrong and how do i treat it?

    • Firstly, it is highly doubtuful that this was the start of PS for you. The fact that it is getting better in a week tells me it’s probably not a full-blown disc herniation either. Head over to my DoctorSchiering.com site and check out the post called “THE TOP TEN WAYS TO LICK CHRONIC LOW BACK PAIN”. I would also consider seeing a local chiro as well.

      Dr. Russ

  106. Marcin

    Hi Russ,

    In some weird coincidence things started looking up soon after I commented here 11 days ago. My nerve issues seem to be slowly going away, first time in months. I was even able to do light squats and deadlifts with correct form yesterday. Your website helped me understand a lot of the things that were happening to me so I wanted to give back and share a few thoughts.

    I think the bottom line is that I had inactive glutes from sitting which eventually caused not only piriformis syndrome but now I see it also must have been the primary reason for sprained ankles in the past. I’m 193cm so I have very long legs. Now that my glutes are much stronger I can feel how unstable my gait had been. The thing with muscles is that you don’t know they are weak until they become strong. I can’t believe I actually used to squat 110kg with these weak glutes. My piriformis must have taken a lot of beating over the years. Actually, both of them.

    For all those people who think they are losing this battle, keep at it! Everybody says to foam roll and stretch but don’t forget to strengthen that ass. If you have a stubborn case like me it’s also absolutely essential to slowly integrate these glutes into the patterns of walking and squatting once they are woken up. Lunges are the best. This will not only prevent your injuries from reoccurring but strong glutes will actually enable you to stretch your piriformis better. Also, stretching muscles is 10x easier when they are warm and tired.

    I also mentioned before that I sometimes experienced an unpleasant nerve “snap” when I sat in lotus position. I now realize it was actually my piriformis letting go of the sciatic nerve. It was unpleasant so I intuitively tried to avoid it, not knowing that I’m actually defeating the point of stretching. As soon as I realized it’s something I should be seeking out, I started seeing effects.

    I’m really looking forward to the next few weeks and the progress I’m going to make in the gym. As much as I hate injuries they helped me understand a lot about my body – but this wouldn’t happen without people like Russ. If only more doctors looked at things holistically… perhaps I wouldn’t have wasted months thinking I have a bulging disc.

    Thanks Doc!


    • Hello Marcin,

      I would love to tell you that my supernatural powers solved your problem halfway around the world, but we both know that’s BS. I love stories like yours. I think that everyone can take something away from this post. Just be aware that not everyone is going to be able to “work through” their problem like you have. There are any number of PS sufferers would would die doing what you are doing. However, I do agree that on at least some level, at least at first, gently, wisely trying to work through a problem can be beneficial.

      Thanks for the comment.
      Dr. Russ

  107. Kay

    Hi Dr. Russ,

    I was doing exercises, leg lifts – lifting my leg to the left only about a few inches high while standing 20 reps. two days later it started with a twitching in my butt muscle (really don’t laugh😉 ) when I was sitting and then it changed to pain deep in the butt muscle. it alternates starts with twitching and then turns into pain.The pain sometimes goes into my foot and leg and butt, or like today just in my butt on the bone part. sitting is terrible (work is really difficult) and lying on my back not so good either (so sleeping is difficult). I feel better when I stand up though it is sometimes in my foot. Is this PS? No idea what to do. Cant take ibuprofen because it hurts my stomach and its been 3 weeks of pain every day now…😦 Help.


    • Hello Kay,

      Something in there (probably the Piriformis Muscle) has been facilitated (turned on). Be aware that there are any number of reasons this can happen. As always, follow standard protocols. You can try to gently work through it like Marcin just commented about. You can do the PS stretches. You can get some sort of massage or Tissue Remodeling. And lastly, never neglect your diet. What you eat is either driving Inflammation or squelching Inflammation. I wish you well.

      Dr. Russ

      • Marcin

        Hello Russ,

        Yes, I am aware of that – but if there is even one person inspired by my post it’s worth it. It’s very easy to fall into victim mentality when piriformis syndrome is ruining your life and nothing seems to help so success stories are important.
        If I have been able to fly over to you for a therapy, I would have done that in a heartbeat, and considering how knowledgeable you are, I would recommend that to anyone with PS. But if somebody is unable to do that, there might be a light at the end of the tunnel if they go about it the right way and they are willing to be consistent about it for months, or perhaps years.

        I’m not lying to myself that it’s over either. I’ve had breakthroughs before but I used to be foolish enough to immediately jump back to heavy training and eventually make the issue worse. It’s much better now but I can still feel sort of a “pulling” to the left in my hip when I walk or squat, even though it’s not painful. To me it’s evidence that I still have too much neural activity in my piriformis so I’m using very light weights and working on my form.

        Anyway, now I understand how difficult it is to unlearn a faulty motor pattern – so eventually sensibility is something I acquired. That’s why I said I learned a lot about my body. Now that my glutes are stronger I have the confidence that if I keep at it, don’t force it and continue with stretches, I may be able to restore the balance in most activities and later be able to reinforce the correct patterns so that I don’t get injured in the future. Being mindful about this little muscle in every step that I make is daunting but it’s doable and comes easier with time.

        Best wishes to anyone reading this.

        Kind regards,

  108. Nicole

    Hi Dr. Russ,
    I have suffered 3 years with intense pain that shoots down my right leg. When I wake up in the morning there is a tightness in my right buttock and the pain is intense, sometimes I can’t even walk. I’ve had an MRI which shows I have a buldging disc on my L4 or 5. I’ve been to massage therapist, chiropractor and I’ve had a one series of three cortisone shot, an epidural and I’m currently taking a mild muscle relaxer because I do not like prescription drugs plus 3-4 ibuprofen a day. I get some relief after a hot shower then a cold shower then taking the motrin. Now that the epidural is wearing off I’ve been told to come back in for another one. The pain in my right buttock it is more severe and now my ankles are hurting mostly in my right ankle, and I have a burning sensation that comes and goes in my lower calf. When I walk for too long my right leg goes numb. I do have a little bit of lower back pain. I’m just not sure what to do anymore. I am overweight, I’m 38 years old and I am a female. I use to exercise but am limited. I’ve begun to eat healthier but exercise is very difficult in this pain. I’m doing stretches that my physical therapist has told me to do but it does only relieve a little. I do pool exercises and chair exercises at this point. What would you recommend?

    • The very first thing I would do is try an intense Scar Tissue Remodeling Treatment on the affected area. If that does not make a difference, try some of the advice on my Doctor Schierling site (“Chronic Low Back Pain and the Thoracolumbar Fascia”).

      Dr. Russ

  109. Ruby

    I started having hip pain,and now I have ,well if I sit let’s say 15to 30min. Or more,to move or get up it will hurt as if I wore broken in between my buttocks the middle bone, I weigh 180pnds. I used to be 145,155pnds,is it because I’m now over weight ,what do I need to do ?

    • While disc problems are often related to weight issues, I don’t find that to be the case with most PS. However, overweight, disc, and some cases of PS are all considered to be “Inflammatory” problems. Visit my Doctor Schierling site for dozens of articles on the best ways to squelch Inflammation.

      Dr. Russ

  110. Marcin

    Hi Dr Russell,

    First of all thank you for your awesome website. Probably the most resourceful place on the net.

    I’ve had sciatica in my left leg for almost a year now (just turned 25, male). MRI showed a minor bulge at S1 but months of conservative treatment went by and the symptoms are still there – and constantly evolving. At first I used to have pains but these days all I have is paresthesias in my heel and the back of my leg, electric shocks in my feet when walking, and an area in my buttocks (near the femur) is numb. Also I started having wet/warm feeling in my calf recently. So all sorts of weird sciatic nerve symptoms.

    I’ve been aware that it might be piriformis for a long time and I’ve done all the stretches, flossing, avoided sitting, foam rolled, strengthened my glutes, worked on fixing my duck-foot gait. Sometimes it feels like I’m making progress and sometimes it feels like delaying something which is getting worse.

    When I sat in a lotus position or something similar, I often felt a “snap” in my butt with an electric shock going down my leg. Piriformis stretches have GREATLY reduced that which tells me it must be related.

    I have nasty trigger points in the butt/where the femur attaches to the thigh (exactly where my butt is numb). Not sure if it’s from the piriformis or hamstring or both but I had a bruise one time after foam rolling – it might be how I tumbled upon your website. It felt like something has separated or “unstuck”. There are other trigger points there which are much deeper and they’re difficult to release even though they’re immensely painful.

    Oh and when I flex my glute in a third world squat position I get a weird sensation going down my leg, almost like something is limiting the range of motion. It’s hard to describe but something is definitely “off” on that side. Could it be fascia?

    Sorry for the wall of text. Just to summarize – I feel like what I have done so far has helped me in restoring some range of motion. I remember I felt like I’m not recruiting a lot of the muscles on my left side when I squatted – they’re firing much better now. So muscle-wise it’s going good but I’m really confused and worried about the new nerve symptoms, especially the “wet/warm” feeling on my calf. I know healing takes time but sometimes I’m losing faith. What do you think?

    Kind regards,

    • Hello Marcin,

      Definitely some sort of nerve irritation. Because diagnostic imaging is so unfruitful for these types of problems, it is difficult to guess what might be causing this. I could narrow it down to the usual suspects as seen / discussed on my site, but telling you which specific one is the culprit, how severe it is, and how long it will take to heal, are virtually impossible via a history. Wishing you the best.

      Dr. Russ

  111. Beatriz

    Dear Dr. Russ.

    I’m a 18 year old female, and I have been dealing with a deep pain since I was 16. It started by only hurting at night, whenever I slept on my side. If I laid on my right, I would wake up because of the extreme pain that has settled on the area around my right upper tight and buttock. The exactly same would happen to the left side.

    My first conclusion was that I must have a deflated and bad matress, but that proved to not be the issue since the pain would happen no matter the surface I slept in. It was a soreness strong enough to make me wake more than 5 times per night, and at the end I’d be so sore that even changing sides wouldn’t help.

    It’s been 2 years and I still have the exact same pain, only it has become worse. Now I can feel it if I run and sometimes when I walk. It’s a very deep pain and it makes my sleep miserable.

    If you have any imput, I’d love to hear it.


    • Hello Beatriz,

      It’s tough to say what this is, but when I see a problem occurring bilaterally, I have to believe it’s coming from the spine — or maybe even systemic. Doubtful it is PS. What does your doctor say about it?

      Dr. Russ

      • Beatriz

        Hi Dr. Russ,

        Thank you very much for your reply. I’ve yet to see a doctor, because I’ve been trying to figure this out for myself, but now it’s come to a point that I know that I simply can’t do it alone. I tried yoga/streching/exercising, but nothing worked for the pain. The more effective method was to take anti-inflammatorys, but even that didn’t help 100%.

        If we can go by soreness, I’d also guess my spine is the issue, since I indeed have lower back pain that doesn’t ease with massages or any sort of muscle therapy.

        I’ll probably see a doctor soon, and in case you’re curious, I can pass by here once again to inform you of the results.

        In any case, thank you again!


      • Am always interested in what you find out, as are my readers.

        Dr. Russ

  112. Jogesh

    I’m 25 years old male.
    I’ve been suffering from stabbing pain in right hip(mostly) for about 10 weeks now. Along with that i also experience episodes of tingling sensation in groin and scrotum area accompanied by weak erections.
    No drug(lyrica) seems to work. Active release therapy(kind of chiropractic adjustment) provide relief but that too lasts only for few hours. After that my hips start getting sore.
    I’ve booked appointment with an neurologist and hope that he might provide me with some solution.

    • Not sure (and not surprised that drugs don’t work), but anytime someone has loss of sexual function or any bowel or bladder issue that don’t respond very quickly to treatment (make sure there is no “Saddle Paresthesia” like that seen in Cauda Equina Syndrome — see my Doctor Schierling site for more info), I would strongly consider a neurological consult — especially after ten weeks. Please do me a favor and let me know what you are told at your visit with the Neurologist.

      Dr. Russ

      • Jogesh

        My neurologist sent me to get MRI focusing on Pudendal nerve. Report showed a lipoma 2.5 cm in size on anteroinferior margin of left piriformis muscle over which pudendal nerve is draped. Then he sent me for nerve root injection targeting pudendal nerve to conclude whether it was lipoma around pudendal nerve causing problem , which I underwent.First two days, symptoms would flare up, but on third day my tingling and pain decreased considerably and i was able achieve erections. this continued for about 5 days and now all symptoms are coming back.
        Whats your take on all of this.

      • Hello Jogesh,

        I am no expert, but you have a fatty tumor that is approximately 1 inch around, and it sounds like it could be causing much of your problem. I would talk to your doctors and maybe even get another opinion.

        Dr. Russ

  113. carol

    I have been diagnosed with ishieal bursitis. I’m wondering if this could be fro. Pirformus syndrome. I do have this issue and USUALLY massage therapy relieve the hip pain and SI pain but the sitting is still issue.

  114. Dan Orcherton

    I have a pain in the lower part, to the right of the anus. It hurts when I sit for a bout an hour or so. It is fine when I get up and walk a little. Not sure what to do. Can you offer a solution. I had a right kneww miniscus tear about 5 months ago, and I am taking Ntures Way (Joint restore) (Glucosamine+Chondroitin and MSM. WHat do I need to do? THanks Dan

    • Not likely a supplement is going to solve this problem. My first thought is Weaver’s Bottom or Ischial Bursitis, which you can read about on my Doctor Schierling dot com site. I also have an article called What are the Most Common Causes of Butt Pain?“.

      Dr. Russ

  115. Joy

    Hi i had sharp pains come and go in my but while sitting. Leg would often hurt along with my hips. While standing on my feet would hurt also. My toes started getting numb. Then later felt like i was walking on a ball. Had pains in my legs until now they have given out where im not walking. I can move them and stand on them but too stiff to walk. Almost be two years no knows whats wrong with me.

  116. Adi

    hi im getting pain in the butt when i drive more than an hour, driving a bike not a car, i dont experience much pain driving car. I live in india, so we are dependent on bikes rather than cars. I don’t kno if this is associated with piriformis-syn., but its miserable to have that pain. No i haven’t showed this to any doctor/consulted a doctor., it usually occurs while driving back home, rather than going to college. My college is around 25kms from my place. please help!

    • Hello Adi,

      Doubtful this is PS. Look at the test I have talked about numerous times in this thread. I would spend some time foam rolling or using a tennis or similar ball to roll around on. Also, try doing the PS stretches for your glutes and TL Fascia and see if this helps.

      Dr. Russ

  117. emily

    I am a 21 year old female personal trainer and hence do a bit of resistence training and run quite a bit. Earlier this year i began getting a very deep pain in my right buttock and hip area. I thought it was my hip flexor but a sports therapist said i had extremely tight piraformis. Whenever I would pick something heavy up I would get a sudden pain in my buttock. Its getting worse but the thing is that it never hurts while I train or run only after even if i stretch. When it is massaged I get a numbness down the side of my leg into my tibialis anterior and outer ankle.
    Do you know what this is?? And how do I make this pain go away?

    • Hello Emily,

      I have left several links to the “Test” I use in the office. Although there is no sure-fire way to know whether or not this is PS, disc, or something else, use your search feature to look for the word ‘test’ then do it.

      Dr. Russ

  118. Kim

    Hello Dr Russ,
    When you say “faulty spinal mechanics”
    would a spinal fusion (L2-L5) be included in that description?
    I have painful adhesions after a discectomy just below the fusion.
    I have additional (different) pain that wraps around my hips and is also deep into my buttocks. Pretty sure this different pain is from something other than the adhesions.
    I greatly appreciate that you explain things in layman’s terms, as I’m not a medical professional.
    Any thoughts or ideas would. Be greatly appreciated.

    Thanks, Kim C.

    • Hello Kim,

      Sorry I was not clearer about that, but yes, a four-level spinal fusion would count as, “faulty spinal mechanics”. According to the latest medical research, it’s extremely difficult (many would say impossible) to tell what pain is coming from what tissue in a normal spine. Once you’ve fused those segments, all bets are off. Bear in mind that this does not mean there is no hope for you. It just means you have to attack these things from any number of angles (Biomechanical, Anti-inflammatory Diet, Gut Health, etc, etc, etc). I wish you the best and if there is any way I can help you out, please don’t hesitate to ask.

      Dr. Russ

  119. Kimberly W.

    Hi Dr. Russ,

    I am writing today to get your opinion on what might be the cause of constant pain in my right hip. It started off in February of this year with just a minimal uncomfortable pain when I laid down at night. It eventually got to the point that I could not sleep due to the pain going all the way down my right leg and causing a numbness and sharp shooting pains on my right hip/buttocks area. I went skiing the beginning of March of this year and after that trip and during it, the pain intensified. I tried a chiro and he did EMS on me but told me that I was too tight to even work on and referred me to a Sports Medicine doctor. I went to see the Dr. and he did a minimal exam and touched what he said was my bursa sac and identified that what I was experiencing was Bursitis. He suggested an injection in to the Bursa Sac and I agreed as I thought he would know best. The pain from the injection of the bursa sac was excruciating. He told me that I would feel better within 4-5 days. The pain went away for a couple of days (not for at least 7 days later) and then came back. My workout is being affected and I am wondering if the workout could also be the issue. I do Barre, Flywheel (used to do this but it hurts too bad now), and TRX training and I play tennis. The pain isn’t going away and my friend suggested your site as it seems I might be experiencing PS. Does this sound like PS instead of Bursitis to you? Should I be limiting my exercise or increasing my stretching more? Thanks ahead of time for your response.

    My best,

    • Hello Kimberly,

      I have never seen a case of Hip Bursitis causing Sciatica. Too tight to work on? Go over to my DoctorSchierling.com site and read my post called “Chronic Low Back Pain and the Thoracolumbar Fascia“. I recently wrote about these injections and their guidelines, and the fact that they are not very effective (and are very degenerative). This could certainly be PS but it is so hard to say without more info.

      Dr. Russ

  120. Laverta

    I hope someone can supply me with some answers. I am a 47 year old female who was diagnosed with Sciatica about 4 months ago. I had started having unreal tightness and spasms in my buttocks and the back of my legs. I have Googled several topics in regards to this and was practicing multiple stretches at home to try and get some relief. The muscle relaxants they had me taking where not providing much if any relief and seem to be causing a exacerbation of my chronic migraines. The pain and spasms have now advanced to my outer foot. Actually both feet are being affected. I am have unbearable pain and cramps in the outer portion of my feet opposite side of my arch. Nothing I do seems to relieve the pain. Now to make matters worse the other day I was taking my very large dog outside and was heading over the back deck steps. My dog saw something and shot after it before I realized what he was doing . So I immediately became airborne off the the steps and while in midair I hear and feel a loud pop up under my right butt cheek. Then I landed on the ground. At first I was afraid to try and move I first thought was I had broke a bone somewhere because of the loud pop/snap sound I had heard as well as the pain that I felt with it. Then I did attempt to get up and immedately could tell my back right leg muscle and butt muscle was not as tight but instead now I am experiencing increased pain up under my right butt cheek especially when I sit down. It is now painful to touch. I’m afraid to try and stretch those muscles now. I don’t know if a muscle or tendon tore or ripped or if there is a bone up under there that broke. I carry a chronic low vitamin D level and have broke just about every toe on my feet just by knocking my feet into something. So it seems as though I’m predispose to brittle bones or osteoporosis although I have never been medically diagnosed with osteoporosis. I sure hope someone has some answers for me. The pain and cramps in my feet is really becoming unbearable and now this pain/injury under my right buttock really hurts and has me worried. I’ll end by adding I’m still having muscles spasms in the back of my thighs it just isn’t as tight or as bad as it was before I heard the loud pop when I went flying off the steps. Thanks in advance for any input. Laverta

  121. O

    Hi Dr Russ. I have been having pain deep in the left side of my buttocks for some time now. However I can’t say if it started before or after I had my baby one year ago. I’ve always had lower back pains on my left side (before pregnancy as I had sprained my back some two years prior) but this sharp pain only became painfully noticeable recently when I lie on my back for an extended period. Attempting to move afterward always feel like I’m trying to bend or stretch something too taunt or stiff to move. (I should also say that my hips are 56ins and so I have a deep arch when lying on my back – don’t know if that’s improtant). However, I’ve had six ultrasound treatment sessions but the pain is still there… Is this piriformis syndrome and what other treatments can I utilise? Will it ever go away? I love the gym but I am afraid to workout now thinking that I might aggravate the inflamed area…. But this inactive lifestyle is also seeing me packing on the weight slowly and am sure that can’t be good either……

    • Hello O,

      My opinion based on 25 years in the field is that ultrasound rarely provides great results — particularly for severe problems. You need to try some form of hardcore tissue remodeling as seen on my Doctor Schierling dot com site.

      Dr. Russ

  122. Brian

    Hi there. Would love to have your opinion. Among other things I suffer from L5 spondylolisthesis over S1, with local pain and nerve pain in the legs/feet.

    I have a long story but I will just focus on one bit – about 2 months ago pain in my rear hip, side hip, and butt area (which has been there for years in various mild forms) rapidly increased over the period of about a week. There is no additional/different nerve pain that came along with this. In the past I could relieve my butt pain by going for a good walk. Now, with the pain much worse, nothing helps other than laying down – even better if I lay down on my back. Heat helps but not much, as does working into my butt with a Body Back Buddy tool. These two things give me more transient relief that lasting relief. I have pills for my back and chronic headaches but they don’t much help my butt pain. My pain management doc thinks it’s referred spondylolisthesis pain but my experience is that every different doctor will have a different opinion about something that isn’t totally clear cut… appreciate your thoughts

    • Brian

      I personally think that my SI joints might be involved. My hips/legs are uneven even with a lift in one shoe, and I had an xray once that showed possible signs of arthritic SI changes. A lot of this pain I describe is very close to the sacrum, especially later in the day, which I suspect is why my pain doc is so quick to blame the spondylolosthesis. I am a 25yo male by the way. Thanks

      • Hello Brian,

        Firstly, what grade is the spondylo? Butt pain often times arises from SI issue (I have a couple articles about this on my Doctor Schierlilng dot com site), but your doc could be correct about the spondylo. Also, have you tried the piriformis stretches?

        Dr. Russ

  123. M

    Hi, I’m a teenage endurance athlete and I think may have this however I don’t match a lot of the symptoms. I’ve recently got back into running after an injury to my iliac crest due to what we assumed, was growing and overworking however after developing another pain in my hamstring/hip/buttocks I am beginning to doubt this explanation and wondering if it may be this or something biomechanically at fault. It aches slightly however I don’t pay attention to this, I get a sharp pain with weight bearing on my hip and it feels like I can’t move it as freely when weight bearing in contrast to the other side, and it hurts to bend down with my legs not bent. I went to physio and found everything was fine except having tight hamstrings due to growing and an slightly flat arch- which could a reason for my pain however it feels deep inside my buttocks near my hip. It hurts to walk sometimes when I’m thinking about how I am walking, so I don’t know if it hurts to walk normally and I’m almost as if limping. I’m also getting intermittent pains in my knees I’ve tried ice, rest, stretching and it hasn’t seemed to ease off! I’m so sick of being injured! Do you have any idea to what it could be if not piriformis syndrome and have you seen any similar cases? I know I’ve probably totally misdiagnosed myself and will have only irritated a muscle however it’s hard not to come up with possible explanations and going to the doctors never really seems to prove that helpful.Thanks for your time and I’m so glad I came across this page/article?


    • Doubtful this is PS. However, it is almost certainly some sort of myofascial issue. Depending on where in the illiac crest your pain is, this could be pointing at a muscle imbalance issue, particularly in a hip flexor, IT Band, or one of the abdominals.

      Dr. Russ

  124. Leta pritchard

    i fell on left leg then rolled onto left hip then i fell over on my coffee cup landed on ribs broke 3. Now horrible pain down left leg and on butt more towards rectum can’t sit. My left leg is numb on the outside all the way down from hip to little toe can’t stands for sheets to touch that part of my leg cant get answers

  125. Jeff a

    I have been having severe buttock pain on my right side. When I lay down at night it goes away. I took three days off from running. When I went back to it, I tried to run 6 easy miles at a 7:23 pace. By the third mile I had to stop the pain in my buttock was debilitating. someone please help

  126. balaji

    i am 21 years old. I have pain down my right leg for the past 3 months. back of my thigh and region between right low back and upper buttock hurts while sitting. i feel pain in all parts of the right leg sometimes especially the outside hip. can u predict what could be cause of this pain, herniated disc or piriformis syndrome?

    thanks in advance

  127. Keeandra

    Hi I’m 23 years old and for the past 5 years I’ve experienced pain in my right half of my butt and recently the pain has been more excruciating maybe because I drive a lot but the pain starts from leg and goes all the way up to my butt only a really deep stretch helps the pain nothing else. I’m just wondering what it is? Would you recommend deep tissue massages? If not what else would you recommend?

  128. Nona

    41 yr old female, not overweight, physically active (fitness instructor) and started having low back (si joint) issues about 10 yrs ago. This was right after I had my 1st born. Pain seemed to come off and on, back would go out about once every year. Very doable right? This past year, my back has gone out a lot more and now have non-stop butt /hip and SI joint pain. Stabbing and sharp pain only on the right side.
    Doctor said its piriformis syndrome irritating the sciatic nerve. I am going to a chiropractor regularly and it seems to help a bit even though it is still there and I have good and bad days.
    I also think I have hemmorhoids, in and external. Could that contribute to this? Not sure, just wondering. I’m doing everything I’m supposed to do. I eat right, I’m active, I stretch, meditate and sleep well. Anything else you can recommend I should do? Getting hopeless at this point!

  129. Vanessa

    This type of pain started during my last pregnancy. It was so bad some days I could not get up to walk with out feeling the worst pain ever imaginable. After delivery it miraculously disappeared. Its been a year and a half and it’s returned. And getting a little bit more painful every day. my dr sent me for an mri and of course found nothing. I’m not sure what to do moving forward.

    • Hello Vanessa,

      All I can tell you is that women get PS at a much greater rate than men. Whether knowingly or unknowingly, much of this starts with childbearing. As far as moving forward, keep your eyes on my Doctor Schierling dot com site because I am going to do a PS “self-help” post in the very near future.

      Dr. Russ

      Dr. Russ

  130. Rebecca

    46 year old female. I have lower back trouble for many years and it was mostly due to having 5 children and carrying them around on my hip. However, a few months ago, I began to feel a deep ache in my right buttock. I could feel it when I walked or stretched a certain way. The pain is worse at night, so bad that I resorted to trying to sleep sitting up, and then just dreaded night time. I just didn’t want to feel the pain and the fear that happens when you can’t roll over, or move, and when you finally can, it is so painful. I’ve tried to describe the pain to my oldest daughters, and it is so difficult to describe. It’s like a Charlie horse, dull ache, “stowed up”, unbelievable sort of pain. I finally broke down and went to a Chiropractor here in town and I’m praying his treatment will relieve me of the pain and let me sleep again. What I’ve read on this site, seems to be exactly what I’m feeling. I want my Chiropractor to read this site!!! I can’t afford the care I need, (single mom to all those angel babies!) is there anything you can tell me to do that is the most important that I can do on my own? I see all the stretches and I’m already doing some, although a couple hit the spot exactly and it really hurts. Also, I’ve a had a rash on my shins for over two years. it comes and goes. Mostly my right leg. One day a few months ago, I woke up with a huge indention in my shin, right next to the rash.(went to the ER, they said take Benedryl) My ankle looked swollen. Can this Piriformis muscle be causing this slight swelling and maybe even the rash?

    • Hello Rebecca,

      Firstly, bear in mind that there is a distinct possibility that this buttock pain could be the result of a disc issue. Secondly, any time you irritate a nerve, there is irritation along the path of that nerve. This can manifest in nothing tangible, symptoms such as pain / numbness / tingling / etc, or it can sometimes exhibit visible or non musculoskeletal symptoms (sometimes these might seem unrelated — HERE). As far as relief is concerned, look back at the link I gave on Thoracolumbar Fascia (it has a number of self-help items). You could also try sitting on a ball or foam roller. Sometimes stretching is counterproductive if the adhesed tissue is not broken up first.

      Dr. Russ

  131. Mike A

    60 year old male…terrible ache in right buttock area. A PT says its Piriformis Syndrome.. His services did absolutely no good. Walking for a 1/4 mile starts the pain…within a 1/2 miles pain go to a 8 or 9… If i start running the psin goes away instantly… When i stop running the pain comes right back… I bicycled 120 miles recently and had absolutely no pain. When i unicycle i get pain…tylenol, ibuprophen does not help…i have been running, swimming, bicycling for 43 years. The pain started about 3 years ago.

  132. sandra

    I have had si joint injection they worked for 3 weeks. Pain is back.which includes pirifmoris pain. It’s been over 11 yrs now of pain. How can I know if my si joint or pirifmoris is causing my chronic sciatica? What tests do u recommend as mri was clear?

    • Hello Sandra,

      There are some simple orthopedic tests that can help, which every chiropractor is familiar with. As far as imaging, these sorts of problems — especially when there is a substantial fascial or muscular component — don’t image well.

      Dr. Russ

  133. Katherine

    My name is Kat, I am 27 years old and recently gave birth to my first child. I knew I would be sore but my butt is STILL sore and it has been about 9 weeks! The doctors and nurses told me it would subside after about 6 weeks, and to expect tenderness since my knees were literally AT my ears while delivering. I hurt after resting or sitting for more than ten minutes or so, getting up helps a little bit, but I am always hurting. Is it possible that during labor/delivery I stretched my glute muscles so far that now I have scar tissue in the Fascia? Is this the beginning of Piriformis? What can I do to relieve the pain, are there specific stretches that help?
    Any help you can offer would be appreciated! Thanks!

  134. Natalie

    I’ve had a really low ache/pain in my lower back for 4 weeks, came on overnight, feels sore when sitting or bending forward, fine standing/walking/running.
    I do weightlifting but cannot recall a ‘bad lift’ or twinning my lower back.
    It’s really low near my butt crack and feels really deep, cannot foam roll it away.
    My sports therapist thinks it is SI joint dysfunction, what do you think?

  135. Tori

    Hello Doc,

    I am 21 years old and I just had a baby 6 months ago. I had a normal pregnancy and a vaginal delivery with an epidural. I developed some really debilitating sciatic pain shooting down my left leg a couple of days after I came home from the hospital. I don’t think the epi had anything to do with it. At first I thought I had a slipped disc but then I realized the pain is more localized deep in my lower buttock next to my hip. I take ibuprofen at least twice a day and I’ve noticed that when I’m up and active at my job I notice the pain less than when I have been sitting down for a while. I feel like an 80 year old woman when I get out of bed in the mornings and sometimes the pain keeps me up at night if I haven’t taken ibuprofen. It’s like a constant stabbing pain in my hip and it jolts all the way down to my pinky toe. I went to a couple chiropractor sessions to get adjusted and some pressure relief but it didn’t seem to help. I’m not as active as I used to be because it hurts so bad I want to scream. What can I do to make this pain go away?

  136. Katherine Palmer

    I am 27 yrs old and gave birth to my first child about 9 weeks ago. My buttocks has been super sore ever since; the doctor/nurses said it would be for about six weeks but I hasn’t got much better. It’s it possible that I stretched out my muscles (my knees were literally AT my ears during delivery!) and am now suffering due to scar tissue in the fascia?
    I don’t suffer from sciatica, but I do get Plantar Fasciitis and it has been flaring up the last couple of weeks. Is this ache going to subside or am I likely to hurt for the rest of my life!?

  137. Denise

    So you just live with the pain? I have been in pain for going on 5 years now. No doctor can find anything wrong according to my Bloodwork.
    My pain is so severe that I wake up every 45min to a hour of sleep.
    The pain is in my butt.. more in the hip and pelvis area leading down to the bottom of my feet. I can not walk in the mornings for the first 15 to 20 min
    Is there a specific blood test for this?
    Any information would be great.

  138. Monina

    Thank you very much for the information. I just would like to ask how many in your practice had the piriformis syndrome as a complication of a total hip replacement? I had bilateral hip replacement and my left was affected that I developed a “foot drop”. The pain is so severe and I’m wondering what I can do as not to let the same thing happen to my right. What to do for my left that has already been damaged I think. Hope you could help me. Thanks. …. Monina

    • Hello Monina,

      I have seen some people with messed up Fascia after having a total hip replacement. Did see a gentleman once who, due to an array of complications, ended up with four different replacements in a couple year period. He had a scar that looked more like a trench at the area of his trochanter. Was able to help him about 60% over three treatments. He had lots of symptoms of PS, but I’m not sure it that’s what you would call it.

      Dr. Russ

  139. Kimberly

    Hi Doc. I am 52, 140, 5’7 female. Recently underwent 3 EPI for DDD(s1,L4-5) and it has helped significantly. However, I believe 2 things are going on and have told my doctor this. RS pain in the hip/upper buttock pain that feels like a spike in the bone has not benefited from the EPI(which I hope never to do again, neck headaches now, getting better each day tho). Hip pain comes on at night after a few hrs of sleep and WOW it wakes me and I have to stand and walk around. Ive been an active woman until this last year. I am the primary driver and have height arches(wore a lot of heals in the day). Any advice would be appreciated as I must convey to my Doc some idea of its source. As you have said ” its not his pain in the butt”. Last two nights have been worse, -6 in Michigan right now, just mentioning as some days I feel like a human barameter. MRI showed some arthritis but nothing worth medicating. Have pain meds for the really bad nights, Thanks for this sight!

    • Hello Kimberly,

      It can sometimes be nearly impossible to tell the difference between a lumbar disc issue and Piriformis Syndrome. As far as the injections go, while I am a huge fan of avoiding surgery if at all possible, you have to understand that STEROID INJECTIONS present some unique problems (i.e. side effects) of their own. The very first thing I would suggest that you do would be to declare war on INFLAMMATION (without the drugs). Click on the link and start reading the posts for more information. Glad you enjoy the site.

      Dr. Russ

  140. Patricia

    Hello, I am 12 years old. This has been happening to me for a long time. I work out, I have a job, and I frequently move truck loads of stuff in and out of a form of storage space. It hurts to walk. It hurts to sit. It hurts to sleep. I commonly find an aching pain in middle part of my butt. Some days I have trouble walking because my leg( any part from the thigh to the feet) hurts. I don’t know what to do. I am so discomforted, I don’t even want to sit down, or really walk anywhere. Can you tell me what’s wrong? Also, every time I sit down, my feet become numb.

    • Hello Patricia,

      There are a couple of clues in this history. Firstly, I am impressed that a 12 year old has a solid job and works out (maybe you’re 21 and transposed the numbers?). An inability to sit is characteristic of PS, but is also a common characteristic of disc problems as well. Because both of your feet go numb, I have doubts about PS. It almost makes me wonder if you have a Grade III (or even IV) Spondylolisthesis. Tough for me to say, but at your age I would have this at least looked at and evaluated by someone who knows what they are doing.

      Dr. Russ

  141. Emily


    Thank you for your informative articles! I’m 21 years old and in mid/late Oct. of 2014 I began to get an aching pain/tight feeling in my lower butt and hip area. I thought maybe it was due to the cold weather approaching, but now I’m becoming more concerned it’s something else. The pain is only in the right side, no tingling or discomfort in other areas of the body aside from lower back pain, but my current job cleaning houses could be the culprit of that (also, some intense lower back pain when my period starts is normal for me)
    Going up any kind of stairs or even doing some gentle yoga where leg raises are involved, I can hear something not quite like a popping or grinding but something in my hip area does make an audible sound. It is more uncomfortable than anything and happens in both hips, although the right side is more prone to pain afterwards.
    There are some days where I wake up and have a kind of limp because of the discomfort. sitting for long periods of time and especially sleeping is difficult. I try to have a pillow between my legs or to sleep on one side to help (lying face up with legs straight gives me a cramped feeling in the afflicted area, making it worse) right now I’m only occasionally taking Aleve or Advil for this.
    I used to regularly see a chiropractor around the time I was in high school for frequent tightness/tension in my back/neck (which still troubles me to this day but I cannot afford to return) during the examination I was told I have flat feet but there was never any mention at the time of potential hip problems?
    a few weeks ago I went cross country skiiing and fell a couple of times on my butt—could this have done something significant to worsen the pain? It’s much more regular since this incident.
    Thank you in advance for any advice you can give

  142. Chelsea

    HI Doc, I’ve been dealing with some sort of piriformis syndrome for 3 years. It comes and goes and then comes back with a vengeance, leave me in terrible pain, not being able to sleep at night and making it painful to sit at my desk, drive, etc. My leg will go numb and tingle at times, sometimes the pain will shoot down the back side of my thigh. Stretching temporarily relieves the pain as well as having someone dig their elbow into it (under my pelvis)… I’ve been referred to physical therapy so I hope it works, but my general doctor did not take me very seriously at all because I wasn’t in pain when I saw him about it. It’s right where a wallet would sit on my butt… it’s a deep pain that feels like it’s under a bunch of muscles. It’s certainly the most annoying thing I’ve dealt with and I can’t live the rest of my life like this. I’m only 27… Pointing me in the direction of a few options to cure this would be helpful. Thank you.

    • Sounds like Piriformis Syndrome. Be at least somewhat cautious with the elbow. I recently treated a woman who was living a normal pain-free and active life until someone put an elbow in her buttock. She developed PS from this that has turned her life upside down. As far as where to find information, I would say that by BLOG POSTS on the subject are a good place to start.

      Dr. Russ

  143. Michelle

    I hope you can help me to figure out what’s going on… Approximately 10 months ago, after a yoga class I attended regularly, I was walking through a grocery store and experienced severe “cramping” in my left hip area. This went on for months, sometimes episodes worse than others. A sports med doctor, after an mri that showed nothing wrong, diagnosed piriformis. I’ve also spent hours in physical therapy, cortisine injections, tens sessions and it still hasn’t gone away. However, my pain doesn’t come when lying down or sitting, its when I walk or stand and aggravated by running or hiking. The pain is excruciating and it’s completely changed my very active lifestyle. I can get the pain to subside with reduced exercise, but it always returns when I resume normal workouts. Help please….

  144. Keith

    Doc, I am confused whether I might have PS, hamstring syndrome, or possibly something else. It all started with carrying a heavy load and a quick unbalanced position that caused shooting pain up my back(pins and needles). At first I figured I pulled a muscle in my lower back, left side. My back was very stiff and painful for several weeks, but it gradually subsided. Now I am back to running, lifting, yoga, etc., however, my hamstrings (specifically where they attach in my buttocks) are extremely tight and I have lower back stiffness/tightness. At one point I had tingling down my left leg for several weeks; although, that is virtually nonexistent now. Using a massage roller or rolling on a hard ball I can feel pain around the outside of the boney part of my buttocks and lower part of my back. Nothing seems to bother me when exercising; afterwards though I can feel my hamstrings tighting/knotting which eventually refers into my lower back. This is more pronounced with any exercise involving the hamstrings. If I massage my hamstrings when they tighten it seems to release the pressure, but only for a little while before things tighten up again.

    Any ideas? Thanks..

    • Hello Keith,

      This could be any number of things. Bear in mind that part of the hamstring muscle actually attaches to the sacrotuberous ligament. This is why problems in this area can be cause by hamstrings, piriformis, thoracolumbar fascia, or all three (HERE).

      Dr. Russ

  145. Tim raleigh

    my right butt cheek pain meets a lot of the criteria, but is relieved by sitting. it’s more of a very strong stabbing pain if I activate the muscle in the wrong position. I have also had the same pain but in the groin, which seems like it might be the same problem but on the opposite side; it’s never been on both sides at the same time. the butt cheek pain seems to be triggered by pressure on the tail bone (SIJ I think), eg lying down flat on a flat floor will trigger it straight away. the groin side pain seems to be triggered by sleeping on my side without a pillow between my legs. any thoughts? thanks greatly

  146. blackwell1117

    Dr.Russ my left buttock started aching at night a couple of days ago then today while sitting at my desk working i began to experience sharp shooting pains intermittently in the outside of my hip. The pain comes and goes sometimes strong some mild. Mostly when I’m sitting or lying down occasionally when walking but it never stays long. No problem walking or standing or dancing. A lol tenderness on my hip bone when I press on it. I also had some.numbness when ever I laid on it but after massaging it it was fine. could this ps?

  147. luv2teachu

    I am almost positive I have PS. Deep buttock pain that is “hard to find” when being massaged, began when I was a runner, pain and numbness down my leg. However, my leg pain is on my OUTSIDE thigh, instead of the back. Have you seen this? Thank you!

  148. Debra Nelson

    Hello,, I’m not sure if I’m doing this right and if it will show up here, but here goes. About 7 weeks ago during Bikram hot yoga I was doing a floor pose called sitting head to knee. I was sitting with my left leg out at an angle, my right leg bent and my right foot pressed against my inner left thigh. We are to then have our arms stretched up above our heads, clasp our hands, turn our body to the left and bend down and grasp our feet 2″ below our toes and then curl and bend down to touch our head to our knees. I’ve been doing this hot yoga for 4 years but during that class 7 weeks ago I lost concentration and I turned my body, bent over and then ‘adjusted’ my left leg by walking my buttock a little forward all at the same time and I felt something….can’t really describe it, it didn’t hurt, it just felt odd, wrong. I was able to finish my practice without a problem. Later than evening I started to experience pain in my upper left thigh, at the very upper part, and I’ve had it since then. I cannot touch my toes from a standing position anymore without experiencing extreme pain in my upper left thigh, it almost feels like the pain wraps around my upper left thing. The only other time I feel pain is when I try to take a running step, then I feel pain in the front top of my left thigh. I have been to a physio therapist who said I have torn my gluteus medius, a licensed massage therapist who says I have tight (erector?) muscles in my back and a D.O. who says it’s my piriformis. When I research all of these suggestions I don’t feel like I fit any of them because my pain does not worsen with sitting or lying down. I can do any movements, including all yoga poses except the ones when I am standing with straight legs and bending forward at the waist or just running/taking quick steps. I can also put all of my weight on the left leg without any issues as well. Can you please help? Thank-you for your time.

    • This is almost certainly not PS — at least not yet. It is, however, some sort of myofascial issue — probably a Fascial Tear tear (microscopic) of some sort.

      Dr. Russ

      • Debra Nelson

        Thank-you so much! I did some research just now and yes, I seem to have more of those symptoms than the other diagnosis that I have received. Would you suggest I do some stretches of that area and in the meantime avoid hot yoga until my pain has gone? or could I continue with hot yoga and just avoid doing any of the poses that would cause pain?

  149. Lyle

    In advance, I want to say really appreciate any insight. I am a 29 year old male, former competitive athlete now suffering from intense pain in my right upper leg/butt cheek while sitting. I pulled/tore a hamstring 11 months ago sprinting in a kickball game (stupid, I know). I rehabbed my hamstring back to 100% over a five month period. I have since tweaked this muscle twice. The first time I was back to 100% in a couple months, the the second time has been a different story. What felt like a minor aggravation has turned into an almost unbearable pain while sitting. I have been told it is a hamstring issue by a PT, but the pain is much different than what I previously felt. In addition to rehab-centric stretching, strengthening exercises and an Aleve regimen, I have had Graston techniques, dry needling, stem and ultrasound performed on me – nothing is working. In fact, I’d say it’s getting worse. I also have a history of neck, pec and back issues, although these never previously translated into leg issues. What are your thoughts? I have an appointment with an Ortho/sports medicine physician this Friday. Will an MRI reveal what my issue is (and hopefully shed light on a treatment)? Should I get a Cortisone shot?

    Thank you

  150. gsrinteriordesign

    After trying to really pinpoint a cause of my discomfort I honed on a possible piriformis injury and your site. Two years ago I over-extended doing a standing bow pose and heard a ‘pop’ and experienced significant pain (in the standing leg). I immediately worked with an excellent therapist who, with some great stretching sessions, greatly alleviated my issues walking and with stairs, but I have lingering pain deep in my left buttock and have ever since. It is definitely exacerbated by sitting for extended periods of time and I’ve never fully regained flexibility on that side. That said, unless I’m doing something strenuous it’s much more like a very restless discomfort (eg during long flights or extended running). Given the activity that is the source of the injury and the remaining symptoms do you feel that it is indeed damage to the piriformis muscle?

    • You definitely “popped” some tissue somewhere. Whether it’s the piroformis or not; who knows? It certainly could be. Honestly, the first thing I would do at this point is to sit on a tennis ball and “waller” around on it in the area of pain (you might need something harder like a baseball). Or you could have your husband stick his elbow in the area and work it out. You have to be careful because one of the worst cases of all out debilitating Piriformis Syndrome I ever saw was the result of a massage therapist getting over-aggressive with an elbow in a 60 year old woman’s glute. She had moderate discomfort until that point. Although I admire her toughness, she is virtually incapacitated at this point.

      Dr. Russ

      • gsrinteriordesign

        Thank you for the thoughts!

      • CORTICOSTEROID INJECTIONS are always a roll of the dice. Part of the hamstring is attatched to the Sacrotuberous Ligament, which is itself intimately related to the Piriformis Muscle. Search my DoctorSchierling.com site, as I wrote an article on this (it may be at Spinal Decompression Missouri). Bottom line, if you have scar tissue in that hammy you run the risk of repeatedly “tweaking” it.

        Dr. Russ

  151. laritaraine

    I have been complaining of right “hip” pain for the last 5 years. Mostly came at night especially after working and around my period. I was told it was due to a lumbar strain. I took epidural injections which worked but then stopped. I was at a loss when my pain doctor offered up Gabapentin. It worked for several months. I realized it stopped working and then I stopped taking it. I then injured my back helping a patient in September. The pain in my back was there, but Deep butt pain was gnawing at me worse than ever. Then a limp came.Now I’m barely walking. I’m going to therapy,and it loosened my leg a little, but I need walker for any long distances. I can’t work because I’m a nurse and its a very strenuous physical job. Long hallways and hard concrete floors. I’ve had 2 children, and 2 epidurals. I’m 48…49 tomorrow and so sad. I am also an RN instructor and can’t do that either because of the running up and down stairs. My doctors are trying their damndest to find out and almost everything has come back normal. I am terrified of getting addicted to pain meds. I just sit here in bed clenching my jaws with this pain. Today I barely made it out if therapy. EMGs were Negative and extremely painful. I can’t live with this situation.

  152. I am in despair. i was diagnosed with PS about 6 years ago, and went through several months of physiotherapy. However, I could not keep up with the exercises I was given, even at a reduced scheduled, because every time I did them I would hurt far worse for the next two days or so. I stretch every day, but am still frequently in pain. I had a cortisone injection about 10 moths ago, which worked for about 10 days. Massage and needling also made the pain worse. Any other ideas? I am really worried this inflammation will become permanent, if it hasn’t already.

  153. karen

    Hello I am 41 yrs old that had surgery in 2011 for a spinal cord compression in my neck. I have had since then pain deep in my butt cheek left side it feels like deep bone pain. I get raking pain in front of thighs knees and feet with no feeling in last 2 toes the feeling feels like frostbite the only way to describe . Can that be ps? I do have bone edema and its so painful. I notice it most at night even tho its painful all the time. Any suggestions to relieve it? I hate the feeling and its now affecting both sides. I don’t wanna have to take pain meds even tho they do help slightly

    • As strange as it sounds, this could be some sort of neurological interference coming from your neck. I saw it once in a woman with a tumor. It’s extremely difficult to say because so many of the tests that physicians run do not show up problems unless they are over-the-top bad.

      Dr. Russ

  154. Debra

    I have recently had pain inmy butt cheek on the right side. The pain radiates to the back of my knee only, not the back of my leg or my hip. It is especially noticable when sitting at work (desk job) , and especailly driving (my gas foot) Standing, walking, sleeping(laying down) are all helpful. Pain medication and aheating pad helps. I am quite active and have found running helps for a day or two, but then sitting starts it up again. Could this be piriformis syndrome? (PS I also have pain in my tailbone)

  155. Richard


    My name is Richard, I have every symptom posted in the article. My question is, is it possible for PS to possibly switch sides repeatedly? And does stretching while the pain is high help or make it worse? Seems like it gets worse when I go to strecth it out.

    • Not surprised that stretching it can make it worse. If scar tissue is present, you are essentially “tightening the noose”. However, I do not think it is probably PS because while I have seen patients with bilateral PS, I have not seen anyone with a constant switching. Sounds like it could be some sort of inflammatory problem.

      Dr. Russ

  156. lynn

    Hello! I have a degenerative disk but I am sure it is not causing the pain I have. I have had the disk issue since I was 17 and I am 29. I have a 2 year old and was in a car accident 6 months ago. I know whatever happened to me in the accident caused this pain I have now. It started out as sciatica and knee tendinitis but now I have a distinct pressure on both sides on my butt. It feels better in the morning and went away for a while. But I went to regenerative yoga and the next day it came back. Sitting is awful. Standing helps it go away. My concern is that I am trying to get pregnant. And I want to know how to treat and get rid of this pain.do you believe that I may have ps?
    Thank you

  157. alex

    Hello, I am an active 21 year old female who lifts weights in the gym 5 days a week. I started having this type of pain in my hip area on the right side and sometimes my hip sounds like it pops when doing certain exercises. It went away for a while then started to come back when going heavier with weights. Recently the pain has become chronic and now I have pain going down my right leg all the way into my knee which is causing pain from my mid upper buttocks to a knot in my inner hamstring towards my knee. I do have some symptoms you described above such as pain when I’m driving or sitting for too long. My chiropractor said that it is most likely misalignment of my hips but going to the Chiropractor only helps temporarily. Please help with your feedback on what this sounds like. I am terrified it can be something dangerous. Thank you!

    • Hello Alex,

      I am a huge fan of STRENGTH TRAINING. As far as your pain, it sounds suspiciously like Piriformis Syndrome. Any time that someone says that they get relief from adjustments, but that the relief is only TEMPORARY, I think Scar Tissue. Although it can certainly be caused by pelvic misalignment, most PS has a “Scar Tissue” component to it.

      Dr. Russ

  158. Aliosha Behnisch

    Hello, I posted a comment yesterday, but I don´t see it today, so I guess I didn´t post it properly. First of all, sorry for any mistakes with my english, I´m writing from Argentinian Patagonia. I´m a 24 year old male, and very active. Since almost a year I´m suffering with low back pain, that turned into bilateral buttock, hamstring and heel pain after 3 months of isolated LBP. As of today, I have lots of pain in the area of the ischial tuberosities and, occasionally, the hamstrings when sitting, heel pain when standing still (if I´m walking, pain will set in after 3-4 hours only), and low back pain almost all the time. The low back pain feels like stiffness. I don´t have the feeling my leg pain is shooting or burning, it just hurts in the buttocks, hamstring and heel, the calfs don´t hurt, and I don´t remember if they did sometime. Strange is, at least for me, that the buttocks can hurt a lot while sitting, but as soon as I stand up, all the pain is gone in seconds, same happens with the heel pain after standing still, if I move or lay down, heel pain goes away pretty fast, and, fortunately, I sleep perfectly well, I didn´t wake up during night a single time in this year. I´ve had x-rays, MRI and physical exams done, no one finds any abnormal thing, one of the doctors even did the slump test with coughing and it was negative on both sides. I have no movement restriction, just pain, almost always. Had blood tests done to test for any inflammation or rheumatism, with negative results. I also did 3 months of physiotherapy, without success, chiropractic adjustment lasted for just a few hours. Even the ibuprofen I´ve been taking sometime didn´t seem to do any good. For the doctors I´ve been seeing (neurosurgeon, 2 different traumatologists, chiropractor) my case is a little mystery, so I was really interested in hearing what you could say about it. Thank you very much in advance for any suggestion you can make, and sorry for the long text, couldn´t keep it shorter. Best!

    • Hello Aliosha.

      Due to the volume of email I receive, I don’t get to all of it right away — and some of it I never get to at all. Unfortunately, about the best I can tell you is that this could certainly be PS. Although bilateral PS is rare, I’ve seen several cases of it — usually in people who have really high arches in their feet.

      Dr. Russ

      • Aliosha Behnisch

        Thank you very much, I really apreciate you took the time to read this. Concerning my foot arches, I remember the chiro took a close look the first appointment, said they appeared normal. I´m gonna see if I can find someone who could do the tissue remodeling you talk about in this post. Best!

  159. Makayla

    I have been having pain in my hip that goes down my thigh and is worse when I lay down or sit. Standing does relieve the pain but if I stand too long, the pain comes back. The pain is always in my hip and sometimes lower back but never in my buttocks. This has been going on for almost 4 years and every doctor I have seen tells me physical therapy will help and so will seeing a chiropractor but neither has helped. I’m a 20 year old female who was active in sports in high school when the pain started. I’ve had two MRIs and X-rays and they have all come back normal. Does this sound like PS to you?

  160. alisha

    I am a 24 year old overweight female with PCOS and Chrones, when the pain started a few months ago I attributed it to my very busy work and school schedule, but it only occurred after I had been sleeping for too long and went away after a few hours of sitting in a chair. Now though. it has become every morning and I have been getting less and less sleep due to the severe pain it causes in my hips and spine. It is a sensation like there is a knot in my spine and that my hips are just dangling off of it, not even connected. One morning it hurt so bad when my fiance tried to help me up and his hand touched my leg I nearly screamed from the pain. Nothing really lessens the pain anymore. Could this be PS?

    • Hello Alisha,

      PCOS and Inflammatory Bowel Issues each tell me a couple of things. Firstly, it tells me that you have a BLOOD SUGAR issue. And secondly, it tells me that you have a problem with GUT HEALTH. These two things together reveal that your body is HIGHLY INFLAMED. Your pain is probably because of a spinal issue as opposed to PS — something that could be solved largely on your own. HERE is what I recommend as a starting point to regain your health.

      Dr. Russ

  161. Archie Thomson

    Hi Dr Schierling

    I had minimally invasive spinal surgery in 2012 for a herniated disc at L4. Initially post surgery, the procedure was a great success, however within 12 months my lumbar region became stiff, aching constantly and clicking whenever i tilted my sacrum forward to ‘stretch’ out the lumbar area. It feels like a release. And I almost feel a tethering sensation down the sciatic nerve and which sets off a dull ache in the piriformis area from time to time. This can happen on both sides of my lumbar, but never at the same time. My main issue however is with the constant tightness and aching in the lumbar region, sleeping is a nightmare. Ive been through hundreds of mattresses, but its always the same in the morning, dull aches across the lumbar, seized and locked almost, hamstrings too… They feel tight. I followed yoga, strict post operative core stabilising excersises and stretches. But to no avail

    • Hello Archie,

      I have told others this, but once you’ve had a spinal surgery, all bets are off as far as me even attempting to speculate what might be causing your problem — particularly via an email on a forum.

      Dr. Russ

  162. alynnita


    I’ve been suffering varying forms of back pain and sciatica symptoms for the past 8 yrs but no Dr. or therapist has been able to properly diagnose it. I did MRI, nerve testing, and xrays. My first symptoms were pain around my sacro when climbing hills, then pain in my lower back/glutes after sitting, and for many years (and still ocassionally now) cramps in the arch of my feet (mainly rt one). My toes would curl under uncontrollably and I would have to breathe deeply to try to release the tension. I am now lying down with a painful left gluteous that is particularly painful along the left side. I got a massage and an osteopath session and both helped some but i am still in a lot of pain and it only improves with ibuprofen. Do you think I have piriformi syndrome? What do yoj suggest I do to treat it? What kind of exercise can I do to preven it and stay in shape? I also plan to get pregnant soon and I am concerned it will flame up and I will not be able to treat it with painkillers or that it will be worse with the changes my body will undergo. Thanks for your help!

  163. Shameeza Allard

    Hello Dr. Schierling,

    I am a 22 year old female who has been suffering from low back/hip pain for about 20 months on and off. The first time it started, it was out of the blue and eventually got worse to the point where I couldn’t walk or sit properly. When I went to my physician, he said it was a muscle spasm and gave me anti-inflammatory pills and muscle relaxers. It helped and the pain went away for a while. When exercising, it would come back slightly but it wasn’t extremely painful. I did a few chiropractic sessions and he said that it was an inflamed SI joint (not too sure about his diagnosis). I stopped the sessions because I moved and because the pain was no longer bothering me. About 6 months ago, the pain came back and again, another physician said it was a muscle spasm. However, this time no medication has helped. Heat therapy used to help as well but it no longer helps. I cannot even exercise or do light jogging without experiencing significant pain.The pain is medial on my right buttock, specifically at the level of my crack. Triggers include activities like running, jumping, etc. I don’t experience any leg pain or numbness or lack of circulation, just pain in my right buttock. It hurts if I stand on my right leg and lift my left leg up 90 degrees so that I am only weight bearing on my right. It also feels very tight when I do certain glute stretches. It worries me that I am so young but I feel so debilitated to the point where I cannot exercise. Do you have any suggestions what this could be? Could it be PS? Is there a problem with my SI joint? I have been diagnosed with mild scoliosis but that was from only one physician. Could that be causing the pain?

  164. Rebecca

    I have a pain deep inside my hip that feels like it circulates around my upper thigh and often proceeded down the back of my leg. Occasionally there is numbness and swelling. The pain is almost constant, causing me to limp. I can not even sit in a chair normally.Can this be PS? Currently I am using heat, streching and yoga to relieve a bit of the pain but after a month, it seems to not be healing.

    • Hello Rebecca,

      It certainly could be PS. After a month of this, I would strongly recommend seeing someone about it. Please don’t ask me who. I would also think about using cold instead of heat.

      Dr. Russ

      • ribaudoj

        I have same issues. Feel it shoot to my outer ankle. Not do much in calf or thigh. More front where hip is. Recently learned my spine has a sharp curve at the lower back area supposedly causing this pain. Now my past MRIs I didn’t have this curve. I have a herniated disk that went from moderate to mild. Im doing acupuncture and starting PT. Funny this is opposite side of where my back probs have been. Only started out as sharp pain in my butt as I turned over when sleeping. Didn’t feel during day. Now it’s brutal. I feel it 24/7. Dr. Russ u said ice and not heat. Why is that? I’ve tried Ice doesn’t help pain like the heat actually does. Can u explain why ice and am I wrong for putting heat on and off during the day? Thank u for ur time.

      • Ice is better at helping relieve swelling and inflammation. Ice, however, can be a double-edged sword that causes spasm. There is some controversy concerning this topic.

        Dr. Russ

  165. Paul

    Hi Dr.,
    My GP never mentioned PS to me, in fact she brushed off my buttock pain. For the past couple of months (after injuring my left shoulder, coincidence…) I’ve had pain on the right side (sometimes both buttocks) mostly when sitting or lying down. I’ve also have pain on the soles of my feet. My GP simply prescribed orthopedic shoes and that’s all. I’m as 37 yo male in fairly good shape.I find stretching helps for short term relief. I should mention that I have not sleep well and have had high anxiety over the past year or so.

    Do you think this can be PS? Can it affect the feet?
    Thank you

  166. Sarika

    Dear Dr Russell,
    Thank you for describing PS syndrome so well. I think that’s what my problem is and I have been in chronic pain for last 8 years now.
    I would like to know the treatment for the same. Please advise.

  167. DavidB

    Hello. Firstly thanks for posting this information; after reading it I do have a query I hope you could help with. When lying on my side in bed with my knees at almost 90 degrees I tend to feel tightness in both my glutes that is exacerbated when I press my knee down into the bed via hip adduction. This increases over time preventing me sleeping properly, which is highly frustrating as you can imagine. I have found that stretching the glute heavily after performing hip hike exercises as prescribed by my physio helps but this relief never lasts the entire night. I have always been highly flexible as a result years of martial arts but still seem to be suffering. I also have a blown disc on the right hand side of my lower back but this is being managed comfortably.

    Do you think this sounds like PS, or could it be something else? Thanks very much in advance for your anticipated reply.

  168. lisarahder

    In have had increasingly severe, constant pain in my left buttock for 4 months now: only one muscle group there, though. If you draw a diagonal line from left “dimple” at top of buttock diagonally down to outside area to top of thigh, it is smack in the middle.

    I seem to be able to use “side” buttock muscles but not “middle” muscle in this area (I.e. cannot lift leg straight back without intense pain, an not sleep, etc). This has occurred with peri-menopausal symptoms so I assumed that was what was causing it. No pain in legs, back, anywhere else.

    What can I do for the pain, please? I am taking a very high dosages of otc just to keep it at bay and this worries me (e.g 6 Aleve in 7 hour period or 2500 mg Tylenol every 5 hours…. and pain still just manageable at those levels.

    Would a progesterone creme help to balance hormones a bit just to see if this is hormonal?


  169. Travis Kibel

    I have had hip, leg, and butt pain for year’s on my right side. The pain in my butt feels similar to a severely pulled muscle. It is tight and tender to the touch. I am 41 year’s old and have had this issue for about 15 year’s. I have researched to try and come up with what could be the problem and your article is amazing because nothing has ever quite fit like what you describe. It is literally verbatim to what I am feeling and experiencing.

  170. Isabelle

    Im a 23 year old female who has had debilitating pain in my butt, thigh calf and bottom of foot for 2 years now. Ive seen 13 doctors and have had about as many diagnosis including PS from a chiro at one point although he seemed to think correcting my neck would fix my problems which it didn’t. My thigh is constantly numb and my hip aches and burns and shoots pain down my leg all day. Driving is almost impossible i can sit for very short periods of time and sleeping is out of the questions without serious sleep aids. Im currently doing physical therapy to strengthen my gluteal muscles and hamstrings to “pull my hip back in place” and alliveate the pain. SO far it has done nothing but irritate my hip. I am getting stronger but its not helping anything. I’ve had a cortisol shot into my SI joint that helped until the numbing meds wore off. I’m on way to many pain killers that just do enough to let me live my life. I lip and im sure my spine is all sorts of crooked. Any other ideas on what could be wrong?


  171. Kayla

    Hi. I am a 30 year old restaurant manager and a busy mom of my 8 year old and 2 step children. I have been in severe pain for 6 months. 2 weeks ago I had si. Injections I am still I n the same pain. I’ve had enough and would give a leg to be out of it. It starts so deep in my bum and down deep in the back of my thighs it starts on either side and I Swear it is ruining my life. I stretch every day and I’m in good health. I have always been active and I’m 113 pounds. What else can I do. My doctor is just treating it as long term pain

    • Doubtful it’s an SI problem. This sounds like classic Piriformis Syndrome. Again, it is quite unfortunate that PS is so often undiagnosed / misdiagnosed. The problem, however, is that even when diagnosed properly, the medical community has little to offer short of pills and injections — or the leap to surgery.

      Dr. Russ

  172. tony perez

    Ive been only getting pain in my glutes and like lower lumbar when I push to go to bathroom is only time I feel it. Its not a horrible pain but a deep feeling runs down the leg abit but mostly centered in middle of right glute to under the glutes and I feel a pinch when going to bathroom. Ne idea?

  173. Lora

    I have been experiencing right upper buttock, lower back, and hip pain for over a year now. I had a hip arthroscopy in April to clean up cartilage and shave down the neck of my femur. 2 months post op the pain came back! Its debilitating, I can’t sleep or eat very much anymore. I know my butt muscles are extremely tight but have found no relief to relax them. Could I have PS?

  174. Mary Guardiani

    I have been living with severe right side buttock/hip pain/sciactic nerve pain for 3 years now. I have been seeing an orthopedic surgeon and pain management Doctor for this. I was having epidural injections in my lower back for 2 1/2 years now, and they do work for a month or so. I was told surgery would work for me since the injections work, so I had a laminectomy on L3 & L4 in June 2014. Since then I still am having the exact same pain that I had before the surgery and I am back to the injections. I can not stand or sit for too long because the pain is there. I’ve never had children and I am 45 years old now. Do you think it could be PS? and maybe I have been misdiagnosed? I also saw a hip specialist who took xrays and said its not my hip.
    thank you for your time,

  175. Ray

    Hi. I am a guy and my employment for the last 25+ years has been in IT where I sat the majority of the time. The comments I’ve read about piriformis syndrome have seemed to be how I would describe “the pain the butt” experience I’ve had the last three or for months. Why would this be predominately a condition for women? I am currently being reviewed by my primary care where I’m not taking lipitor 10mg, and have been put on NSAIDS 600mg for a couple of weeks to see whether the pain subsides.The pain as I describe it feels like fibers from a butt muscle that are periodically inflamed where it occurs deep in the muscle. Could this be PS?

    • Hello Ray,

      Certainly could be PS. There is absolutely no reason why it couldn’t be. It’s not that men can’t get it — I’ve seen plenty who have. It’s just that women are far more prone to it than men. Probably the result of hips that are built for child-bearing.

      Dr. Russ

      • Ray

        Thanks for your reply Dr. Russ! Other than rest right now, are there any stretching exercises that can help with curing this? As my wife tells me, I don’t have childbearing hips, I’m 6’2” about 200 pounds. What are some recommendations for healing?
        Thanks again!

      • Hello Ray,

        Other than the specific things for PS (see my DoctorSchierling.com site for stretches), HERE are some articles I have written on helping heal your body, whatever the problem is.

        Dr. Russ

  176. Melissa

    Hello doctor,
    I have bee suffering with severe hip groin pain for almost a year now. It started after I gave birth to my latest child a year ago. I don’t know if the fact I had two failed epidurel had anything to do with my situation. A normal birth. A few weeks after my birth I noticed a sharp stinging pain in my low back and inside my groin area, sometimes would shoot down my leg.
    I asked my obgyn and the person that did my epidural and they both blew me off as this was normal. I have seen many doctors that tell me that it’s just a muscle sprain of some kind.
    The pain prefers me from rolling over in bed, picking up objects or my child, driving with my foot on the pedal, deprecating my legs when moving out of my car, laying in my back or stomach is something Ivan not due.

    Any ideas as to what possibly could be the problem?

  177. Heather Harris

    Hello Dr. Russ! I am a 31 year old female that has been experiencing what I consider to be debilitating right hip pain for over a week now. I have always been very active and have 4 kiddos to chase after. My pain started while playing in a company volleyball tournament but surprisingly it was not due to any trauma. I was actually standing around waiting for the game to start and had a feeling like my right hip was “locked” and when I went to move it felt like my hip popped and it was followed my excruciating pain. It is painful to sit, lie on that side, and to bend over. It is causing me to walk with a limp because it hurts to bad to get full rotation while walking. After walking for a while, it seems that the pain eases just a little but the minute I sit down or get still it starts back in full force again. If I had to describe the exact location I would say it’s “in the hip joint”. Do you think this sounds like PS? Thank you for listening!:-)

  178. Heather Kennedy

    Hi I am 41/2 months pregnant and have horrible but pain only on the right side of my buttocks. Its mainly when I lay down and switch sides. And when I go from sitting to standing and now sitting. I only weigh 127 pounds and 5’6 in height. I am currently layingon a heating pad and it when I am laying down and I cough or sneeze it really feels like a sharp pain. It feels like it got worse in the last couple of weeks. I go to my obgyn on Thursday. Just wondering if you could give me some advise. Thanks so much!

  179. Yazz MK

    Hello Dr,

    I had perthes diease when I was small and I underwent a surgery. The doctor had cut my bone twisted and fixed through steel rod.

    I was doing fine for 4 years, I use to play a lot and due to that the rod got displaced so I had to get it removed. After that I was totally perfect I continued playing beach volleyball, doing gym and many other physical activites for long time.

    Now I am 22 and started working and stoped my physical activites and its 1 inch differnce now in both the legs i wear a heel inside my shoe (not noticeable) and i have gained around 20kgs in last 2 years (since i stoped playing and doing gym).

    I recently started experincing some sort of hip bone pain its very slight and continuous (usally starts while driving i guess and resting) I went to see a doctor and he sed its all fine and my surgey went very good he sed. He gave me pain killer and joint maintence medicne. He sed i have arthirities and i can only prevent the wear and tear of my hip bone by being cautious but i will have issues by 45-50’s (maybe may need to replace the hip bowl).

    The pain was gone for a while from my hipbone but again I am experiencing the same slight continuous pain in my right hip bone although I am taking the joint medicne vitamin tabs as directed by the doctor.

    Also that I am driving a lot from few months and my car is low and has bucket seats, usally I feel pain while driving only but for that i have put a cushion support but its almost the same pain again.

    Please advise me doctor.


  180. Ryan Robins

    My upper-outer left calf started hurting playing basketball a few years ago. Over the last three years I have had chronic problems with this calf where I get pain in the upper-outer portion of the muscle when I exacerbate it with physical activity (e.g. basketball, volleyball, hiking, or even long walks). I’ve been to several physical therapists and doctors and received every treatment and test imaginable (eSTIM, aSTIM, dry needling, massage, nerve test, ultrasound, MRI, compartment syndrome test, etc.). Nothing was found in these tests and no therapy solved my problem. I will occasionally have a dull ache in the calf but the pain would typically start up when exercising, until the calf will eventually give out and I will start to limp.

    I’ve also pulled my left hamstring muscle multiple times since high school (I’m now 34). I was playing softball a few months ago when I injured this hamstring again SWINGING THE BAT. This injury was not like my previous hamstring pulls which always occurred when sprinting and always “popped” the hamstring muscle in the middle upper body of the hamstring. This softball injury happened in the mid-outer portion of the hamstring/thigh and did not occur while running and did not feel exactly like my previous muscle pulls. Hard to describe but I thought I should get it looked at.

    So I’m back in physical therapy now and this is the first time that a therapist has mentioned that maybe my hamstring and calf problems could be related. We’ve been working on strengthening the hamstring by performing nerve glide stretches, periformis stretches, lower back stretches, hip and glute strengthening exercises, etc. My hamstring has been slow to heal though and it’s been very frustrating. I’m also now starting to feel pain in my other hamstring (on the right side) directly under my glute. Over the last three months I’ve had X-rays and and MRI of the left hamstring and knee that have come up negative, showing nothing. The pain in my hamstring is seemingly constantly jumping around. Sometimes near the outer thigh, sometimes closer to the butt. The pain in my right hamstring is closer to the glute.

    Something interesting though is that the pain in my upper-outer calf has been significantly lessened and less consistent over the last 6 weeks. It’s almost as if my pain in may calf has traveled up to my hamstring(s). I’ve never had back problems and haven’t had my back examined. I’m frustrated and confused. Thanks for any advice you can give.

  181. AGrier

    So I’ve tried physical therapy, deep tissue therapy, chiropractor and on 9/25/14 I had a piriformis injection that cost me a pretty penny. Pain came back full force this weekend. Very frustrating to try so many doctors and treatments just to get no where. This by far being the most expensive. Now what? My muscles are so tight on that side from my hip down to my heel. I try hard to stay active, I have a half marathon Im supposed to be training for. Ive stretched on my own and used a foam roller but no relief. Massage therapy and chiropractor again? I feel alone and unguided by so many doctors who clearly dont have a clue.

    • Hello A,

      Activity can be good, but running — particularly on hard surfaces such as concrete or asphalt — can stir up an existing PS. It’s unfortunate that more doctors are not more aware of this problem.

      Dr. Russ

      • AGrier

        I run on gravel, we have a levee running trail here. Trying a massage therapist today and a chiropractor. Also looking for a podiatrist? Perhaps the reason for my constant pain is because I’m constantly stepping/running wrong. Any podiatrist in Houston area you could recommend?

      • I am assuming you mean Houston Texas and not Houston Missouri (only about 40 minutes drive from here). Don’t know anyone there, but would consider contacting Shawn Eno at Xtreme Footwerks in Idaho Springs, CO and asking who he would recommend in the Houston area.

        Good luck,
        Dr. Russ

  182. Grace Reaves

    This site has been most informative.

  183. Ash Herbert

    Hi Dr,
    Thank you for your article.
    I am 26 and have recently been told that i may have piriformis syndrome.
    I had a fall onto to my buttocks in March 2013 which resulted in lower back pain which got progressively worse over 6 days to the point of complete numbness from my lower back down. I was told this was due to swelling around my spinal cord and once it went down the numbness went away but the pain stayed.
    At first it was just lower back pain but after about 2 months i started getting pain in my hips as well worse in the left. I have had this pain since with no diagnoses as to why despite having MRI, CT scan, Ultrasound and Xrays. Recently I have had increasing pain to the point of severe pain and pain down the back of my left leg and a burning pain on the balls of my feet.
    Just wondering if this sounds like Piriformis Syndrome to you as i would just really like a reason as to why this is happening and a way to fix it as it seems to just be getting more painful.
    My GP has referred me to a physiotherapist although i am hesitant as i have seen one in the past who didnt help but this was before anyone ever mentioned that this might be the issue. Is this the best course of treatment? Or do i need to see some kind of specialist?
    Any advice you can give would be wonderful.
    Thank you, Ash.

    • A physio might help. It totally depends on the practitioner as well as what is really going on with your piriformis. Best of luck. By the way, hard to say if this is PS from the description. Have you seen a chiro at all?

      Dr. Russ

  184. Rhett

    My first Dr. App.
    And the doc is already moving my pain into my lower back Yupp. Tile man
    “It’s your back “. Says the Doc
    Going to give me steroids. ????
    What the hell .
    The pain is out of my ass crack around my hip.
    Help !!!! I thought steroids are bad for you? Rhett. Ya I’m a Guy

  185. Ender

    Hello doctor. Do you think that an overly tight piriformis muscle can cause kneecap maltracking?

    • Hello Ender,

      It might be an over-characterization to say that “anything can cause anything”, but in many ways it’s true. Fascia covers every part of the body and links it all together. I have broken Fascial Adhesions in people’s neck and given them relief from chronic back pain — and visa versa (HERE).

      Dr. Russ

  186. Michelle

    I am desperately trying to find an answer to my increasing pain in my back hip bum legs and feet. I have had issues with my back since i was about 20…i am now 42. Sciatica started when i was 19 and has never gone. I have had a multitude of things done over the years…cortisone injections, facet joint injections, acupuncture, nerves fried…allsorts. Ive been to docs so much about it with no result i just lived with it. But of course its just got worse and worse. I went back last year at the end of my teather and after an MRI was told id got spinal stenosis. So…had an op for that in spring this year but pain in my bum hip legs and feet has never gone away…its just getting worse. I am a painter and decorator by trade and therefore put my body through its paces but I am continuously worried that im going to have to quit…but more so that the pain and discomfort is going to get the better of me. When i had another scan it showed excessive scar tissue in my buttock area and cleared me of sacral joint issues which left the surgeon thinking it might be piriformis syndrome. Im now having to wait for another referal to confirm if it is. In the meantime im dosed up on everything i can just for my body to function each day and pray that i get enough sleep each night to see me through the next day. Can you shed any light…??

  187. Krista

    Hi dr.
    I have sero/negative rheumatoid arthritis and about a year ago my it band was sore finally got better. But in may of 2014 I was awaken by a Charlie horse feeling in the side of my hip and my dr at the time did blood work and said my magnesium was low so I am taking magox. And now this past 4 to 5 weeks I get this pain in the groin area and the side of my hip and the side of my leg and knee and starts aching and I get sharp pains don’t know how to describe the pain maybe stinging, burning and aching all at once haven’t been sleeping well cause it hurts so bad. Went back to the dr and recommended physical therapy and the therapist said it’s my it band is really tight but I have great flexibility and I go to the chirorpractor and get adjusted doesn’t help. The more exercises I do the more it gets irritated. I started wrapping my thigh and it helped for a bit but now it doesn’t help. My pelvis gets twisted and pops out pretty easy. It hurts in the outer side of my hip to even turn my foot inward and to cross my legs and also it hurts to pull my knee to my chest and to have intercourse. The only relief I get when I lay down is to lay on my belly but my back hurts if I lay on it too long. I get sharp pains in my leg when I drive the little handy bus for work. I have a lot of scar tissue in the abdomen area and I had 2 kids the youngest is 8. But I noticed since I started at a daycare 2 years ago in fever I have more joint pain. But I have never had my hip and leg hurt so bad on a scale 1-10 my pain is a 13 some days especially at bed time or it starts going crazy when I sit on the floor or chair or like I mentioned earlier when I drive the bus. I’ve tried to stretch but I can’t hardly get my leg in the position to stretch it and even hurts to lift to put my sock on or to get dressed. I have that feeling that something is wrong and it’s not my it band. Oh and it hurts if I put my leg outward too. That has hurt way before this other pain has started and it has hurt to have intercourse since I’ve had my kids first it was my left hip and now it’s mostly my right one that is giving me trouble i don’t know what to do anymore I am tired of not sleeping and hurting all the time.

    • Hello Krista,

      This may or may not be Scar Tissue, but the very first thing that I would do is to read THIS POST. No idea if this could provide solutions to you, but it has been a Godsend for many people with Autoimmune Diseases (including RA). If you will search my site for the topic in the link (I realize it’s kind of gross) you’ll see I have several articles dealing with it.

      Dr. Russ

  188. Katrina Leforce

    Thank you .. It was has almost been a year and was doing great .. Now I am very sore and feels like my right side is on fire.. My back aches when I overwork it but the muscle in my butt feel like they are one fire on right side. I guess need to get back to back doctor and see what is going on . It really bothers me with housework and working just cant feel like this all time.. It like a flare up and inflammation or something .. I am so uncertain – going make appt see if can tell me what I need to do to correct this issue. Thank you for your time

  189. Katrina Leforce

    Hi.. My name is katrina .. I had back surgery Oct 2013. The surgery went very well and felt great .. I am having issues with my butt muscle – gluteus it seems . Right now I have a tremendous pain starting from my left side and wraps around my hip .I had a spinal Fusion L4 – L5 due to slipped disc ad said had a my vertebrae’s were cracked on both side hitting the nerve on the left side. I no longer have left side pain all coming form my right side. It seems to be exactly what you mentioned. Is there a cure ? What do I do ? I am only 40yrs old just seems way to young for all this ..

    • Hello Katrina,

      Once you have a fusion, all bets are off as far as me being able to tell you what this is via a blog post — something that is almost impossible to do in the best of situations. Could easily be some sort of Fascial Adhesion, but it could also be something else, like a residual of the surgery.

      Dr. Russ

  190. My Life in operations

    Hi Dr

    As you may read through my posts, I have had many operations, last one Wednesday last week for adhesions.
    Unfortunately my leg pain hasn’t gone if anything it seems to be worse, it goes all the way down my left to my ankle, when I press hard into my bottom it does subside, I do have lordosis. My question is could it be due to my sticky out bum or could it be something else? I know its difficult to say but this pain does come and go, I spent 7 days in hospital a few years ago when it flarred up, I had all sorts of tests, steriod injections ( one namely an injection into the coxis, extremely painful) and nothing helped and tests came back negative. Also playimg golf last year the pain did go.
    I have my stitches out this Thursday.
    looking forward to your reply
    A very painful person

    • Hello Jacqui,

      Looked up your site and it has been taken down, so I know almost nothing of your history. The Lordosis is not because of your “sticky out bum”, although the opposite could be true. You could have a Piriformis issue, but it is almost impossible to even guess from reading this.

      Dr. Russ

      • My Life in operations

        Hi Dr Schierling
        Thanks for my reply, I’m not sure what you mean about my site, I’ve been on it and it’s still working?
        If there is a problem please elaborate.
        My pain is still there and my leg and ankle are a little swollen when I’m up and about.
        I have started small stretches for my legs and although aggravated it feels nice when I stretch if that makes sense.
        I have just been through so many operations and procedures I am trying to get myself into shape, and hoping that will help.
        Kind regards

      • I took a look at your site, “My Life in Operations“. The best piece of advice I could give you for this problem (Adhesions are almost always the result of overt or occult inflammation) would be to read THIS POST. Best guess is that there are some chronic and severe underlying issues that you could deal with to help yourself. All these operations are taking years and quality from your life.

        Wishing you the best,
        Dr. Russ

      • My Life in operations

        Thank you for your help it’s much appreciated.

  191. sue

    Hello doctor, I have pain on my left buttock. No pain or numbness down my leg. Now it’s painful when I’m sleeping. Stretching will relieve the pain a little but living with it everyday is now a barrier. Any advice?

  192. Sandra Swaffar

    Dr. Russ, my daughter was diagnosed with levator Ani syndrome and pelvic floor dysfunction a year ago. She has had the Botox injection three times, but unfortunately, this treatment has not been successful. She hurts with deep agonizing butt pain mainly on the left side. The pain is so unbearable that she cannot live without pain medicine and that isn’t always successful in treating her condition. She has had many injuries over the years. Falls and trauma directly on her bottom. She has had a bad back from her early 20’s and at time when washing her car and bending over her back would go out. She was told she had sciatic problems back then but after resting, it would get better and she would be able to do her daily routine. She also woke up with drop foot after falling asleep in an awkward position. After many months of therapy she regained full motion of her foot, thank God. She also was pushing her car up a hill after running out of gas but slipped and fell and the car door knocked her down straddled and the front left tire ran over her leg. Luckily she was able to get over that without lasting complications. In 2010, she began complaining about her feet being hot and her legs having tingling. Although that is a problem, she says she can handle that, but the problem has settled in her left buttocks and her left side is completely locked up tight and is very painful with deep excruciating pain and is throbbing and also hot stabbing pain. She has seen a colon rectal surgeon who after examining her, said her rectum was extremely tight. She also as seen a chiropractor but he has not been able to get her left side to move at all. Her right side can be moved. She has been aligned, but the chiropractor is puzzled as to why he cannot get her left side buttocks area to move. The chronic pain never leaves, is excruciating and runs down her left leg. The pain runs from the middle of her butt crack, mainly in her left butt cheek and inside thigh and her left leg has a different sensation than her right and is also weaker. She says if she lefts up her butt cheek, she can sometimes feel a little relief but the horrible pain is still there. We have read on your blog and also about the FS syndrome as well as all if the muscles running through and around the sciatic nerve. Have you ever had anyone who has been diagnosed with pelvic floor dysfunction who also had sciatic problems if any kind? She says it feels like a hot iron poking and jabbing her inside and around her rectum. She also says it feels like the bones between in the center butt cheek on both sides are pulling apart trying to rip her apart from the inside. She has been dealing with this for going on two years and she is getting very discouraged, bc it is robbing her of her life. She cannot work or do anything for any length of time as she cannot sit for very long and sometimes she cannot sit at all. She spends a lot of time laying on her stomach bc that at times takes some if the pressure anything but it only lady’s for minutes. Even touching her rear against the sofa cushions is very painful when laying on her side. She rarely can lay on her back and only for a brief time. She is scheduled for an MRI and the colon rectal surgeon as ordered an additional part to be done on the same MRI on September 12th. Do you have any idea or any input in to what in the world is going on with her. We are open for any input you may have as she has to get over this dreadful tragedy that is crippling her life. She has no life. Please help us with this, if you can. I don’t know where you are located in Missouri but we are in Little Rock, Arkansas. Please let is know your thoughts.

  193. Connie

    Hello Dr. Russ,
    I think I have Pirifomis Syndrome! Thank you for your detail blog article. Your article is the closest to my symptom that I have found so far, I had the pain ever since February 2014! I have been suffering from pain in my hips (pelvis), sometimes groin, butts, shooting pain to my legs. Laying down, sitting, and driving are very difficult position for me, I have difficult time falling a sleep due to pain. Standing is my best position, mild exercise helps like walking and stretching. Also heat helps with pain, warm bath and heating pad.
    I have been to 4 different doctors, Rheumatologist, OBGYN, Urologist, and Gastrologist, they all could not help me! My MRI does not show anything.
    What kind of doctor do I have to go see? What kind of test do I have to do?
    I would appreciate and value any of your input. Thank you very much!

    • Unfortunately, there are no sure-fire tests that will show up Piriformis Syndrome. Some say MRN is the thing to use, but they are few and far between, and not covered by insurances. There are some newer forms of electric muscle testing that are being used now.

      Dr. Russ

  194. Tracy

    to whom this way interest :
    I am one of those people whom has allowed self to suffer around ten plus years. Forcing self to learn to live with the on again off again always different degrees of measures of the pain enflicted during each time around and varying from lasting three on average to seven plus uncomfortable aggregating days walking about like you are a hobby horse having to try n explain whats wrong and correcting their assumptions. stated. This malfunction that us individuals end up getting infected with figure out in every passing inscodent we obtain knowledge. It might attack you like clock work and or hit you in shorter time or months may go by. Also the unleasing of pain can be moderate to server or any degree inbetween with no prior warning. By all accounts this is an unpredictable disease. It first shows up with no warning, puts your mind in guessing mode as well as trying to decide if the present never felt type of dramatic waves of lashed out pain near this before, should I go to doctor or manage my tolerance?
    During entire suffering, hope and pray it wont last much longer. Then just as it appeared, it fades and disappears.
    Your bewildered and not understand why. After a couple more, then few more after those you notice kind of a pattern. Even in feeling unsure and increasinglly nervous of what the unknown label actually is you choose to press your luck past your breaking point, Wearing the invisable mask being so careful to hide your true pain, until your standing in doctors office with questions prepared. The longer you sit there waiting the irrigation festers. Your turn, you ask questions all the proper tests are given. I realize I’m telling him what I have at same time he’s insisting I’m fine nothing is found wrong. I’m angry.No final diagnoses given.
    As I stated in beginning years have flown by. I still have pain and no real answers .
    I turn to google.
    thank you for this material

    • Karen

      I have commented some time earlier. I too have had symptoms for multiple years and am now seeking treatment. The Chiropractor was treating for piriformis syndrome, but now treating for lower cross syndrome, which offers temporary relief, but at least there is relief. I am also seeing my PCP, a podiatrist, and a massage therapist. Xrays now show spondylosis to the lower spine and heel spurs to my feet. Podiatrist and PCP have been treating my symptoms with celebrex and then mobic without success. I only allowed two weeks of each and had exacerbated asthma and pitting edema, so now just taking tylenol. The podiatrist has found and is treating me for plantar fasciitis (which I doubt is my foot problem) and Tarsal Tunnel syndrome (which is the most likely). He has offered a night boot, special stretches, and special made inserts for my shoes which are helping. I really think I am suffering from lower cross syndrome, spondylosis, and tarsal tunnel syndrome in which only chiropractic services, stretching exercises (from both the chiropractor, this website, and podiatrist), proper shoes, a night boot, losing weight, and massage therapy are helping. I would like to try Rolfing someday, but that treatment is expensive. Good luck to you!

  195. Julie.m.franke

    Hi Dr.

    What is the best thing to do for pain in buttock when I have no choice but to sit?

    Thank you, Julie

  196. Diane Zeiser Israel

    Dear Doctor,
    I have piriformis syndrome. My xrays and MRI with contrast showed only minor wear and tear on spine. I am a 56 year old, white female. So far PT has been useless with the exception of a hands on manipulation done by my son in law who is a Dr. of PT. (he lives to far away to utilize him on a weekly basis) I am considering pain management and some type of injection done by them This has been going on for 1 year and I am in incredible pain. The pain is worse when I sit and then move to a standing position. Pain in the butt all the wy to my knee, most of the time. Any ideas?

  197. Aman

    Hi dr Russel. I am suffering from pain in my left buttocks from last 2 years. Now its getting worse and finnaly after this long they diagnosed me with piriformis syndrome. I am taking physiotherapy now and doing stretches .they are doing laser thyrpy on me. How much it is effective.

  198. Gabbie

    Hi doc, I too suffer this major problem, usually the pain begins just before my period is due. Then the painful swelling and discomfort of the foot and toes seems to subside as my period starts. Does this have anything to do with menstrual part of things?
    Please help me😦

  199. Suzanne Youngblood

    I had a sacral nerve stimulator implanted underneath my fascia on my gluteius muscle. Due to an injury, the implant was dislodged which tore my fascia. Is there any way to treat this without surgery?

  200. Victor

    Hi doctor, I practice weightlifting one year ago, one month abo i started a very intense routine with high loads and high reps with heavy weights, after a hard workout day in the next day i felt a pain in my whole right leg for some mi minutes, the pain dissapeared by itself. Next day during my warmup session i realized i couldnt reach my right toe with my right hand with extended leg because a terrible pain behind my knee when i tried this action, i continued training because i was able to do any exercise. Since this issue was not confortable i decided to visit to chiropractor (who did massages, electricity, heat, in my leg) , i think it was a bad decision since after chiro session i was worse. Four days later i visited again to chiropractor and i finished worse, the pain was continuous and more notorious when i walking (pain located in external calf). The next day i visited to the doctor and diagnosed a sciatic and also sent me to physiotherapy, my condition did not change (i stopped my training). 4 days later i visited to traumatologo who ordered a MRI, next monday i will have a appointmen with the doctor so my condition is certainly stable but with a pain in my external calf when i walk, i have no lower back pain, i have no butt pain, however when i try to run or sprint i feel a tug in my butt. What is your opinion? Thanks a lot.

  201. Nne

    Pls Doctor Russ help, this pain is making it hard for me to sleep and now I’m my lying with my face down…simple movements even with my right foot affects the centre of the left buttock . Its 1:45am in Nigeria please read my previous comments as well. Thank you so much.

  202. Nne

    could frequent “crack back” exercises wear out ones spine i do it about 6 – 12 times a day depending on my activity and these days it hardly releives the back pain even after the “crack” pop sound that comes from bending over backwards and pushing my shoulders behind

  203. Nne

    Please advise me. My left buttock has felt sharp pains at the centre like I’m being injected over and over it stops for weeks days or months and then resurfaces and repeat. I have had issues with lower back pain and buttock pain for some years nowi just realised its not easy to ignore. I am just 20 ( female)

  204. Chy

    I normally next write in these comment boxes however I have had CRONIC sciatica pain.. I was diagnosed with stenosis, degenerative disc d, rupture disc, bludge disc blah blah blah.. I’m 36 for the past 3 yrs there was not one single day not one that I wasn’t in pain or on FIRE from the sciatica down my left leg. Then my leg started goin out completely.. All I know is I went to cvs bought an ace bandage wrapped my leg this sounds so stupid n silly but I’m on day 3 of my pain comin down from a 1000000000 to maybe a 10.. I woke up the past two days with no burning or numbness wth… I’m sooo scared even writin this I don’t wanna jinks myself … Bt sometimes the cheapest n oldest remedies I guess do work … Just try it I only the ace bandage wrap nothing fancy or exspensive … Just try it it’s uncomfortable the first day bt not now I’m still in shock

    • Hello Chy

      This is very interesting. One of the ways that I have learned to determine whether or not Scar Tissue (particularly ADHESED FASCIA) might be and underlying mechanism of a person’s Chronic Pain, is to squeeze the area with my hands and then have them move. This is fairly easy to do in extremities and in the neck, but not so much with a piriformis. My guess is that my squeezing (or your Ace Bandage) is essentially taking the place of the Fascia. Let me know how it goes. Be aware that the longer you wear any type of brace or support, the more chance you have of weakening the area.

      Wishing you the best,
      Dr. Russ

  205. catherine paquette

    i have severe pain in my hip and buttocks area along with pain in my r back my lower back doctor cant figure it out i have had hip, SI joint, facet joint and a epidural injections with no help at all i cant walk more than fifteen feet when i have to stop i cant ride a bike

  206. John

    I was pitching in a baseball, a few months ago, when i came up limping after finishing a inning. The pain, which was centered in my upper left leg, was fairly severe but not unbearable and i was able to finish the game. However as the weeks progressed the pain did not subside. It started in the glute muscle in my left leg and traveled down to about my mid thigh. After about two months of this pain I went and saw a chiropractor/sports medicine doctor about the pain. She suggested scar tissue could be at fault and since then has been doing weekly, and sometimes twice weekly adjustments to my leg. My concern after reading your article is that I have experienced that temporary sense of relief after visiting the chiropractor that you described seeing in patients with PF syndrome. This relief for me usually lasts for about 4 hours to a day depending on my level of activity after the session, with the longest period of relief being about two days. Since my visits the pain has gotten better but I still have days where I can barely bend over due to the pain in my leg. My question is do these symptoms points towards PF syndrome, because to this point nothing has stopped the pain.

    P.S. I am a right handed pitcher so I land on the left leg as I push off the mound.

    • Hello John,

      I probably actually see the phenomenon you describe, far more with patients struggling with CHRONIC NECK PAIN than I see it for those dealing with Piriformis Syndrome. When patients tell me that Chiropractic Adjustments are the only thing that helps, but that the results only last anywhere from a few days to a few hours, I have to suspect that Scar Tissue is a major culprit. Although other chiros may argue against me, my experience is that adjustments alone are rarely enough to break the Scar Tissue. You can see this in some of our VIDEO TESTIMONIALS where people — chiropractic patients — have had PS for two or three or even four decades, and get immediate relief from getting the Scar Tissue broken. It sounds like you could possibly have a form of PS.

      Dr. Russ

  207. Helen

    Wow I wish I could find someone that could treat me properly. I have been suffering from what I believe is Piriformis Syndrome since July 2011 !! I have basically given up running and feel really depressed about it. All the symptoms above just describe me exactly but when all the therapists that I’ve been to (and trust me there’s been dozens) test me for ‘nerve’ impingements or send me for MRI’s, CT’s and whatever else, they always come up with another diagnosis and want another 3 months to treat it (and charge like wounded bulls and still get nowhere).
    I’ve had enough…… As I sit here in bed typing this I can feel the tightness in my glute getting worse -it feels like I’ve got a permanent lump in my backside !! And if I don’t change position it turns into a bad ache and leg pain (down near the distal hamstring tendon on the back upper lateral side of knee).
    Very very frustrating when no one can tell me after 3 years what is really wrong !! Definitely sick of therapists who just want my money😦

    • melissa

      I can’t afford a Dr any more. I did have MRI which shows mild stenosis but the pain in my butt is so bad and yes I feel a bump and a tightening. As I run the glute tightens, and then radiates outside of hamstring and I also feel I can’t plant my foot down correctly. I try stretching, rolling and yoga but I am so tired of the butt pain. It has been 3 years for me. I feel like I walk lopsided and also bike lopsided.

      • Hello Melissa,

        I feel for you, but would advise that you give up running until you figure out what is going on and how to solve it. You are likely making it worse. Do some strength training for awhile.

        Dr. Russ

  208. Kristi


    This is really interesting. Two years ago a had just finished my 2nd body building competition and was training for a half marathon with my husband. About a month before the run a started getting really had hip pain. I ignored it for a few…got new shoes but it got to the point I could barley walk. I went to my orthopedic. I have a herniated disk in my l5s3 and thought it was bursitis and gave me a cortisone shot n said rest. Well 3 weeks later it was still killing me to walk…he said it couldn’t be my back and referred me to a hip specialist. The hip dr did a MRI with injection. He said I had slight tearing and tendinitis but nothing abnormal. He gave me an injection in my hip using x ray. Still nothing. I then went to another hip orthopedic and get said it wasn’t my hip but my back. Sp he referred me to his partner. ..long story short he gave me 2 epidurals in my back, teo 4 session series of accupuncture and referred me to a private physical therapist. I worked with her for av few months….no pain relief at this point. I then went to two more different physical therapist….still no help. No one can tell me what it is. At that point it has gotten a little better its not unbearable to walk. I still csnt run and exercise like I want. So from there went back to thr 2nd hip dr. By now I have had MRI, bone scans etc… the dr. Then says I have an i mpingement in my hip. …sends me to his other partner. She said she doesn’t think is bad. Now almost two years later I hav e reallt bad pain on my glute that radiates to my hip and in groin sometimes and down my leg. Ot hurts when I go for walks etc…. im am athlete and this is really killing me…I just want to be psin free and workout. I am currently getting adjusted regular by chiropractor snd massages. Any help or advice you could give would be appreciated.

  209. Ellie

    Hi im Ellie and im acctually 16 years old. Ive occasionally had hip pain tht would go away n come back. But the other day i started training for a fitness challenge (n might have pushed to hard). And i started getting this pain in my hip. A few days later it was in my upper buttock and it just seems to be getting worse. Sleeping is a struggle bcuz its pulsing and when i lie down the lower middle of my backn my thigh starts hurting as well. I dnt know what to do.

  210. Demetris

    I had two posterior (right and left) laminectomies at L5/S1 vertebra in the past.
    On 9th Jul I walked 5 km after many days of inactivity and during the last 1.5 km I felt a tolerable pain in the buttock and I kept going on.
    The pain was persisting and worsening next days and concentrated at the area of hip joint. When I press the greater trochanter area at right femur I feel a strong pain. I have problems with driving , sitting, climbing stairs ,walking and even sleeping. Not any movement of lumbar area or coughing causes pain. I realize the pain may be due to lumbar area, trochanter syndrome (tendonitis or bursitis …) or piriformis syndrome but I cant specify which is the cause of pain.

    • Hello Demitris,

      This is one of the problems with these sorts of problems — they have the ability to mimic each other to quite a degree. It is also why I cannot say with any sort of accuracy what your problem is.

      Dr. Russ

  211. Sophie

    I am 63, female, and began a different kind of work last year. I was formally employed at a desk all my career and changed to work where I am required to be on my feet, walking and standing on concrete floors for the entire shift. I have high arches – what kind of shoes should I be wearing? I’ve been buying the best most supportive I could afford but maybe that’s a mistake? Currently just stated chiro adjustments after 3 months of sciatica caused by piriformis tightening and I can barely make it through a shift without leg pain that feels like a bear trap around my ankle. So, what type of shoe would help in this case? Is the work possibly aggravating the situation? Thanks so much for this article.

  212. rorehmani

    Oh and I forgot to mention two things:
    1. Standing still, without leaning on anything, creates (i) pressure on my lower back (same region as where I’m in pain when I sit) that eventually turns into pain if I persist, (ii)burning sensation in my shins, both of them equally, that increases as I persist, (iii) after having persisted for about half an hour, there is high pain in my heals, although if I press on them, no additional pain is felt.

    2. I have had 4 cortizon shots over the last year in different places in my lower back. No relief from either ones.

    • Hello Rorehmani,

      This one is tough to call. Could be a nerve entrapment issue due to Scar Tissue, but without looking, it’s impossible to say.

      Dr. Russ

      • rorehmani

        Thank you for your reply. Do you have any suggestions for “next steps”. As you can guess, I’ve already had an MRI of my entire spine (from the head all the way down) and nothing was found. I’ve seen a number of physiotherapist, ostheopaths, and chiropractors, to no avail. And I’ve seen not one but two Physiatrists, who both are puzzled at my capacity to do physical activity, but yet sitting causes such high pain in my lower back.
        Thank you,

  213. rorehmani

    Hello Dr.,

    Ever since April 2013, I am unable to sit on my behind without immediately feeling pain. The pain is described as very sharp pain in the S1 / L5 region (as much on the right than on the left) and is present down to the tip of my butt crack. There is also muscles pulling in the rest of the back muscles up to the neck. The pulling is strongest at the base of my neck and base of my head, and soon turns into a burning sensation due to the continual pulling. The longer I sit, the higher the intensity of the pull and intensity of the sharp pain, but also, the longer the pain will persist even after stopping the seated position. I’ve noted that if I sit without having my bum touch anything (i.e. when at the bathroom), this pain isn’t immediately triggered, but comes if I remain in that static position for a while (and the rate of increase of the pain is smaller). I’ve also noted that the pain increases at a slower rate if the chair is in tough leather than in cushiony fabric. And also, if I put an object that presses on my lower back where the pain is felt, the pain becomes less sharp. Lastly, if I crouch down and stay on my tip toes such that my heals are pressed in the middle of my bum, this provides a release of tension of the muscles in my back.

    The only way I’m able to function now is with the help of daily dose of pain killers + avoiding as much as possible to sit in a way that creates contact with my bum + being active as much as possible (work-out and stretch every morning, and interrupt my static moments with frequent pacing breaks).

    The only time I reached a moment without any pain was the time I spent an entire week where I had not sat even once, and where my static moments were almost inexistent aside from sleeping at an angle on my electric bed, once again without any contact on my bum. I had spent all my awake moments moving around.

    I’ve passed every medical test my doctor could think of: all is fine. I’m 28 years old and have lived an active lifestyle since I’m 21 years old.
    I stumbled on your page when I saw that MRIs wouldn’t be able to spot the scar tissues, and that some patients obtained relief from physical activity. I’m hoping you could help me shed some light on this ordeal.

    Many thanks,

    • Ben

      Hell Noelle,

      I have the exact same symptoms you describe, as soon as my buttock is on a surface, a sharp pain which quickly increases into unbearable realms sets in. This one-sided pain seems have it’s center deep in my buttock, in the ‘lower half’ around the top of the hamstrings, and radiates to the outside of my upper thigh. Standing up gives me a couple of minutes until the pain comes, but if I walk around a little I can get some relief, but standing still for a minute makes it come back.
      The only way to get a prolonged pain free position is to lie on my back and out my legs up, pulling the the bad side’s leg (my right) towards me.
      The pain seems to come from the piriformis area, or the top part of my hamstrings. It is difficult to pinpoint it. What I don’t have is pain near my knee or calf, or foot.
      My doctor said my spine looks fine, going for an MRT next week because I need this fixed as my job requires me to sit for hours.
      I am quite anxious about this as even on pain relievers, I can barely sit longer than for a minute or two.
      I would be thankful if you could inform me if you come across any info that might be helpful for condition. I will report back if I do.

  214. paul watters

    Doctor I am writing you from Belfast n Ireland my wife and my mother both had saitica I sympathised with them both because I feel like I have the same problem as these people mine comes and goes but the pain increases when I drink alcohol please I need your help thank you in advance paul watters. I must stress I am a 41 year old who works as a chef

  215. April

    Hello! Thank you for this info. I am surely overweight, my height is 5’3″ and I weigh most likely 190lbs. I am planning on engaging into sports and going back to the gym again(my last successful gym visits was at least 2yrs ago). Is this a bad idea if ever I have this? I am still not sure if this is why I have this butt pain, but I’ve been experiencing this pain for 2mos already. Would this be worse if ever I engage into sports, gym, and massages? Thank you so much in advance!

  216. Njenga

    First im a male.One day while working out on a treadmill; I felt a sudden sharp pain on my lower back. It was so intense that I had to stop what I was doing and went to work. The pain in my lower back subsided but another pain in my right butt cheek emerged. The pain is concentrated at my butt cheek cup where it connects the back thigh. The pain just throbs and it is an annoyance especially when driving. I feel the numb pain and tightness when running or walking

  217. Mary

    I can only pray that I’ve finally found an answer to my 30 year pain issue. I’ve had ever test possible including bone scans. Nada… No answers. The pain is centered in the hollow of my right butt like a deep nagging hot ache. Pressing on it is what I would describe as a hot danger, very localized. It radiates to my lower back, around to my hip and in my knee, down the back of my leg, around to my shin and has begun to cause numbness in my big toe. I was born with displasia and wore corrective shoes. Yes, I just dated myself. Massage is torture but it also “hurts” good. When the weather changes I’m in agony. What should I do to get relief now that my pain in the butt problem has a name?

  218. Jessica

    Thank you Dr. Russ for such an informative article! I was a police officer until I suffered an injury to my back which ultimately led to an artificial disc replacement at L4-L5 and a spinal fusion at L5-S1. The surgery greatly improved my quality of life and my chronic back pain is now manageable. However after having 2 children I noticed that some of my pain has worsened. It starts at the lower right side of my back and radiates through the middle of my right buttock and down to the outer right side of my hip and upper thigh. Then my right leg hurts bad and I have to take norco for the pain. I had this pain for many years, but having 2 babies 17 months apart seems to have brought it back with a vengeance! I massage my butt cheek and it hurts like heck but I notice that it helps with the pain. Do you think it’s PS? If so, do you think that the procedure you talked about might help me? I hope to find a doctor in San Bernardino county or Los Angeles that is knowledgeable about this topic. If not I’m going to have to fly to Missouri to see you! Thank you Dr.Russ for taking time to read my questions.

  219. Noemi

    Finally a website that describes my pain exactly. I have been trying to explain to my husband the discomfort I’ve been having for about 2 years now but it’s so hard to explain to others until now. I am a very active female, mother of 2, run 3X/week, do bootcamp 2X/week, sit in front of a computer for 8 plus hours, and we have concrete floors all throughout our home. The pain is getting more intense, I know I need to back off on the exercise but I can’t seem to give it up. Not sure what the next step is, I guess I should probably seek professional help. I’m going to do some research on tissue remodeling, hoping I can find some relief. Thank you for this great website!

    • You are very welcome Noemi,

      Dr. Russ

      • Liz siljander

        Dr Schierling,
        At a healthy 28, I’ve suffered with debilitating chronic pain in lower back and butt area after an injury 6 months ago, the pain Moves from one buttocks area to the other and often radiates in lower Back and sacrum throughout the day. It feels like a deep burn/ache, pins and needles.
        Before the injury I was dealing with s curve scoliosis.
        The pain is excruciatingly worse when I sit, especially in the car. Vibration, walking uphill, sitting, picking up objects, anything to taxing leaves me crippled.
        The only relief i get is from sleeping pills, being in the pool, and steam rooms.
        Are these symptomatic of Piriformis syndrome and sciatica?

      • Hello Liz,

        Always remember that Sciatica is a symptom and not a diagnosis unto itself. Although Piriformis Syndrome is a far more common cause of Sciatica than previously imagined, your problem is almost certainly disc related. When pain moves from one side to the other, it is highly doubtful that your problem is PS. However, that can and does happen, depending on the type and manner in which the disc is injured.

        Dr. Russ

  220. Khairul

    Hi again Dr,

    Well, now the pain is pretty more intense. Esp on right buttock lower left side. Cld it be the sympton? My right leg feels slightly weak. But im left legged. So yea. It hurts slightly going up staircase tho. So yea, im on my way to the A&E. Anyways im from Singapore. I hope the Doctors know the exact diagnosis. *SIGH*

    Thanks Dr Russ.

  221. Phillip

    I’m having a pain on my right side leg whenever I try to bend and touch my toes or when i try touching my ankle while sitting and having my right leg on a chair. while on my back trying to extent my right foot upward. The pain is from the right side of my buttock flowing down wards the back of my leg i can feel the sensation in my big toe (right feet) . Even trying to my ankle and it depends in which angle i turn my head i could feel the pain extending upward the right side of my neck to be exact like if I’m stretching a vain leading to the right side of my ears. (walking normal its just bending etc)

    • Hello Phillip,

      The description of moving your neck being able to cause pain tells me that it is probably a disc putting tension on your dura. In other words, this is probably not PS.

      Dr. Russ

      • Phillip

        Hi Dr. Russell
        I’ve never had a surgery and the longest time I spent in a hospital was 8 hours taking saline & MD for malaria. I take a 15-25 minutes walk to and fro work daily and the rest of the day sitting in front of a computer working do… do the the necessary. I also did a little research (a disc putting tension on your dura) But didn’t find that must answer I’m still with this pain. the diagram with the (sciatic nerve) speaks best for my condition that’s the region in which I feel the pain when ever I bend or lift my leg at a certain degree sleeping seem to be the best remedy i’m about to get up and head home after writing this. so is there anything else you could advice me on
        thank you

      • Unfortunately, nothing more than what you will find in my articles on PIRIFORMIS SYNDROME.

        Dr. Russ

  222. Khairul

    Hi Doc,
    Back in August 2012, I did a L5S1 spine fusion surgery. Fast forward long gone are those days where i can barely stand or walk for 10 mins before the pain starts to go from the side of my left thigh all the way down the left foot.
    Came Monday (30th June 2014), I notice this dull pain that begins on the outer side of my right buttocks almost to side of my right thigh. Well not much discomfort. N not a hassle. So yea. Now its Thursday (3rd July 2014) n the pain is still there slightly increase. That i walk with a limp at the start. It gets better as i go. After period of sitting , once i start to walk it hurts. Any recommendation? Is it the above mentioned diagnosis?

    I did not fall down or anything. Prolly i overstretched as on Sunday i had some great moment with my wife.

  223. Steven O

    I suffer from a deep ache in my left leg. It’s at it’s worst when driving. Around five minutes after sitting in my car I get an ache in the area directly under my buttock and also in the upper-outside of my thigh. If I’m driving for long periods the underneath and outer side of my knee also begins to hurt. Once I’m out of the car I hobble for around five minutes but after that I’m fine again. I also get the same pain if sat down for too long, especially if I’m cross-legged or on the sofa with my leg drawn up under me for example. When I drive I have my left heel down and I pivot on it to toe-down on the clutch or brake, it’s this swivelling movement that seems to cause the pain. My doctor has never been able to work out what’s wrong, but it sounds a lot like what you’ve described here. Assuming it is – is there anything I can do whilst driving to minimise the pain? Maybe pull my seat forwards/backwards or up/down?

    Many thanks for your great website!

  224. Charles

    Im going on on a little over two years of chronic back pain. Started as a muscle strain from an injury at 18. Since then I’d throw my back out easier and easier with every passing year. As the recent series of injuries accumulate, the pain gets worse and worse. The moment of injury feels like a muscle strain, then its disc related, L4-L5 ish. As the weeks go by after the injury the pain goes to the sacroiliac area, tail bone. Now that I feel better, I feel it in my glutes, not in my glutes but through my glutes, deep. If I stick my thumb on the side over my hip bone a little to the rear, I catch it. Its sensitive to the touch yet I walk around not feeling it.

    Dont know if I have this condition you wrote about but when the dust of my injury clears (strains or bulging disc, so im told) I feel it in that spot. No pain shoots down my leg though. Its all hip bone, sacroiliac, tail bone and all the way to the other side like a U shape of pain.

    Just wanted to share my story.



  225. Mariam Rizkalla

    Hi dr Russel
    I think it might be my problem
    I got deep pain in my right hip suddenly 18 months ago. It was after a period of hard gym workout and bad eating behavior . I went to several doctors and physiotherapist and they told me it might be periformis syndrome . I’ve been having many sessions physiotherapy and at the gym to strengthen the muscle sometimes I feel I’m better and sometimes not. I feel pain all the time . Did X-rays, cts and MRI and everything was normal. So I was wondering if you can help me? Thank you

  226. jose

    I just finished helping some family friends move this weekend. Today is Monday and I have high pains in my butt bone, I just finished reading the article on PS and I’m wondering could it be this or did I just sprain it in the move.
    Thank you

  227. Naomi Chudy

    This sounds exactly the problem I have. Had MRI’s with no problems in the lower back. I have had treatments with a person who is a Neuromuscular Therapist and he was the first person to mention the Piriformis muscle. I slipped down the stairs approximately 25-30 years ago and have had a problem ever since – and always thought that it could have been due to scar tissue or tissue damage. I do Pilates which helps short term but wonder if there is anything that could help long term to deal with the pain.

    • Hello Naomi,

      If you have scar tissue, you will likely need to have it broken up and remodeled if you hope to have long term pain relief.

      Dr. Russ

    • Maureen


      My Dr thinks I have bursitis in my hips, but it sounds more like the PS.

      I have a deep pain in my left buttocks and at night my hip pain raditates down my legs almost to my knees.

      I hurts mostly at night when I lay down, the pain gets so bad it wakes me up. So I roll over until I awake in pain on that side, continuing to roll over until it is time to get up I usually take an Aleve and a tylenol before bed or try rubbing and Anti inflammatory concocted by the druggist. Both help me sleep better.

      From what I am reading it seems as tho the best thing for this is walking, but I find that if I walk it is worse that night.

      Is there anything else you would recommend.

      Thanks Maureen, Vancouver BC Canada

  228. Brenda S

    Thank you for your article. I had an MRI, which showed herniated discs. However, I am hurting exactly as you described in this article. I have an appointment at a spinal clinic on July 1, 14. If they cannot help me, I would like more info as to seeing this doctor for an appointment. Thank You

  229. CC

    Hi I just was diagnosed. I thought it was my spine ( i fell skating on woodfloor 6 years ago) Where is this doc, I need to go and see him. The pain in my butt is horrible!!!!. It comes and goes, but the worse when I am cleaning around the house😦

  230. Julie.m.franke

    Great article! Have been trying to figure out root cause of my pain..tarlov.cyst, bulging disk, etc. Seen on mri. But this sounds exactly where my pain is located.

    Best remedy now is my goal so I can work and drive with least amount of pain.

    Thank you.

  231. JM

    My name is Jeff I’m 20 years old and I’ve been dealing with this since age 14. I’d like to fly out to where ever this doctor is and get checked over. No doctor in this area can help me. I’ve been everywhere and I can keep living in this pain! Help

  232. Keri

    Hello I am a 21 year old female, I just recently had my first child 2 months ago. Toward the end of my pregnancy I started to get bad butt pains. The best way to describe it to anyone was as if I had fallen on my bottom and it was a bad bruised feeling. I thought it was only something that came along with pregnancy so I waited it out. Here it is 2 months after I have given birth and it has not gotten better, in fact it is worse. Same feeling, as if my bottom is badly bruised. It is constant now though, all day every day. It hurts badly to sit especially for long periods at a time, and I have to find a certain way to sit and not move or it will hurt even more. Also the longer I sit the more excruciating the pain. And it’s almost unbarable to stand back up. I literally feel like an old woman when I get up, it takes me a minute to stand straight. But whenever I walk after a few seconds I’m fine and nothing bothers me also once I lay down I can’t even tell it ever hurt. It’s the craziest thing ever and it’s driving me nuts not knowing or having the slightest idea of what’s going on. I do not have other pains really except in one of my shoulder blades but none in my legs or feet. I know i have done nothing (such as fallen or bruised my bottom) for it to feel this way. Do you think this could be ps?

  233. Harpreet Singh

    sir, i am 50 years old. recently i travelled in the train and due to some problem i have travelled my whole journey by sitting on the iron box, the total journey was of 14 hours and after that i my buttock is start paining and now i cant even sit properly , now whenever i try to sit my buttock pain dont allow me to.
    plz help me….

  234. Rosemary

    When I was pregnant I started having pain in my right leg. I could not sit or stand for too long. After my baby was born, when i returned to work the pain came back. I went to a dr and he did not know what was wrong. I went to another dr and he diagnosed me with piriformis syndrome. He said I should heat the area and sit and roll on a tennis ball. I am doing just that and doing stretching excercises.

    It is getting worse and at work (I sit) and the pain is unbearable. i went back to him and he gave me pills and said I should continue with the tennis ball. The pain is affecting my lower back now as well.Every morning going to work I travel with the train & when I get off by the station , I can bearely walk.My whole right leg pain and I have to struggle walking.

    I don’t know what to do.

    • Hello Rosemary,

      When the stretches and exercises alone do not work, it is time to try and figure out what is actually causing your pain. One of the first things I would recommend is this simple little test (HERE). No, it is not definitive. It does, however, give a lot of people a starting point —- an idea of what their problem might be. This is particularly true for those who live in areas where doctor visits and advanced imaging are not easy to come by.

      Dr. Russ

  235. Chris de Jager

    Dr. Russell Schierling

    I am from South Africa and in 2007 had lower back disctectomy L5/S1. Upon wking up from surgery I had the most incredible pain in my left foot which over the years has been misdiagnosed by many doctors, I can only wear flip flops, any other shoe my foot cannot handle the pain. Recently {2014} a Neurologist determined I had piriformis problems and that my sciatica nerve could be pinched. As I was in the process of moving from Johannesburg to Cape Town (1400 km) and was not looking forward sitting for such a long period. In essence it was decided that a Neurosurgeon will perform the operation to release the pressure. Surgeon said my buttocks area was badly inflamed so he also pumped in cortisone. After waking up from the operation I still had the same debilitating foot pain as before, it feels as if my toes are going to explode at any moment. In any event, 4 days after the operation we left for Cape Town by car, and amazingly I could handle the trip with very little pain except for the foot. However, 6 weeks later all the symptoms are back and the pain is driving me insane ! — I can only imagine that the cortisone did it’s magic for the 6 weeks and now wearing off. The Neurosurgeon that did the operation said that my sciatica had no elasticity and was like a piece of string. I asked him if I should be doing piriformis stretches and he said yes. However I read elsewhere on the Internet that at this stage and due the period the sciatica was pinched nothing should irritate the nerve right now and must be left alone to recover.

    My question is, can the sciatica recover?, will the elasticity return? — the pain is really bad, the operation must have worked as the back of my left thigh I can now pinch and feel it faintly whereas before it was dead to any touch — do you have any advice for me please — the way I feel right now is that they can take off my right foot and would be very pleased, and to relief the pain, meds no longer help, I am now addicted to Tranqioan to sleep at night — looking forward to your response —

    Much appreciated
    Chris de Jager

    • Hello Chris,

      I feel for you. In many, if not most cases, a “pinched” or irritated Sciatic Nerve can recover. Hard to give you advice with this. I have had great results with any number of post-surgical cases (HERE and HERE are a couple of them). However, cutting off the foot would do no good. As strange as it seems, you would probably have “foot pain” (phantom pain) even though you were minus an appendage. The truth is that once a person has had surgery, solving their problem either surgically or non-surgically becomes far more difficult.

      Dr. Russ

      • carol

        I would just like to add something here as a point of reference because I had sciatic pain for 20 years! I took every known drug for it and I did all the correct exercises. The only relief was to walk. Sitting or laying down or resting off my feet aggravated it all the time. However, I lived in South Africa for a while in Johannesburg and when my pain was at its greatest I sought out a sports surgeon who instantly diagnosed the problem. Being a woman my hip on one side had softened in child birth and in going back had trapped that nerve. However, he recommended I go for physio which I did. Every day for 6 weeks! They started with the massage of my IT band which was extremely tight and painful but they did both sides of my body for that. They also put electrodes to heal the damaged tissue on both sides of my hips not just the affected side. They stretched me and I had lots of exercises to do. However, the result was a long last pain relief for many years. Sideways bending was out of the question as this would re-trigger pain and so I was careful what I did and still am. However, I have after 30 years just experienced a serious bout again and this time discovered that I had fasciitist(?) and had the muscle worked out which was extremely painful to do, along with the IT band again which was also tight. I am reasonably pain free but discovered now that the pain is in the piriformis under the sciatic nerve and I will probably never be completely free of pain because of that. The secret I am told is to work that IT band, and stretching exercises every day before and after any workouts and before even just going about every day work. Also I was told to keep the core muscles strong. I am a 66 year old woman and am lucky to know what works and what doesn’t. I also found the best long term relief from the pain was ordinary aspirin taken on a full stomach and under the watch of a physician in case it has adverse effects. I am very grateful to that sports doctor in Sandton City all those years ago who believed that the pain wasn’t in my imagination but in my bottom and leg.

      • Thank you for sharing this Carol,

        This is exactly what I have talked about (HERE) when I tell folks that with many cases of Piriformis Syndrome, the Piriformis Muscle is not the sight of the problem. It just happens to be where the Sciatic Nerve is being pinched. Anything from HIP FLEXOR PROBLEMS, to IT-BAND PROBLEMS, to HAMSTRING PROBLEMS, to weak core (HERE), or even adhesions in the ABDOMINAL MUSCLES have the ability to cause Piriformis Syndrome. There are those who argue that this is not technically PS. Call it whatever you want, but if the SCIATIC NERVE is being pinched or irritated in the Sciatic Notch, there is the potential for buttock pain and or leg pain.

        Again, I am thrilled that you found a solution to your problem Carol. I truly believe that short of Rigor Mortis, there is someone out there who can help you with your problem, whatever it is. For some, I am that person (HERE).

        Dr. Russ

  236. Anna Scarpa

    I have had 4 kids and my back and hip pain began when I was pregnant with my 4th child. During my pregnancy, my joints easily slipped out of place. My baby is now 3 1/2 years old and I am still suffering from severe low back/ hip pain on both sides. It hurts to sit and stand in one position for long periods at a time. My muscles tense up and spasm when standing in one position such as waiting on a long line. My thigh muscles are also extremely thight. I can tolerate walking short distances and pain feels better when lying down. I do see a PT for stretching exercises but am not feeling better as of yet. I have to say, when they press down on my glute muscle, it hurts like crazy. I also try to do the ellipitcal for about 15 minutes each night. Before I had children, I was very active and never had any issues. Walking and sitting were never an issue. I was very big into gymnastics, which is not even a thought in my mind now. Was just wondering if this was PS? Thank You!

  237. Kim

    Are there any exercises or stretches you suggest. I do crossfit and run and I suffer from this it’s horrible. I foam roll and stretch as it is. Thank u

    • Hello Kim,

      The truth is, some people with less serious problems can completely lick their issue with stretching and exercises. Just remember, however, that if you have Scar Tissue present, stretching or exercising has the potential to make you worse (HERE). This phenomenon is common enough that I literally see it every day. This is why Scar Tissue remodeling often has to be done before anything else.

      Dr. Russ

  238. Jenny Galvin

    I’m a 45 yr old. I have been suffering with sciatic pain for 4 years now. I do not have a disc issue. I have pain that is worse at night. I can hardly sleep. Pain in my left buttocks shoots down my leg. I take a lot of advil. I feel a bit better since I have lost 20 lbs. I do stretches and ice packs. Not sure if it is PS. But if it is what can be done.

    • Hello Jenny,

      Tough to say what it is. Could be a form of PS, although PS is usually worse with sitting and often relieved by lying down. If there is no disc problem, there is undoubtedly a Scar Tissue / Fascial Adhesion thing going on somewhere.

      Dr. Russ

  239. Karen Lagalla

    This is it exactly and it is excruciating. Thank you.

  240. Karen Niner

    I am 49 years old, but 25 years ago I had my first child. I remember afterwards I had severe pain to the point of paralysis to the lower extremities. The OB/GYN called this Sciatica Nervosa and recommended heating pad treatment 20 minutes at a time several times a day. Didn’t really work, what worked was begging my husband to give be “butt rubs”. Several years later, I had low back injury pulling a patient from the gurney to the bed.
    This incident left me with excruciating pain from the left hip down to the left foot, inability to walk appropriately,etc. The MRI showed herniated disc, had discectomy and laminectomy which worked for the next 10 years and no need for “butt rubs”. 10 years later, I began having numb feet and cause for another MRI. This MRI showed fragment in scar tissue. Had 2nd discectomy without success (not sure that the fragment was removed). For the past 2 years I have had tremendous right foot tightness and arch pain, especially when I press on the gas pedal and brake. With a half hour drive to and from work, I am just dying when I get home in the evening and unable to do anything. My husband is actually wanting to cancel vacation because of my pain.
    I did have an Xray of my feet which show HUGE spurs so I am now being treated for plantar fasciitis, but I can tell you that is not working. I have requested my husband do the “butt rubs” again, and that seems to relieve much of the tightness to my feet.
    I have had physical therapy in the past for piriformis syndrome and SI joint dysfunction (one hip is always higher than the other), and those stretches offer temporary relief.
    I am sure this is worsening piriformis syndrome rather than plantar fasciitis. Or maybe I now suffer from both. What do I do now? Are there special shoes I can wear?

    • Hello Karen,

      The first thing to remember is that the presence or absence of a heel spur is not a good indicator of whether or not a person will have PLANTAR FASCIITIS or not. You sound like you may be one of those people that I mentioned a few comments ago, who has an ‘occult’ or hidden Piriformis Syndrome — a Piriformis Syndrome that is essentially being masked by a co-existing disc problem. Sciatica can affect everything in its path and has the ability to mimic many other problems, including PF. There are no special shoe for either PS or PF (people develop these two problems having wildly different foot types). However, there are very specific shoes for certain foot-types. Although I understand some of the general rules in this arena of footwear, the person I always refer to is the person who literally saved my life — Shawn Eno of Xtreme Footwerks in Idaho Springs, CO. You should also be aware that stretching tissues that have microscopic adhesions and scar tissue in them can actually be counter-productive without breaking the scar tissue first (HERE).

      Dr. Russ

  241. Sabrina

    I think you will enjoy it!! It’s an Irish sport:) thanks for your help hopefully il get it sorted

  242. Laura Abeke

    Hi, I am a 29 year old lady, I had a baby via CS on the 7th of March 2014, almost 12 weeks ago now. Quite recently, I began having pain in the middle of my butt when I sit down, along side aches in my thighs when I walk, try to sit or try to get up from a sitting position. I haven’t been to see the doctor yet but do you think it could be PS and if so, what can I do to ease the pain. Thank you and look forward to reading your take on my situation.

    • Hello Laura,

      Guess I am not sure what you mean when you say, “in the middle of my butt“. I would assume you are talking about one of your butt cheeks? Could be PS, but doubtful if it is not doing anything to your leg.

      Dr. Russ

      • Laura Abeke

        Thank you for your reply. The pain is right in the middle, the openning between the butt cheeks and I get aches in my thighs but no pain from my knee downwards. Thank you for your time, I’m very grateful.

      • Hello Laura,

        This is probably not PS. Not sure what it may be, but it does not sound like Piriformis Syndrome. Not that I believe for one moment that THIS is your problem, but it’s a good reminder to people to be diligent in their search for solutions.

        Dr. Russ

  243. Jaimie

    Hi I am 38 year old female. I have had sciatica and back pain for years. Two years ago (08/12)ended up having emergency microdisectomy surgery. Six months later found unsuccessful so then a laminectomy with pedicule rods and screws were implamented. I still suffer with chronic pain and mostly in my buttock area very deep. Although not sciatica down the entire leg but it seems to still be present at my ankle and foot level. I feel as if I am being passed around to different doctors. I am to receive my next cortisone shot next week ( the first one unsucessful)however my latest doctor feels I need a neurostimulatlor in which I am nervous about. My quality of life had went downhill. I am no longer able to do the things I used to love. As with activity the pain only gets worse. I am constantly on ice and a tens machine..Desperate to get relief its been two years of feeling as if I am someone in her eighties instead of thirties.. Any insite would be appreciated. Thank You

    • Hello Jamie,

      Cannot tell you if what you have is PS or not (certainly could be), but it does bring to light an interesting and common situation. Many times people have what I call a hidden PS that is either masked by a true disc problem (i.e. they have both problems concurrently) or they have a PS along side an ASYMPTOMATIC DISC BULGE. It is my opinion that this is one of the reasons that lumbar disc surgeries are not more successful than they are.

      Dr. Russ

  244. Sabrina

    Hi I’m Sabrina I’m 28 and play Gaelic football iv had most symptoms u have mention above. Iv seen a few physiotherapists and have got many different answers such as rest, exercises and to strengthen my core. Iv followed all these instructions and nothing has worked over the past 2-3 years. Also iv never been giving a clear diagnosis as they never seen to know exactly what it is. That’s until iv read your piece and it sounds exactly like the pain n throbbing I constantly have playing sport and after. I also am getting lower back pain now is that because of it? I’m just so frustrated it’s not getting any better if anything it’s been gradually getting worse. I’m not over weight play sports 3 times a week I’m 28 and have no children. Is there any advice u can give me ?

    • Hello Sabrina,

      Although I see more overweight people with PS than people of normal weight, it is probably due to the fact that nearly 70% of Americans are overweight. In other words, I’m not totally sure weight is a driving factor in PS. Be aware that if you have Fascial Adhesions, your problem will often be made worse by stretching or therapy. Find someone in your area to break up the adhesions and see what happens. BTW, I am going to have to look up Gaelic Football and see what it’s all about.

      Dr. Russ

  245. Patrick Carman

    Dr. Russell,
    I am an avid male bike rider, and I generally do not complain of pain or ever have to see a doctor. Exactly one week ago, after riding an average of about 13 miles a day for 4-5 weeks, i got off my bike and noticed that deep in my glutes was sore (important to note I biked 1400 miles last year without issue and have always biked a lot with no issues). I thought nothing of it, and figured I was just sore. I can walk pretty well, there is a little pain, but sleeping is uncomfortable in certain positions, sitting on anything thats not cushioned hurts like hell, especially my bike seat. I cannot even look at my bike right now. Even going to the bathroom is a painful experience sometimes. I am a very in shape, young (28 y/o) athlete, and I do not stretch very frequently. A friend of mine with spina inbifida has been letting me use 2x of his vicodins daily for the last 3 days to combat the pain as ibeprofuen doesn’t cut it. I can work, standing isn’t out of the question, but the pain is becoming intolerable. i have read the entire article and will start stretching to see if that helps, is there anything else (I really, really don’t want to go under the knife if i don’t have to) that I can do? Thank you for any insight!


    • Hello Patrick,

      This sounds more like Pudendal Nerve Entrapment — a problem not uncommon in hardcore bikers. I cannot help you, but knowing this will get you started. Please let me know what helps.

      Dr. Russ

  246. Catherine

    I have been suffering from piriformis syndrome since I was about 15 years old, however I wasnt diagnosed until recently at 18 years old. I understand that I am much younger than most of the people affected by this syndrome and that I may have an extreme case? I have found things that manage the pain ( stretching, going on short runs, and oddly enough, wearing shoes with a heel ) but my pain is still very severe. I have noticed that my pain seems to be very bad for a couple weeks or so and then go back to a dull ache- it seems to come in waves. I am studying to become a medical assistant and I have realized that I need more help and information to any treatments that can get rid of my chronic pain as the job requires a lot of being on my feet. Do you have any suggestions other than what I have been doing? I have been reading about a new surgery that has a higher sucess rate? Is there any truth to this?

    Thanks for the info.

    • Hello Catherine,

      If this is actually Piriformis Syndrome, it would be the youngest case I have seen (HERE is one that was close). I would assume you have done all the stretches and exercises. Not sure about the surgeries out there. Some have done well, some have done poorly. The best thing you could do as far as that goes is to search the internet message boards. My best advice to you would be to continue educating yourself. I believe that there is a solution for everyone, it is just a matter of finding it.

      Dr. Russ

  247. Gail

    I’ve been a school bus driver for 22 years and have suffered terrible pain in my right butt and leg. I’ve been to countless doctors but no one has helped. Retired now and the pain is so bad I can’t stand, sit or lay down. I’m tired, cry all night and so depressed as I can’t garden or do any activity. The doctor I’m seeing now ran every test, shots, meds and is baffled. The only way I can find relief is to lay down, lift my leg and rest it on the back of the couch with a hard object under my butt check. After finding your web site and reading the whole post I feel hope. Thank you so much!

  248. Mark kavanagh

    Hi my name is mark 4 weeks ago I was admitted to intensive care with pain in chest and struggling to breath it turned out I had sepisis of the blood which affected my lungs and kidneys.Luckly I made a good recovery and they discharged me . My problem is now thou being at home for last week I have lost a lot of muscle weight and I have got some severe pain in arch of foot and numbness in big toe I can not walk without the pain and limp I can not stretch my leg out or lift it up when sitting without sever burning pain this has set me back with my recovery what could this be, at the moment I’m seeing a psyio she things it’s nerve damage the pain is so bad I can’t sleep and the pain killers the doctor gave don’t work

  249. Laura Halford

    I am a 52 year old female that has been suffering with pain that go from my lower back across the right hip an travels down the right leg to my foot when I have to drive. I was in a bad rear end collision in Jan 2011 that left me with several injuries including a torn Labrum in my right hip which I had surgery in 2011 to remove. Since then I continue to suffer with extreme pain in the right hip area especially when sitting and driving I just want to cry if I have to drive anywhere or sit somewhere for any real period of time. My MRI’s show tears in my Gluteus muscles and inflammation in the bursa sack but the pain when I drive is more intense and goes from my low back through the hip to the front and I believe the Rectus Femoris muscle and sciatic Nerve are effected going down the leg to my right foot when I use the leg to step on the gas and specially the brake and hold down the pedal. I believe I will ask my surgeon if I could also be suffering from this condition. D you think it’s possible?

    • Hello Laura,

      It is very possible. Particularly with tears severe enough to be seen with an MRI. Remember that very often the Piriformis Muscle is not itself the problem. It is simply the place where the sciatic nerve gets “pinched”. The Fascial Adhesions that often times cause Piriformis Syndrome can occur just about anywhere in the pelvic girdle area.

      Dr. Russ

  250. Samantha

    Mt name is Samantha and I am 29 years old. I recently had a baby 8 months ago and about 4 months after he was born I have had severe leg, back and butt pain. It feels like a knife in my back and runs down to my toes. I have been on meds twice so far and I am now in physical therapy but still no relief. The only thing that seemed to help a little was when they gave me prendzone but I know I can not live on that. It has slowed my ability to walk and even lift my baby. Is there any treatment out there that can help? ?!!

  251. Eva

    I’m a Swedish woman of 57 who works as a free lance journalist, narrator of films and author. I am in fairly good shape and have always been exercising in different ways. Am not overweight, have a very good muscular tonus for my age. Twelve years ago I was diagnosed with psoriatic arthritis and have since then had hip surgeries on both sides which went well – i.e. I have no pains there, and the hips are fully mobile after the most recent operation three years ago. No problems there (as far as I can tell).
    But last year I had a period of severe butt/buttock pain when sitting too long. I then bought a “memory foam” cushion to put on my chair (a good adjustable one), and the pain went away after a while.
    But now it has returned with full force. Since January I am suffering from pain sitting down on a chair or in a sofa, or even half-lying down in bed. I have tried different chairs, pilates balls, standing up etc, but nothing relieves the pain. The pain is not piercing, more like tingling, irritating and hot burning – in the areas which are under pressure: the butt and down the thighs. It feels like the sore butt you get from sitting for hours in a church bench – only it appears after two minutes. It just won’t go away and no one can help me or understand what this is! I have been doing exercises and stretching but nothing helps.
    I am now desperate since I have great problems doing my work! At some of the places I work there are possibilities to read or write standing up, but not everywhere and not at home. When I work standing up for too long I get pains in the lower back and my feet start to hurt. My economic situation is going rapidly downhill and unfortunately I can’t afford to come to the U.S. for treatment.
    Can this be the dreaded piriformis syndrome, and is there a physician known to you who can help me here in Sweden? Where can I start?

  252. Ryan

    Hi, I am a 27 year old male who plays Soccer 3 times a week, runs alot during this because of my posistion and go to the gym 3 times a week also for weight training. While playing soccer after about 30 mins I get a very aggravating pain in my left hand side of my buttock on the boney part (feels like a joint) which forces me to stop running and even walking becomes painful and uncomfortable, after a little research I think its called Greater trochanteric pain. This pain lasts for the evening after the match and eventually starts to ease of the following day about lunch time and feels like I can then run/train again, but another 30 mins into excercise it starts to play up again.
    Can you please give me any advice/treatment/exercise I can do so I can get back to full strength as quickly as possible,

    Any help would be appreciated.

  253. Keith

    In 12/12 I had a l1- l5 lumbar decompression .As soon a sI came out from under the anesthesia I had severe spasms in the area I now know as the piriformis muscle. To date I have regular sessions that are painful enough to be debilitating. I have been to Barnes Hospital in St Louis to their Neuro Surgery department, all they could tell me was that I was not a candidate for surgery. I followed up at Rush Hospital in Chicago where again reviews of my ct and MRI indicated I was not a candidate for any surgery. My latest episode sent me to the ER because i could not control it with the oral meds I have been prescribed.I have suggested the piriformis has been the problem all along. The surgeons and my pain management Dr look at me like I am nuts. I am ready to go to Mayo Clinic next. Do you have a different suggestion. Also we have considered inquiring about a piriformis release. We know this is a direct result of the surgery as I never had this problem before. I am afraid something happened during surgery. The surgeon assured me this was normal and temporary and would not even last a year. Any help, thoughts will be appreciated.

  254. Mad Hatter

    I am a 31 year old male. I work on my feet for 8 hours a day and even though I’m over weight I’m very active. I never sit down even at home. And I have never had a problem. Until about a week ago. I was working on my lawn mower and went to tip the lawn mower over and got a sharp pain from the bottom of the back to my calf muscle. The pain went from the lower back through the buttocks to the hamstring and in to the calf muscle. I went to a chiropractor and he had told me I had a bulging disk, and told me to put ice on it. Its been a week now and the lower back pain has subsided but the muscles in my buttocks, hamstring and calm are very painful. The worst is during the night time when I lay in bed. The pain is so severe I haven’t gotten a night sleep in over four days. Thank you for posting this article and making this syndrome known. I will approach my chiropractor again next week with this information and see where he wants to go with it. Until them is there any temporary relief so I can at least sleep at night?
    Thank You Again

  255. Larry Shyers

    I am a 66 year old male that had total right hip replacement surgery 3 years ago. I have had increasing pain the the right buttock and down my right leg including symptoms of neuropathy in my right foot. I have had PT, epidural injections, facet joint injections, and medication. The pain is increasing. Any suggestions?

    • Hello Dr. Sheyers.

      I have seen people who have problems with scar tissue / Fascial Adhesions around the site of surgeries, including hip replacements. I have also seen hip replacements cause PS in a couple of different people. As for the neuropathy (if that is what it is), I have written about that HERE.

      Dr. Russ

  256. Theresa Dixon

    My Physical Therapist is treating me for this. I found your website extremely informative.
    Thank you so much… Now I know the cause of my pain.

  257. kaitmc

    Dr. S,
    I am unsure if I have piriformis syndrome. I am almost 8 months pregnant, and for the last few weeks I have been getting a very sharp, stabbing pain in my upper left buttocks (always in the same spot right near the midline of my body) when I go from sitting to standing. The pain feels like I am either being stung or stabbed by a sharp needle straight into my buttocks. Every time it happens I am sure that I was stung and I look for some sort of mark. As my pregnancy progresses, this pain is occurring more frequently. It is also increasing in intensity and time. I rotated my pelvis in bed today and the pain was so intense I cried out in pain for 10 seconds before I realized what was happening.
    I also think I have SPD (I am certainly self-diagnosing a lot since becoming pregnant) and that is getting much worse. I am 26, was very active before pregnancy, and generally healthy and fit. I have not been able to do much of any exercise, even walking, without my pelvis feeling like it is being torn in half for the last 4 months.
    Do you think this shooting/stabbing pain will go away after pregnancy, or will this become a common occurrence?

  258. SY

    I am glad you have published this article. I think there is a general lack of awareness of piriformis syndrome in the medical community. I am a physician myself and must comment on the following:
    –piriformis syndrome was never taught to me in med school or residency (internal medicine)
    –i diagnosed my own self after coming down with IT band syndrome, and discovering i had numbness over the sciatic nerve distribution while shaving my leg with a razor
    –i realized more than a few patients, friends, colleagues, and relatives were having some form of the same thing
    –when i brought up piriformis syndrome to my own doctors, my medical professors, my relatives’ doctors, they would either not know what the hell i was referring to, or they said “oh!! piriformis syndrome! that’s so rare…”
    YEAH RIGHT! more like underdiagnosed!
    I am glad to see finally that someone else is recognizing how common this muscle problem is (and making that fact known!). The piriformis tightens as a part of living (with sitting, all sorts of minor injuries, falls, biomechanical irregularities etc). and with the sciatic nerve running through the piriformis in half the population, it’s no wonder it’s common.

  259. Susan

    I just got home from a spine center and I had to keep telling the doctor that I knew that I have piriformis syndrome. He offered me drugs, injections, surgery. I declined it all. I told him that I wanted an MR neurography so he wrote the order. I even had to tell him that even though the MRI says I have bulge/hrrniation at L4 L5 that people with PS have the same and more on their MRIs. It seems like doctors are clueless when it comes to this. Thanks for the information you have provided. It has helped me.

  260. Amy

    I was diagnosed with piriformis syndrome recently. I am a medical transcriptionist, do you think the constant sitting and using the foot pedal might be what is aggravating this all the time?

  261. Sara

    Hi. I a 36 year old long distance runner. I have had to put my marathon training on hold as I was having lots of pain in my outer right knee at the insertion point of the IT band. Very class IT Band Syndrome symptoms. The pain started when I was going downhill, pain was bad going downstairs for a few days after, running uphill was much less painful, etc. I’m on day 8 of rest. My knee does not hurt during daily activities, but as soon as I start to run I have a stabbing pain in my outer knee. But now, when I’m at rest I also have a dull ache up the back of my thigh (lateral side of the back of the leg), which goes into the buttocks. Is it possible I have IT band syndrome and a pisiformis syndrome? What are the best stretches I can do to help with these symptoms?