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 usually 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 12-15 times more often).  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.

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 and surgery do not constitute “effective treatment” for Piriformis Syndrome.  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).  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 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.  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


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

  1. 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

  2. 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?

  3. 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!

  4. 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

  5. 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

  6. 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.

  7. 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

  8. 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!

  9. 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?

  10. 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?

  11. 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!?

  12. 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.

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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….

  19. 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

  20. 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

  21. 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?

  22. 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!

  23. 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?

  24. 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

  25. 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

  26. 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.

  27. 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.

  28. 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

  29. 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)

  30. 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

  31. 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

  32. 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

  33. 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!

  34. 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?

  35. 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

  36. 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

  37. 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!

  38. 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?

  39. 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

  40. 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

  41. 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.

  42. 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.

  43. 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?


  44. 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.

  45. 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?


  46. 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

  47. 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?

  48. 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?

  49. 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,

  50. 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

  51. 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?

  52. 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! :-)

  53. 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!

  54. 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.


  55. 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.

  56. 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

  57. Grace Reaves

    This site has been most informative.

  58. 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

  59. 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

  60. 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

  61. 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…??

  62. 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

  63. 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

  64. 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

  65. 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.

  66. 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?

  67. 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.

  68. 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

  69. 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!

  70. 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

  71. 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?

  72. 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.

  73. 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 :(

  74. 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?

  75. 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.

  76. 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.

  77. 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

  78. 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)

  79. 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

  80. 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

  81. 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

  82. 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

  83. 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.

  84. 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.

  85. 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

  86. 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.

  87. 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,

  88. 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.

  89. 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

  90. 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!

  91. 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

  92. 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?

  93. 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.

  94. 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

  95. 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.

  96. 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

  97. 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.

  98. 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!

  99. 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.



  100. 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

  101. 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

  102. 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

  103. 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

  104. 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 :-(

  105. 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.

  106. 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

  107. 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?

  108. 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….

  109. 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

  110. 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

  111. 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!

  112. 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

  113. 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

  114. Karen Lagalla

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

  115. 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

  116. Sabrina

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

  117. 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

  118. 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

  119. 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

  120. 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

  121. 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

  122. 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!

  123. 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

  124. 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

  125. 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? ?!!

  126. 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?

  127. 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.

  128. 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.

  129. 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

  130. 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

  131. 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.

  132. 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?

  133. 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.

  134. 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.

  135. 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?

  136. 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?

  137. Bill

    Thank you for your article. I know exactly when this happened for me. I was lifting a 150 lb box up steps (with my back straight) when I felt a small amount of pain in my butt. I just continued lifting the box but with the other leg and continued about my business. After we had all of our equipment packed in the van, I had a nauseating feeling, so I had to stop driving and lie down while my coworker continued driving. I took 5 days off of work to lie on the couch since I could not get up due to the pain. I had some bruising on my butt, so I must have torn a muscle. I have since gotten much better 1.5 years later, however I can still feel a very small amount of pain in the piriformis muscle. I just had a message, and she could feel that this muscle was tight and immediately said it was piriformis syndrome. She was able to message the muscle which helped relax it and made it feel significantly better. I would recommend a message from a well trained message therapist since this helped significantly. Of course I need some exercise to strengthen the muscles to help reduce the problems further, but amazing results from the message!

  138. ubaid

    Thanx Sir for a great article on priformis syndrome…
    i,m suffering from this from 2 years..
    this pain increase in summer and decrease in winter…
    i,m using physiotherapy of heat and tens therapy for my rght buttock and takinkg meloxicam+thiocolchicoside+pregabalin twice a day and vit b1+b6+b12 once a day…from past 6 days..
    there is a little improvement..
    there is any suggestion from you i will be thankful to you..
    i tested complete blood examination and xray..those reports are ok …
    do you recommend mri for this..;?

  139. Timothy

    I work mainly on a concrete floor all day, I am a 31 ur old male in @ 5,11 at 185 lbs in, was great condition, but one day I woke up with pain in my left butt area and was in more pain when I walked. Then later through that day I drove about half an hr and went back home, then I went up the stairs lated on the sofa for 5 mins, and when I tried to get up and walk I was unable too. My left leg was in too much pain, shooting to my butt area to move or walk and since then I have beenusing a walker. MRI and xray show up nothing but can’t walk and no one knows why and I am in so much pain.

  140. madhu chandra

    Hello Dr. Russel,
    The information i got from your Blog and website is really very informative and useful. I live in India and I have Sciatica from past 7 years in my left leg. Everyone who diagnosed told me that i have herniated disk. Everybody with all forms of medication treated me including chiropractic treatment to homeopathic and acupressure treatment. I had absolutely no difference in my condition, neither increased or decreased symptom. I was puzzled fully with such condition. Now i know after doing simple test of yours that i have PS.
    Very sad that people are very poor in diagnosing a problem and show urgency in treating the person and of course make money.
    Now please tell me how should i proceed to treat this condition? You mentioned that surgery is not useful…
    how about physiotherapy treatment?

  141. Ian Morrison

    I’m a truck driver and have been for many years I keep reasonably fit
    One day as I was putting on my boots for work I got a small twing in my lower back so I took care driving but as the night went on I got very uncomfortable while driving especially down my left leg and went I got home and went to bed I could not settle my left leg was sore but as the week went on my back was ok but my leg was sore standing up or walking or if I crouch down the back of my left at the thigh and lower calf were very sore when I tried to stand back up and is still sore when trying to walk after it what can it be and how do I treat it

  142. veronda

    hello dr
    i am having pain in my right leg sometime numbness. The pain set in my butlock and travel throughout leg, but my knee hurt, can not stand or walk for long period i have a big knot in the back of my right knee. I made appointment with my Orthopedic but had to cancel What kind of dr should i go to. driving it hurts to drive or sit at my desk feel like a ball of pain

  143. arizabal

    I had chronic lower back pain for about six weeks last October that seemed to follow an injury in the gym I can assume only happened from over stressing muscles. I do kickboxing and at the end of a class when I was doing sit ups, every time I did a sit up I would feel pain in my left butt cheek. By a week later I had sever back pain and numbing/tingling in my arms and legs. It eventually wore off after excruiciating pain for 6 weeks. I have done kickboxing for 4-5 years and that was the first instance after not having been to the gym for a year. I assumed I exerted myself too much too soon.

    Anyway today I am slowly running and getting back to working out. However after a prolonged period of running both of my butt muscles get tight to the point that I can’t walk. If I wait a few minutes it goes away. Will this decrease the more I’m used to running? Thank you

  144. Becca

    After my second child I began have deep pain in my lower right buttock. It happened every once in awhile (I thought when I did more walking) and now it’s constant. I consider myself to have a high tolerance but I know it’s bad because little things are frustrating to me and cause me to want to lash out. The pain can run down the back of my leg and almost wrap around my ankle. It’s hurts whether sitting, standing or walking. If I put to much weight or turn quickly on that leg it’s painful. Thanks for any advice!

  145. Alexa

    Hi Dr. Schierling
    Thank you for posting this article. I have been at a complete loss for the cause of my back pain…as has my GP, physiotherapist, and chiropractor.

    What kind of health practitioner should I be looking for in terms of helping me with what I believe is likely nerve entrapment from the piriformis muscle? I don’t even know where to start in terms of fixing this problem for good. I am female, 33 yrs old, on my feet a lot, suffered a spinal injury a few years ago lifting something much too heavy. Spinal cord swelled and caused vomiting and visual issues for 24 hrs. Since then, I’ve had a corticosteroid injection in my SI joint 2 years ago for constant pinching when sitting in my hip area and it worked wonders. However, I have a chronic burning pain in my lower back, from sacrum to just under the scapulae and what feels like sciatic pain from my buttock to my toes on one side. I take celebrex for anti-inflammatory relief with good effect but it is hard on my stomach and I really want to get to the underlying condition and stop with the anti-inflammatories. Xray and bone scan normal. Next step is MRI, per my doctor. However, I feel like the sciatic pain is secondary to inflammation somewhere because of the hot poker feeling in my lower back (as well as down one leg). No numbess or weakness in the leg.

    Please help…
    Thank you –!

    • Hello Alexa,

      Unfortunately, there is not a specific kind of doctor who will be able to help you with PS. The truth is, not very many people in any of the various branches of the healing arts are well versed in taking care of people with this problem.

      Dr. Russ

  146. lynn

    Hi doctor
    My name is lynn and im 25 years old, I’m a flight attendant and I do work long hours on my feet, im also 5kg over weight but for the past week I’ve all of a sudden been suffering with a nagging sharp pain from the centre of my left butt cheak all thecway down my leg and its only relieved with pain meds or if I honestly just forget its even there.

    Do you have any feed back for me that could help me because I really am in alot of pain constantly.

    Thank you

  147. jessica

    I’m 22 years old. I have had problems with my left knee since I was in 6th grade. First I damaged the cartridge on the inside of my knee. Then about 2 years ago I had tore my meniscus…. not to sure how I did that. I’m still in pain and on April 8th I’m going to have surgery on my pirformis muscle. I have been in pain for a year and a half with this leg. I have gotten a cortisone shot but it did not work at all. I also got some other shot to paralyze the pirformis muscle and it worked for about a month and I was pain free for one whole month. So I have decided to get surgery done hoping it will work. Any suggestions?

  148. Nombulelo Baba

    I am a 48 year old female in hospital in South Africa as we speak, admitted for lower back pain. They have done every test possible; urine,blood, sonar, x-ray and MRI but have not found the source of the pain. I realises yesterday aftee a physiotherapy session that the pain came more from the upper part of the buttocks than the lower back. Not sure of the exact difference though. I’ve been given all sorts of painkillers including valium and all help for a while. When the effect wanes, the pain starts all over again. There has been a difference with the two sessions of physiotherapy so far.
    I spent a lot of time sitting down an driving. The pain started last week when it became painful to sit down and again when I have to stand up. Didn’t feel it much when walking.
    Could this be the Pirifornis Syndrome?

    Thank you

  149. Jon

    I have a pinpoint pain in my left buttock. When I get out of bed in the morning, while sitting up, usually within 10-15 minutes the pain disappears but am still sore. I have a wooden peg which is oval and has a pointed extension. If I press the area manipulate the tissue, and move the peg around(quite painful)the pain also disappears. This may be helpful to others.


  150. Jerry Jackson

    I was overcome with this problem since 1999, the year I turned 50. Until then, I could walk miles, take long trips, was an avid outdoorsman, and owned my own business. It ended my life as I knew it. 14 years later, no improvement, having taken every med in the VA pharmacy except pain pills which I cannot endure. Is there ever any hope? Hurts only when I sit.

  151. Dahn Roy

    Dr I found your website and hope it is the answer to my prayers. 36/m 24 lbs car salesman who meets every one of your causes walking on concrete, over weight, spine damage, blowing though shoes, poor posture, too much time sitting … you just described a car sales man’s life. I had a bad mva 1 years ago and there are multiple problems with my low back. Including dish degeneration, whatever it’s called when my spine slips forward at disk, S ponder SOMETHING Or Other Narrowing Of My Spine AND So on. Have seen pain specialist for last 10 years. My condition is when my leg goes to full extension there is a “pop” in my left buttocks perfectly horizontal with the top of crack bout 2 inches left of spine. I am take over 10,000 steps a day and I am fine first thing in the morning but as day goes on and I walk I get practically Paralyzed. My left leg hurts both muscle and nerve to my foot especially on the left side of leg. Best relief is curled in fetal position on bed. Tried meds, injections, mri, everything. What kind of doc do I need to see to help me.

  152. Doug

    I am a 44 year old male and suffering from major pain in my buttocks, down my leg and causes me to walk funny. I have had three hip surgeries to the same hip to repair the labrum. I had neck surgery in Oct. 2013 for two herniated disc. I have recentley had mri’s of low back and cat scan of neck. The doctors say my neck and back are fine. I have had this pain since my first hip surgery in 2009. I had a cortisone injection in the pirformis muscle thee weeks ago and felt amazing. The shot is now wearing off. What can i do?

  153. Christina O.

    My pain is deep in my left glute and hurts more in the morning and when I stand after sitting for a while (though it hurts all day). There is a dull ache when I am sitting, standing, laying and walking but a deeper and more pronounced pain when I “flex” a certain way. My lower back feels great, it’s just the glute and the back of my thigh. Could this be PS? What stretches or treatment would you recommend?

  154. Chandra

    I am 43 have aim in my right buttock in right hip down back of my leg sometimes my ankle starting to have a lot of pain in the arch of my foot (high arches) can’t sit for very long wake up constantly, I am slightly over weight I do work on my feet for long periods hardly sit excersise some, lately feel like my right leg is gonna give out when walking, not sure where to start as far as treatment or even what kind of doctor I should see.

    • Unfortunately, there is not a specific “kind” of doctor that will be able to help you with this. However, there are individuals within different fields that do a good job of taking on Piriformis Syndrome (if that is what you have — sounds like it could be).

      Dr. Russ

  155. jay

    I think this explanation pinpoints my issue. I developed this issue when deadlifting in the gym. It’s been ongoing for 4+ weeks now. Heating pads and stretching helps, for temporary relief(to shovel snow, work out, etc) but then it comes back. I’m thinking after a month of this, the pain will never go away…

  156. B.J.

    Hi Dr. Schierling, thank you for your excellent blog and follow up. I am a success case for spinal decompression. Small to medium L5/S1 bulge on right side indicated in August 2009. Started decompression on a Triton DTS that day. After the first 20 or so treatments within a couple months, I continued decompressed about once every 5-6 weeks. Fast forward almost five years to now and my life was really back to normal. But…for the past couple of weeks I have been experiencing strange sensations that started at the back of BOTH thighs while sitting; not as painful as sciatica, but annoying nonetheless. A few days after initial onset I noticed this my glutes and hamstrings were tight. Glutes have remained somewhat tight, but not every day if that makes any sense. Have done five decompression treatments in 2 weeks and I am only slightly getting better. MRI is scheduled in two days to rule out disc issues. Will randomly get odd pain at the top of my butt near the hip on the side of my body? I did the piriformis or low back sciatic test from your site, but couldn’t really reproduce pain in either one, ha! What do you think?

    Take care

  157. Barry

    Thank you for answering my question. I’m still at a loss as to what my ailment is, but at least I can rule things out. Thank you for your help.

    • Patricia

      Dr Russell, please help me with your opinion. I had surgery 15 mos ago. Herniated disc, deg disc pinching nerve, scoliosis. It got rid of the nerve pain. Now I hurt to sit, right in the center of buttocks. Have nerve pain down the center of back of right leg. Was told by a neurologist that have PS. Had two injections in hips, no help at all. Now I have pain down the outside of my left leg stopping just below my knee. I have had MRI and CT scan. Have done acupuncture, PT, massage, chiropractic. My physical therapist and my massage therapist do not think I have PS. They rotated my leg in a way that they said I wouldn’t be able to do if I had PS. I’m at a loss.

      • Hello Patricia,

        Impossible to say without looking at you, but look through the posts just prior to this one. The test for disc -vs- Piriformis Syndrome is there.

        Dr. Russ

      • Patricia

        Forgot to mention that pain goes away when lying down. Also, have been poked and prodded but can’t reproduce the pain.

  158. Annette

    Hi Dr.Russ,

    I have never had any lower back pain……but after getting successfully treated by a wonderful Chiroipractor for Costochrondritis last year……I suddenly got this burning pain in the center of the “dip” on my upper right buttock while bending down to pick up my dog (15lbs) ! It was absolutely terrible…..I could not sit down, just stand or lay down for days…I went back to my Chiro who said it was my Piriformis Muscle…..over time is has lessened….but after returning from a 10 hour flight from Europe it has started burning again…….long story short when i sit for long periods of time it comes back…just in the same area, no pain in legs…just in the one area, it burns like a red hot needle is being pushed in….I am standing as i type this…..I have a 6 hr drive tomorrow and am just dreading it…is there an easy fix….does Lazer Therapy work for this…….

    Thanks You,


  159. Justin Clark

    Hi Dr. Russ,

    I am a 29 year old male approximately 5’9” 200lbs. For the last six months or so I have been having pain in my right hip/buttock area and also my lower back, namely the right side. To give some background I was running marathons 3 years ago (at approx. 160lbs) and developed a leg injury that I was told was peroneal tendonitis (or tendonosis after more research). This injury abruptly stopped my distance running and I switched to resistance training. It was not nearly as exciting to me as the running. So after a few months I pretty much just started leading a sedentary life. I also work in an office at a desk job for a living, so not much activity there. As I approached 200lbs in 2013 I decided I better start to try to lose some weight. I started cycling as I was still worried about the previous running injury. After a couple of months of cycling 2-3 times a week I took a break for a couple of weeks and one day hurt my back (August 2013) while doing nothing more than bending over to pick something up. At the time it felt like I had pulled or torn something in my lower back (lumbar region). I was hardly able to move and made an immediate appointment at a chiropractor to be adjusted as I had fallen out of my previous regular adjustment schedule. Within a few days I was feeling better, still sore and painful but able to move around. After a few weeks I started feeling a right side hip pain (mostly when standing from a seated position, at my desk for example). Generally I could do some stretches for a few days and the pain would subside. I decided to start getting active again thinking that it was my sedentary lifestyle that was causing the pain. What I noticed after a little while was any time I did something impactful (running or p90x for example) my hip and back would start to hurt. The most noticeable pain is always when standing from a seated position. The pain starts in the hip and seems to radiate or shoot to the right side middle of by lower back. I could generally stay on top of my stretching and the pain would lesson, but not go away entirely. When the pain is extremely bad I can’t even sit for half of the day at work without having to get up and stretch to try and help relieve it. I started to go to my chiropractor a few times recently over the last couple of months. The last time I really made it a point to mention the hip pain and how it was effecting my daily life. He did some acupuncture to the area and it has really been painful the last 5 days since he did this. In the last 2 weeks I have discontinued any impactful exercise and have started doing yoga. I felt like the pain was getting a little better until the recent acupuncture. I do like my local chiropractor, but I am not sure if he understands my issue completely. I was doing some research and came across your page. This is new to me and I wasn’t sure if my story fit into the piriformis syndrome category, so since I saw this nice comment and answer section I thought I would ask. Thank you in advance for taking the time to read this and any response that you may have.

  160. Barry

    My symptoms are almost the opposite. I cannot bear to stand in place or walk as the pain is crushing; however when I sit, the pain subsides, especially if I place my right ankle on my left thigh and press down on my right knee. Could this also be PS?

  161. Carrie Kimball-Koenig

    I’ve had a spinal fusion (T11 – L3) nearly 20 years ago. I’m a 34 year-old female with chronic performs pain on my right side. I’m now 15 weeks pregnant and can hardly walk or sleep due to the pain. I’m typically very active and would welcome any suggestions on how to manage the pain.

    • Hello Carrie,

      Honestly, when you get into fusions like this one (you do not say what it was for), all bets are off as the array of potential symptoms. It could be due to the pregnancy as well. Go to my Blog and start looking around. I just wrote a post on GLUTEN & CHRONIC PAIN. If your problem is purely mechanical, you’ll have to figure out how to fix (or at least address) it. However, as strange as it may sound, there are lots of drivers of Inflammation, and Gluten is just one of them. Follow the links within the article I linked to here to learn more.

      Dr. Russ

  162. Wendy Hebert

    Hello! So lately I have been having severe pain in my right buttock, to the point of bringing me to my knees. I had worked in fast food for 9 years, 10 hour shifts of non stop walking. The floors were concrete. Well I just got a new job working with animals, also on my feet for long hours on concrete. I have suffered lower back pain for years ( numerous hospital visits for the pain being so intense ). I still suffer lower back pain, mostly the lower right side. The pain in my right buttock started last years ago although it was once every few months and only lasted a couple minutes. Within the last two weeks, it has lasted longer and longer. Today, I almost had to leave work because I could barely walk without wanting to collapse from the pain in my buttock. What could it be and what can I do to even just ease the pain?

    • Hello Wendy,

      The first thing you do is to read the blog post I gave another poster concerning Chronic Pain. There are lots of ways to help squelch inflammation, and this is a good place for you to start.

      Dr. Russ

  163. Sean Hogan

    Recently I took a 4 hour drive and after an hour of driving, pain developed in my right buttocks and into the far upper part of my thigh and became worse the longer I drove. I do not have the pain in any other situation. Now the pain seems to start to develop more quickly when I am driving – after 30 to 45 minutes I can feel slight pain. On the long drives, if I use cruise control and bring my right leg up so my foot is flat on the floor it seems to lessen the pain.


  164. James McKibbon

    I am a fit 46 year old male with no previous health issues. My job requires me to sit much of the time and the floors I walk on are a very hard surface. I have been in my profession for 20 years and admit I haven’t always worn the best footwear nor have I practiced the best posture while seated. Sometimes the chairs I would sit in at work would make my buttocks go numb from lack of padding so I would slouch to take the pressure off one area or lean to one side or another.

    Approximately 15 months ago I woke up with a strange tingling feeling in the center area of my right buttock. I found it odd as it wasn’t a sensation I had ever felt before. (Somewhat similar to a limb that fell asleep but it was more concentrated in one small area of the buttocks and didn’t go away when I began moving around). It was slightly annoying bit not really painful. The next day it was even more sensitive and was becoming somewhat painful and it felt like it was beginning to run down my right leg.

    Within a day or two I had a debilitating pain in my mid buttock which ran down my leg. The feeling was like someone had bent me over at a 90 degree angle and inserted a metal rod in the middle of my buttock and was trying to push it down and out the bottom of my foot. It was pure agony. I would put the pain at 9/10 and could only find relief if I was laying on a bed in a certain position.

    This pain lasted for two weeks at that level before it began to ease off. During that time I visited 3 doctors and a physiotherapist. The doctors really didn’t help at all and I’m not sure if the physio did or if it was just time that allowed the pain to subside.

    After about 6 weeks I was able to get back to most of my normal activities within reason as I didn’t push myself as I knew I wasn’t back to 100% yet. Over the following 3-4 months I could feel what I believe was my sciatic nerve running in my buttock and running down my leg but it was more like I was aware of it than in pain from it.

    The next 6 -8 months it seemed to revert back to feeling normal. Then one morning I woke to a sore lower right back. I figured I might have slept funny or tweaked a muscle as it wasn’t that painful or in the buttock area. This lasted a couple of weeks then one day as I was walking I felt my leg tingle with the feeling of the sciatic nerve. The following day it got worse and by the third day I was once again in agony.

    This time around I could feel pain in my lower back but it wasn’t unbearable. The unbearable pain was shooting from my back down my leg with the most severe part of the pain in my upper leg area. The pain wasn’t the 9/10 I had experienced before but a steady 7.5/10 spiking up to a 9/10 every few minutes. However, this time I couldn’t find a position to sit, stand or lay that would relieve any of the pain. When I bent over it felt like someone stuck a knife in my lower back and upper leg and was trying to pull out the nerve.

    After about 4-5 days of this type of pain (the Dr. Had given me no pain medication) it finally began to subside. As the next week progressed the pain lessened down my leg to about a 5/10. However, I could now feel nerve pain shooting down the outside of my outside right thigh just below the skin from my hip to about about 3/4 the way to my knee. The pain was a 5/10 but fairly constant.

    As I write this I feel a shooting pain down my outer thigh between the hamstring and quad muscle a well as the nerve from lower back about belt level down to my foot.

    I should also mention that I had aches and pains in my hips and hip flexor area for a year or two prior to my first acute sciatic issue. I somewhat ignored it as “I’m getting older” bit the areas are all close together.

    This sciatic pain has occurred twice in just over a year and it has an negative impact on my life. I would love to find a solution to this problem or someway to prevent a third episode. (Provided this second one eventually heals). I would love any advice I can get!

    • Could definitely be PS. Might be disc though. These two can be tough to tell apart. I have information for this on my BLOG.

      Dr. Russ

    • Kim

      Omg I have this Same pain how can they just let us suffer?

      • Few of the doctors people see for these sorts of symptoms really understand PS.

        Dr. Russ

      • James McKibbon

        I agree that few doctors actually understand what it feels like. For that matter I know people who have had sciatic pain but what they describe is more like moderate pain and it seems to makes them uncomfortable. I have what cannot be described as less than agony when this first occurs. Completely debilitates me to the point of near insanity. It’s been about 6 weeks since my second issue with this and the pain has subsided to the point where I am just in some pain but not agony. Now I just hope I don’t re-aggravate it!

  165. Alicia M.

    Dr. Russ:
    I am 49 years old. I have always and continue to run and weight lifted. I began experiencing the pain about 5 years ago. I could not sit or put any type of pressure on my left cheek. I could not drive because my leg would totally give out while driving. I went to the doctor and he said I had sciatica. I decided to lay off running for about 6 weeks and the pain went away. I use a sponge roller and tennis balls are my best friend, I do yoga, stretch before, during and after runs and also do pigeon pose to help stretch. It does wake me up at night sometimes and I only take meds when necessary. Not only does my left cheek get numb and very tight, but my hamstring as well. I have no pain at all in my lower back, just my left cheek and down my leg. I was told by a chiropractor that I was “crooked”. One of my hips is higher than the other. Would this also cause an issue

  166. gilles

    I have a history of low back pain and until a year ago or so meniscus in the right leg. A few months back I decided to rum for exercise, a sort of walk run mostly on front of my feet. But I suddenly woke up one night with excruciating pain in the genitals. My arches hurt as well. Presently it’s mostly my arches and my butt when I sit. I sit at the computer all day long. Most of the genital pain has subsided. I have been working on my butt with trigger point therapy, on my own, and freeze it four times a day. I also freeze my arches. The butt pain is very debilitating when sitting on my bike to work or at work. Although get pain in the butt when I work it with a ball to break down the tissue, it subsides and helps a little. I do get some relief by intensely massaging my calves.

    Is this piriformis or disc? I can’t tell either way by putting strong pressure on the lower spine or on my butt. I get no pain on the spine to speak of, and the butt, well, it doesn’t take much to fin spots to induce pain while I put therapeutic pressure with the hard ball.

  167. Kris

    Trying to make a long story short! A year ago weakness developed in right leg, physical therapy seemed to improve it very little. Shortly after right knee went out causing a fall in which, lost complete use of right leg. After mri revealed spinal stenosis, bulging discs, spondylethesis, thought about going through with back surgery until neurologist did not believe that would help getting use of leg back. He sent me to another neurologist that did an EMG nrrve study diagnosing me with lumbar plexopathy. Since then, a year later, the drop foot has not improved, but muscle atrophy in leg and right buttock has. I am now out of wheelchair and walking with walker. The main complaint I have is pain in the right buttock. My back just feels tired, but sitting in a chair hurts right buttock that radiates down right leg. I can only lay down on my back, but after laying down approximately 15 minutes the pain in right buttock starts and continues down thigh. At times it feels there is a washcloth folded up and I am laying on it. Once I lay down and the pain starts it continues to the point I have to take percocet. I want to stop taking pain meds and was wondering if this could possibly be piriformis related or if you thought it was from back. I have changed mattresses multiple times, tried different cushions, TENS unit, physical therapy etc. One Dr states it is from lumbar plexopathy which could lasst up tp 24 months, and another says nothing can do until pain is unbearable and do back surgery. Have also had CT of abdomin and right hip, but not sure if that would show area of piriformis muscle. In the past year I have come a long way, but was wondering if you had any ideas on the right buttock pain. Got a walk in bath tub and cant even sit in it with cushions. I can just touch the area on right buttock and it will start hurting and go down leg and continue until pain meds start working. Any suggestions would be greatly appreciated. Thank you in advance.

  168. Patrick

    Dr. Russell
    I’ve been experiencing pain running from my lower back to my butt down the back of my leg to my calf on my right leg. I’ve also had twitching associated with this pain. I believe this to be piriformis/sciatic related. I just started steroids for the inflammation. The pain is a dull ache with burning sometimes in my calf. What’s odd is the twitching. I’m seeing a neurologist next week for a look over. Does this sound like it’s related to piriformis compressing the sciatic?

  169. Shaan

    Dr. Russell, It’s been good month and half last time when posted here, since then Ihave gone through 2 MRI’s, lower back and scrutum, hip area. There is nothing in MRI which reveals the source for pain in buttocks or hip area. The pain is only there when I sit for couple of minutes and try to get up. the intensity is very sharp probably around 9 on scale to 10 (10 being highest). I literally bite my lips while getting off chair. Anything specific checkup you can suggest or any doctor you can recommend in NJ area. Much appreciate, it’s really getting hard to live with this pain. Thanks

  170. Jowo

    Thanks for this post doc. Mine is different, I have a pain but not really so painful in the my butt crack near the anus. it feels like it is the bone but then when i touch the bone it doesnt hurt. So i am suspecting it could be a nerve and it only hurts a bit when I am sitting or lying down. what do you think this is??


  171. Pierce Bruce

    Hi Dr Schierling
    I am 61 yeays old and started experiencing servers pain in my buttocks and lower back and hamstring area on the left side of my body this has been going on for about 3 weeks and has gotton progressively worse especially while walking and sleeping every move I make in bed is painful I have tried naproxen and pain pills with very little relief. Is it possible I have the condition that everyone seems to be talking about please help I can’t take this any more
    Thanks Pierce

  172. annelene

    Hi! I’m 15 weeks and have been having pain in my left buttock area that radiates down the back of my leg. Now it seems to be focusing in the buttock area especially in the center and around the groin area. Its a pretty sharp pain like and 8/9. It stops me in my track. Its most painful when I bend forward and back standing. Getting up from a chair is also painful. Is this all due to my pregnancy and is there a possibility of it going away after birth which will be a cesarean. Thanks in advance!

  173. Nancy

    I am at my wits end. My husband is 55, suffered a cardiac arrest and subsequent brain injury 16 months ago. In September he started complaining of pain in his bottom- constantly . He has suffered some loss of function on his right side and has a hitch in his gait. He’s had all the tests, all negative. The doctor has tried several different meds – prednisone, clonidine, albuterol, and nothing has worked. He can’t take NSAIDs because of his cardiac history. We don’t want to try narcotics, his cognitive skills are impaired enough. So we’re stuck with Tylenol. He needs to sit on a donut all the time, he walks about 2 miles/day, and gets some relief when he is not sitting. The pain does not radiate anywhere . Thoughts?

  174. Jolene

    I have a pain under my right butt cheek where my buttocks and leg meet??? It’s been there now off and on for almost a year now. I get some relief from a Tens Machine but it’s temp. It at times hurts so much I have started to limp a little and now I’m having lower back pain. I’ve seen a “pain management doc” and after one visit, they think it’s Piriformis Symdrome and want to do some injection needle in my back and/or in my Piriformis muscle!!??? HELP! What is this pain caused from and how can I help stop this pain?

  175. Erik Johnson

    Hello, my name is Erik and I am a athlete experiencing problems similar to these. I’ve had X-ray done of my spine and hip and mri done only of my spine. They found a cyst in my spine that’s pinching the nerve. They say the only way to fix it is surgery but the pain is only in my hip/gluteus medius region. My back feels good. I’m scared that surgery will end my basketball playing days. I’m experiencing all the symptoms of piriformis. Could it just be piriformis that’s causing all if this and not the cyst?

  176. Danielle

    I am a 26 y/o female and student. I recently started have pain in my top left inner buttock. During the day, I would say the pain is a dull aching “2,” max “3,” if at all. However, when I go to sleep at night, I wake up from moving in my sleep to severe pain at around a “9” and it takes me almost two minutes to flip over. I can’t get out of bed in the morning without help or holding on to something. It’s now at the point that I cannot lie down unless I’m going to sleep because if I stay awake too long and the pain sets in, I can’t even get to sleep. After walking around and showering, the pain lowers itself back to the dull ache. I’ve tried taking NSAIDS before bed with no luck. I just went to my primary care physician and he thinks it may be my SI joint, but I’m not sure. He did an XRAY and some lab work to check infection. I don’t really have the “shooting down the leg” pain, it mostly stays in my buttock. Just any advice or suggestions would help so maybe I could bring them up with my doctor.

  177. Marla Bauer

    I believe I have Piriformis Syndrome. Oct 24, 2013 I had a back fusion L4, L5 & S1. The X-rays at my follow up appt with the Doctor came back good. Doc said everything was progressing along as it should. It was now time to follow up with physical therapy. Right about this time I began to experience this sharp pain in the my right buttock which radiates around to my hip and goes into my thigh. The PT diagnosed my piriformis muscle and gave me some stretching to do to help it. Well this only seems to make it feel worse. I have not been going to PT regularly due to bad weather, got the flu and to be honost the cost. Just got done paying for my surgery. My back feels pretty good. I have an appt with my family Dr on Feb 6, 2014 and I’m going to get his advise on what I should do next. I’m asking you also do you think I have PS and if so should I go to PT, a chiropractioner or something else. I am a 53 yr old female. I work in a office environemnt. I don’t have a regular exercise program. I am probably 50 lbs overweight. Also do you think this surgery could have brought this condition on? Thank you for any advise you can help me with.

  178. Carolyn Edel

    So, have any of you done any weight lifting to strengthen the gluteus maximus muscles at all? It is the largest muscles in our body, as we age it becomes weaker and if not exercised in its entirety, meaning outside as well as inside pelvis especially us women and childbearing it becomes weaker and because we use our legs and all muscles attached things happen. How do I know….I have a fusion in my back of the L4- L3 vertebra. I have 4 rods in my back. I am a weight lifter as well as a runner and I walk my dogs a lot. I also came to learn, listening to my physical therapists as they do know what they are talking about, that I am right leg dominant meaning that it does a lot of my work and my left leg and glute muscle had become weak and I do mean weak…..then the piriformis hurt bad. I was told that I had to strengthen my glute muscles more and concentrate my leg workouts to single leg isometric workouts to strengthen the left side. Well, no meds, listened intensly to my massage therapist and physical therapist and 6 years later I have no more of the pirformis issues….I do suffer from tight muscles that cause back pain but, like I said, I listen to the people that have degrees and know what they are talking about in terms of strengthening the muscles in order to aleviate the problems. The pirformis muscle is responsible for the outer and inner rotation of the hips, no medicine will make this better…..trust me I know! strengthen your core and glutes and things do get better. definitely keep up with the chiro and massage…meds are all that a doctor can help with and that is the truth, oh and surgery! Which yes I had but my vertebra was slipping and if I didn’t then my back would of become completely broken! My muscles I get massaged and my back is very good and it is a lot better then suffering from pain in the largest muscle in our bodies! Just telling it like it is!

    • Hello Carolyn,

      Thanks for the response. Indeed, strengthening muscles can be of tremendous benefit to people with all sorts of problems, including Piriformsis Syndrome. Be aware that while the strengthening approach will work for some, in many PS sufferers, it will fire things up to the point of misery. Many people can do Yoga or exercises like “The Founder”. These can help (The Founder is a big help to me personally). However, I deal with many people who have tried virtually everything, including radical dietary changes, to no avail. Unfortunately, there is no ‘magic bullet’ for PS. What helps one person might ruin another. I myself have a host of exercises I do. When I go overboard, I fire off several days of spasms in my Piriformis Muscle. I am on the back end of one such episode. Stupid me tried to do too many Kettle Bell Swings and ended up stirring things up a bit. Thanks for your input.

      Dr. Russ

  179. Angie kijjo

    Hello Dr, I am 35 mother of two. I started feeling pain deep in my right buttock a year after the birth of my second child (Caesarian). I thought it was due to the many injections I have had over the years. Two years down the road the pain is in both buttocks. Every morning when I wake up, my feet hurt and I walk with difficulty. The moment I bend to do anything, it’s worse and standing up with difficulty also. It’s what I go through every day. I live in Uganda where I don’t think such diagnosis can be made let alone treatment. Can you help me.
    Thank you.


  180. Amy

    I am 36 yrs old, good health and excercised regularly until July 2012. While swimming in a pool, I tried to upright myself to walk out and wham… EXTREME BUTTOCK PAIN, right at the crack of my buttocks. Couldn’t walk, stand, sit or anything. Went to urgent care and dr says PS, gave me pain meds and sent me on my way. They worked for a few days but it didn’t go away. Went to my reg doc and he Rx Etodolac. I took that for about 8 months and it helped greatly but started to not work after awhile. Went back had MRI showing DDD of L5/S1 but not much else. I’ve done PT, injections which worked for a day or two, accupuncture, chiropractic adjustments… nothing works. The pain is so unbearable. Pain Managemeng doc suggested Dekompressor Discectomy after doing a discogram, where he thought my disc was bulging and leaking fluid causing the pain. He did it and now I am worse than when I started. So now, I take pain meds, Etodolac and started Lyrica and I get about 3-4 hours of relief out of 24. It feels better to lie down and heat definitely helps, not ice. I’ve quit my job and my family is trying to support me while I figure this out. Went to 2 Neuros, one says do a fusion, the other says disc replacement. But the three MRI’s don’t warrant this kind of surgery. PM doc says I don’t need surgery, that I need to work it out biologically. Nothing is working, my life is hell and this pain is so intense that I’ve lost everything in my life. I can’t sneeze, cough or look a weird way without pain. There are two pains. One band across lower lower back, that comes and goes. The butt pain, that is deep in the cheek, runs down the back of my left thigh (dull and achy stabbing pain) to just before my knee is CONSTANT And now I feel aching down to my ankle. All I know is, as soon as I get out of bed, it all starts, it’s definitely compression induced. I can’t live this way anymore and am at my wits end. Please help.

  181. Patty

    I am a 52 female I have right side only buttock, hip and groin pain now for just about 6 yrs. I started with it all when I was at my healthiest weight and eating healthy walking 4-5 miles a day about 4-5 days a wk. Pain sometimes goes down my leg, back and outer side and into my knee, ankle and right side of foot and underneath 2 sm. toes also top of that area and it goes numb and sometimes tingly. (Buttocks sometimes feels numb, burning & tingly) It also hurts when foot is on peddle while driving and walking. Standing & sitting too long makes it worse also bringing my knee upwards (like marching) while doing pool exercises makes it worse & stairs & hills. I have had x rays mri and mylogram seen different drs. Pt many times, chiro. (Which totally aggravates it) acupuncture, injections you name it I’ve tried it. I also have fibro which hasn’t bothered me in yrs. and when it did only in my neck shoulder area. car accident a yr. after all other pain started. So I don’t believe its fibro. (the lower pain). I am determined to find out what is going on! Depression has taken over me and just like all want my life back. I so appreciate it if you could get back to me. Thank you very much, Patty

  182. Jeanice lewis

    I, like some of the other ladies, have serious pain when sitting and lying down in my butt which radiates to my hips. I have Graves’ disease and Hashimotos. Rare but both. Since my thyroid problems, this has occured. The doctors had put me on steroids for nine months which cause serious weight gain. I was 5′ 5 and 123 now after weight lose, I am 140 pounds. I quit exercising regularly, and I was a serious athlete. Will yoga stretching over time fix this? I have decided I am going to heal my body this year! I am in a water fast under md care and am in serious pain in my butt and hip area now? Why is this happening so severely? Any answers to my issues?

  183. craig cooley

    Thanks for replying…I’ll check em out!!

  184. cc

    My pain started about 7 years ago. The first time I felt an pain was after a fall. It hurt for a few days then stop. A month or two later it bothered me again, but again stopped. It did this periodically for a couple of years. As time went on the pain increase and lasted longer each time. I now experience the pain on a daily basis. It does not bother me during activity. It keeps me awake at night — or wakes me up — and sometimes while sitting, but only about 5 percent of the time. I had xrays, an MRI, and a bone scan of my lower spine. Nothing showed up. Upon doing my own research its appears to possibly be my piriformis muscle causing the problem. The only thing is, the movement used to help diagnose this does not cause me any pain. I should add, there is no position that either worsens the pain nor makes it feel better at night when lying down.
    I am a 49 year old female, healthy, have gone from exercise, to no excercise, back to exercise, and it seems to make little difference. It bothers me more after exercising, but not during. It is a deep dull ache, more like a tooth ache. It is right in the dead center of my buttocks. The pain does NOT radiate. I have NO pain down my leg. Laying on a tennis ball used to help, but no longer. Ice used to help, but not as much anymore. Opioids are the only real relief, but I do not use them. This is ruining my quality of life. I can’t take the pain anymore and I walk around tired all the time. I hope you might have some answers.
    Thank you

  185. gemqueen007

    I am a 52yr old female, about 18mths ago, i noticed that the back of my legs were painful and stiff, and it hurt to walk – i had to change the length of my stride. I put this down to getting older. Recently I have very sharp buttock pain, and this radiates through my hamstrings, – it is still difficult to walk due to pain and stiffness, and it seems any kind of pressure no matter how small causes pain. I now have issues sitting, my buttocks are in constant pain, and very painful when sitting. if i do try and sit, i need to position myself and hold onto something before lowering my self down (still painful). I am not athletic, my job is fairly static, not much moving around. If i sit too much the pain is more of a dull sensation and i have to get up.. and then i am back with the cycle of pain. I have started some stretching and I think it helps – its too soon to evaluate. I am also on Simvastatin – I stopped these due to the issue of muscle pain – however i do not think this is causing my issue. Thank you very much. I am not sure if this is disc or a piriformis issue – would appreciate any feedback

  186. Daniel

    Have had pain from June 2013 to present nothing helps . Pain runs from top of butt crack down right legs hurts in hip and the most pain is behind knee and the ankle. I can push behind knee and can’t hardly take the pain . Please someone help . Stopped taking narcotics scared to get addicted . I found Bayer back and body works better than anything to ease the constant pain. I can’t put my socks on for months now . Help. Sorry I’m a male

  187. Wandres

    Hi I am 28 years old and I have been in pain for a month now. I started experiencing pain after a game of basketball in which I did not experience any fall or other form of collision to my body. It simply started hurting since that day and it is still on going.

    About me:
    – overweight
    – flat footed
    – bad posture
    – not very active but when I do play basketball I am usually sore for a week
    – job does not require sitting as I am on my feet all day
    – I have dealt with a herniated disc in the past

    – can’t sit at all
    – unlike my previous herniated disc in years past, I have no numbness or constant tingling yet. It does go numb or tingles occasionally when I force myself to sit through the pain.
    – sharp pain on my left hip, butt and lower back area. Mainly around the top left side of my butt
    – walking over time seems the best as it does stretch out and slowly it allows me to sit
    – can’t bend to my left
    – when I wake up I can see my upper torso and the lower torso being misaligned. The top part is leaning to the right while the left hip is sticking way out to the left.
    – most pain is after I wake up after being in one position too long

    Doctor, please diagnose me as I am trying to see if this is Ps, bursitis or another herniated disc. Thank you.

    – Wandres

  188. Kim

    I’m a 47 yr old female and have been dealing with pain in my lower butt where it meets my leg and radiates to the hamstring area. In the past it wa just on my right side and now my left side is beginning to get the pain. I use to be a runner until this started. I continue to exercise and just deal with the pain. I think I hurt worse the day after any exercise activity. I do sit at a desk all day. It just feels like I need to stretch but it doesn’t help. I have gone a month or two without exercise and it feels better but as soon as I start activity, it comes back. IB Profen therapy does help a lot and the pain goes away but I don’t want to take meds all the time. I get lower back soreness also and had an MRI on my lower back but it really didn’t show anything. Does this sound like it could be PS? I’m so tired of hurting!
    Thank you,

  189. Shaan

    Dr. Russ, I read the entire site and comments, I couldn’t make up my mind if I am in the same boat as others. I am 43 year old male. I am not over weight and do moderate work out on regular basis. I have severe sharp pain in buttocks and center joint(close to crack) when I am trying to stand up from chair, regardless how long I sit. I could be sitting for 2 minutes and if I try to get up it’s pretty sharp pain. I have no other symptoms such as pain in legs, or numbness.
    Much appreciate your response

  190. Star


    I am a college student and last quarter I noticed my buttocks starting to hurt when I sat. As time progressed, it has become difficult for me to sit and even lay. Right now, my butt, my hip area and lower back ache each day. I cannot sit as it is too painful to do so but have to in class. I can’t sleep on my back or sides anymore because it hurts my butt and hips to much.
    I don’t get much excersise- about 6 hours per week.
    At first it hurt only to sit on hard chairs and such but now even sitting in the couch (although not as much) or bed is too painful. I often times have to wake up during the night to readjust my sleeping position or sleep on my stomach (which is bad for me since I have dislocated disks).

    If I took up exercising, do you think it would help?
    Also, I am not overweight

  191. Kendra

    I’m a 36 y.o. female, overweight with desk job. Went to my GP today after 3 days of excruciating pain originating in my right buttock radiating down my leg into the side of my calf. Standing and walking are extremely painful and the pain is quickly relieved by sitting or lying down. No trauma experienced prior to the onset of pain. Naproxen (375mg), ibuprofen (800mg) and cyclobenzoprine (10mg) have all been ineffective in reducing the pain. (FYI Naproxen and Ibuprofen were not taken together)

    Post examination, my doc suspects PS and has prescribed gabapentin (300 mg) and dicoflenac (50mg) for the pain. I don’t feel comfortable talking an anticonvulsant with so many side effects (thoughts of suicide, blurred vision and involuntary eye movements top the list) and so little clinical proof of alleviating nerve pain.
    During my exam doc checked reflexes, strength and mobility (reaching for floor, leaning side to side, walking on heels/toes)- which are all still good. I had tenderness in the buttock area with palpation- no other areas of tenderness. I have a history of intermittent lower back tension and discomfort (why I had cyclobenzoprine on hand). If the pain I am experiencing is primarily while standing and walking and not sitting, do you agree with the doc’s Dx of PS or is this more likely a disc or other problem? I would like to find a way to treat this without the use of potentially harmful medications.
    Thanks for your insight!

  192. Rachel

    Ive been suffering for 6 years with what was thought a sacrioliac problem, only to find it was a trapped piriformis muscle after been treated by a trained sports therapist and paid for, the NHS after 6 years were no help at all

  193. k borbely

    I’ve been waking up several times a night to reposition due to serious pain in the middle buttock area that you describe in your post. The pain tends to subside by mid-day. Sitting does not seem to be a problem. Being unable to sleep due to the aching is concerning and not sustainable. Any suggestions for dealing with the pain that develops during the night?
    Thanks for your advice.

    • Unfortunately, that’s not a lot of information to go on.

    • craig cooley

      Howdy!! About 6 years ago I began having extreme stiffness in knees…podiatrist said go put spenco orthotics in your work shoes (not your running shoes) your arches have fallen. I did and 24 hours later it was gone.. never looked back. About a year ago I had archcrafters make custom ones, thought they’d last longer. It was great, then a year later knee stiffness/pain returned. I figured, well, they didn’t last very long and I tried to just use spenco ones again.. no dice.. 4 months later I’ve tried every orthotic/shoe combo I have and its worse… can’t run at all. I do custom tattoo work for a living… I began having “sitting on a burning marble” pain under right buttock.. started piriformis stretches, and…it disappeared!! But, now pain in right leg, calf tightness top of foo, shin splint type feelings, cant run, etc.. Can arch /orthotics issues cause PS, and if so, suggestions?

  194. jay

    Hi. I have had persistent pain in the center of my left buttocks for about three to five months. I recently had a hernia operation on the left ignual from working out. Im a 32 year old active male and work out regularly. The pain in almost constant and increases drastically when sitting or lying down. I have also had pain in the left foot which felt like i was standing on a roll of dimes. I also have a job where I am seated in a vehicle 10 to 12 hours 5 days a week. I have had xrays of both my foot and buttocks with no results. Do you think this could be as you’re ddescribing?

  195. Cherese

    I have been experience pain in my buttocks and so I came across your website. My pain originates deep within the buttocks close to the hip. As a result I have experience mild pain and numbness down to my toes. Is this consistent with piriformis syndrome? I am hoping to rule out neuropathy.

  196. Antonio

    Hi, two weeks ago I sat on the floor for about 2 hours. When i stood up I felt my left leg numb and weak. by the night some back pain started. The next day I felt some disconfort when sitting and some pain on the buttock.
    The pain in the buttock has, lessened a little. Right now I only have it when sitting, sometimes, but now I have so severe disconfort on the buttcrack all the time, specially when I lie down. The leg stills with some weakness and numbness but I dont have any pain when walking. Could it be PS? A disc problem? Sorry for my english,

  197. Angela

    Hi. My ten year old daughter has deep pain primarily in upper right butt check for past 7 months. She is constantly rubbing the area. She sometimes has lower back pain but the worst pain is in the upper butt. Tried rest, PT, braces, and have had MRIs and bone scan to rule out stress fracture and disc issues. Thinking of trying dry needling and/or chiropractic care. Btw, she was a competitive gymnast and now just plays soccer and lacrosse.

  198. Missy

    I am a 40 year old woman. I’ve had on-and-off pain deep in my left buttock for the past 1 1/2 years. For about 10 years before that I had similar pain in that region but it would go away if I laid on my back with feet flat on floor, raised my hips, and dropped them to “pop” my hip back in place. Sometimes it would help if I laid on my back and someone pulled on my left leg and gave it a shake, or if they held me in a Heimlich-like position and “shake” out my spine. Chiropractic always helped- for a few days. The situation became worse during each of my 3 pregnancies (I gained about 60 lbs each time).

    More recently, I’ve been pain free until 1 1/2 years ago. I was hiking up hill and broke into a jog, and in that moment it felt like my “pinched nerve” had returned. The pain has lingered longer, and stronger, ever since. I used to run marathons, but now I sit at my computer for long periods of time. I also have pain in my knees and heels, poor balance, and remnants of tibial torsion from when I was a child. I believe all these pains are connected to the way I carry my skeletal structure. I tend to stand on leg or the other, jutting my hips out a lot, or jutting my hips back for an overly arched back. I am working to correct my posture.

    Yoga stretches and getting up from my chair to stretch bring temporary relief, but only sometimes. Even driving hurts. My local orthopedist couldn’t find anything wrong via x-rays and MRI. Neither could the specialist at Stanford. The x-rays and MRI *did* reveal a bone spur (I’m calling it a spur but it may have another name- it was like a “nubbin” near my left SI joint), but the doctor concluded it was an uncommon, but harmless, bone abnormality that didn’t contribute to the pain.

    They have me on physical therapy now, doing exercises to strengthen my core muscles and buttocks. I hope it works, but I’m a bit skeptical that this will improve the situation for the long term, since I did similar stretches in yoga for 6 months with no long-term improvement in pain. One massage therapist who was also a physical therapist observed that my left buttock muscles were atrophied in comparison to the right side.

    While the pain does travel along that imaginary line you described above, I only notice the line of pain when I press on the area. When I’m sitting (and sometimes walking or even lying down), and when I’m not touching the area, it feels like an acute sharp pain in one spot. The feeling is as if there’s a pinched nerve, and like it’s a bone out of place that just needs to be forcefully pushed back into position. The MRI showed no signs of inflammation around the SI joint, yet it hurts almost all the time now.

    I was rough on my body when I was younger, and I easily could have acquired this condition through an injury. One time I jumped off a 60 ft. cliff into water and I landed perpendicular. My spine was seriously impacted when it hit the water’s surface. I was paralyzed for a few moments and floated to the surface, where people pulled me back into the boat. I regained the ability to move my limbs after a couple of minutes. I remained very active in contact sports and long distance running for years after that.

    I just learned about Piriformis Syndrome today. Does my description of symptoms sound like PS to you? I am very impressed with all the information you’ve shared on the internet, and with the time it must take for you to read and respond to each of our questions. Thank you!

  199. Jan


    I am experiencing pain in my butt, which travels to side, top of leg. I get a tightening sensation round top of leg going towards groin area. Also aching in lower front of leg. I’ve been to a physiotherapist and got exercises to do, but no improvement. Any ideas as I don’t get a shooting pain down back of leg. Thanks

  200. Sasha Bryant

    Hello, I suffer from pain in my right hip (although I have an old pelvic fracture injury on the left side) I stand for a living (hairdresser)&am afraid I’ve been favoring my left side but putting weight on my right. I was diagnosed 3yrs ago w herniated disc’s L-4,L-5,S1 .. Now I fear w this chronic butt&hip pain this seems to be a piriformis issue, w extreme fascia/scar tissue. Is this a logical diagnosis. I’m with out health insurance right now,but honestly another doc visit or MRI isn’t really going to help either way. Let me know what you think&what I can do for this chronic pain? Yoga/massage? Thank you, Sasha Bryant

  201. Ann

    on december 6th, while walking to my office i experienced the worst cramp in my upper left butt cheek. the pain got progressively worse on sunday december 8th. the pain went from my upper left butt cheek down to my toes. it was a radiating sensation that prevented me from walking. i was literally in tears. on monday december 9th, the pain had subsided and by the time i got to work, the pain was all gone. i went the entire week with no pain, feeling great, then i woke up on friday december 13th with the same pain and today, december 12th, still in pain. i have to admit that this time around the pain isn’t as severe as the first episode….what could this be? i’m not an athlete, i work out periodically, but not much. i just need a solution to this issue. i can’t imagine dealing with severed cramps in my buttock area forever. your advice is appreciated

  202. woodz1491

    Hello, It all started about 1 week ago….
    I was in the gym and had just completed various lifting exercises with no pain. I decided to get on the rowing machine (maybe knock out 2000 meters for ol’ time sake). After i secured my feet in place, i bent forward to grab the handle and boom! It felt like a burning lightening strike from my glute to me toes (right side). Well, for the past week it has hurt so bad i cant sleep. The pain has subsided a little and is now localized in my glute but i cant sit for very long nor walk easily. I have also experienced extreme weakness in my calf muscle(to the point of limping soley from weakness, not glute pain) and my hamstring is getting weaker by the day. besides seeing a doctor, most likely happening soon, any suggestions or cursory diagnoses?


  203. Steve D.

    I was playing soccer with my kids one night a little over a year ago (I was also in the middle of training for a marathon) and as I started to run quickly, I felt a little snap in my left hamstring. I immediately stopped running because it hurt obviously. I took a week off from training and everything felt normal so I went back to training. Through the next bunch of weeks,I would have a little pain and numbness in my buttock running down to my knee but it wasn’t incredibly painful so I kept running. I ran the marathon with the pain and numbness, and continued running thereafter. Soon after the marathon, I started getting some pains in my opposite ankle. So about 6 months after the marathon, the ankle got so bad that I had to stop running. And of course the pain in my left leg and buttocks is still there – deep down and hurts when I sit for long periods.. Any thoughts?

  204. katie


    Im a 28 yo female. I ran my first full marathon in May and got some butt hip pain but made my way thru it. I just ran a half 3 weeks ago and my pain is back. That line you talk about from the top of my butt to the boney part on the side of my hip, the pain is right in the middle and deep. Is this what you’re talking about?

    When I lay on my back and do that stretch it feels a.m.a.z.I.n.g. after the 1/2 a med student suggested me to look into my piriformus and consult my doc who said it was i.t band pain. But I feel like my doc won’t listen to me. What do you think, and where should I go?

    I don’t want surgery. And I want to run a 1/2 may 2014. The pain comes on strong like clock work at 4-6 miles into my runs. I can do less then that with little to mild tenderness.


  205. Desiree Blazek

    Hi, I’m having a pain on my left side where the butt meets the thigh and it goes down my thigh to my knee. Could it be Piriformis Syndrome? Its only been going on for a week now, but I work in a factory and i do a lot of bending/ squat like movement. Just worried that work could worsen it?

  206. Bill

    I am relatively confident that I have piriformis…my solution … straight leg raises and celebrex works wonders.

    • Hello Bill,

      I would doubt you have Piriformis Syndrome. But regardless, Celebrex is dangerous stuff. It was temporarily taken off the market at the same time as was Vioxx — but put back on after determining it was somewhat less dangerous and deadly than Vioxx. Drugs sometimes work, although there is often a serious price to pay for using them.

      Dr. Russ

  207. Mackenzie

    So I’ve never had hip pain however I do have pain in my buttocks. It hurts to stand up from a sitting position and hurts to lay on my back and move from side to side when laying down as well. I don’t have any leg pain. Could this be PS?

  208. Daryl

    Dr. Russell, is it painful to get an adjustment in general?

  209. sue

    hi I have a pain on my left glute only. does not radiate to my legs or lower back. Been on-going for a year.

  210. Joe Ali

    Hello Dr. Russ:

    While browsing for PAIN in the BUTT in the web I found this site. About three months back I had sore throat and infection. Dr. gave me Amoxicillin for 10 days twice each day. It caused me five to six times bowel movement for about last 7 days. After completion of medicine, I am feeling strange thing like “Pain in the butt” if I sit for more that 15 min in one setting. But when I stand, walk and work no problem at all. The pain goes away in few minutes.

    Now I wonder whether it is the symptoms of Sacroiliac Joint ache or Piriformis Syndrome. What should I do? Please suggest. Any medication or any life style change or physical exercise or any rubbing cream to apply?

    Joe Ali

  211. Laura

    Hi Dr. I finally have cured my Sciatica/piriformis. My pain started about the time my husband bought me a Ford Edge. I had slight pain before I got my car most likely from driving my daughter’s Ford Focus. I changed my office chair to an exercise ball which helped a little. When I changed my Edge with my son’s Impala my pain was got within 3 weeks. I just had to find what triggered my pain and it took about 8 long painful months.

  212. Hi Dr, I just wanted to know about 6 months ago I got a cold that caused severe coughing and towards the end of my cold when I coughed it would feel like I was being bent backwards because it would cause severe pain in my buttock closer to the middle than the outer… there was no pain in my back it just pulled very painfully in my buttock and down the back of my R leg..would this be PIRIFORMIS SYNDROME? it continues to hurt but my cold is finished ..

  213. faryal akhtar

    hey Dr. RUSSELL i was searching on net about deep pain in buttock when i found your page . i myself am a medical student but couldnt diagnose it by myself…. i just want to know how can i make a confirmative diagnosis that i have this…. please help

    • Hello Dr. Akhtar,

      Although there are a whole bunch of newer technologies (a new way of doing EMG’s, MRN’s, etc) the diagnosis is still largely clinical. In other words, the people who know anything about this problem are so few and far between, you’ll have to make the dx via your exam findings.

      Dr. Russ

  214. Daryl

    Hi again Dr.,

    Thank you for my last reply. One more question if you don’t mind.

    What should I expect the Dr. to do to differentiate between a disc or PS? What would you do?

    I don’t live anywhere close to you. If I could come to see you, I would.

    Thank you,


    • This can be a real challenge and then some. Go read my posts on DoctorSchierling.com about Asymptomatic Disc Bulges and the similarities between PS and Disc. You will understand why it can be nearly impossible. I have had several people that looked just like PS but was Disc. Have seen hundreds diagnosed as Disc that were PS.

      Dr. Russ

  215. Irene Nkanta

    Can this Piriformis Syndrome cause late period? Because this is the first time I am experiencing this.I have done pregnancy test and the result is negative. The pain on my butt is so severe. Could this be the cause?

  216. Mike Ferrera

    Hi Dr.

    I have been dealing with back issues over the last 8 months. Went saw my dr and he gave me some steroids. My back issue has cleared up but now this pain in my left buttocks is still there. Really really tight in the mornings when i wake up and i also cant stand up straight. Its almost like im indented at my left hip because it is so tight and when looking at myself in the mirror i form an S shaped and hunched over cuz its so tight in that area. You think this could be PS? As the day goes on it loosens up and i can straighten myself out better. When i went to the doctor they performed an x-ray and it came back negative. In fact my dr said my spine looked “perfect”. Im just so sick of this tightness pain in my buttocks area and i don’t know what to do? Back to the dr? chiro? physical therapy? Im taking motrin 800mg twice a day. I enjoyed reading through this site!

    any feedback would be appreciated

  217. Daryl

    So this pain will never go away? Thank you for this article. At least now I know what I’m dealing with. I was diagnosed with pre-osteoporosis on the left side. My pain is on the left side. I also work on concrete but had this pain long before that. Also wasn’t sure if it’s arthritis. I have osteo-arthritis iny right knee. I’m now experiencing same kind of pain I’m my left knee but thinking this pain is coming from the left side of the butt. Do you think it’s worth checking out by a doctor if it’s chronic pain?

  218. Lacinda

    I first noticed this pain 11 years ago while pregnant with twins and after that just off and on but it has gotten worse and this whole week it hasn’t let up any…its just a sharp pain deep within the lower buttock left hip area and it just hits me when standing, walking or sometimes just moving. I can lay down on the floor and cross my left leg over the right and i really can feel the stretch and the pain but its like it feels better….what else if anything can I do?

  219. Kim

    Hi, I am 47 year old female. I read through your article and feel I may have this Piriformis. I have bad feet, poor posture, work at a desk all day (ever since I can remember). I am in overall good health, had blood tests etc and a physical. I am maybe 20 pounds overweight and not a lot of exercise. I get headaches, more like neck aches very stiff. I have been having back pain for about a year in my lower back, more like the upper part of my butt with some weird ache in my upper legs down the front and sides. I was having low back pain on Friday at work, a little worse then usual, but tolerable. This pain lasted throughout the day and night, coming and going. Saturday when I woke up still the same pain, we took a drive about an hour and was still feeling bad. It seems when we got out of the care and I was walking around it went away or felt better. Few hours later when we drove home the drive was killing me, we had to stop so I could stand up for a minute and stretch. The stretching was painful as well, like very tight muscles when I would bend over, like when you exercise. When we finally got home If I stayed moving around the pain was not so bad. Then around 10pm when I sat down with in minutes the pain started, within a half hour I felt like I was in labor, very bad pain in the upper part of my butt as you describe at the top of my butt crack and going around my hips and into my legs a little. The pain was so bad it made me cry. I know something is wrong, but don’t want to be paranoid. I took 4 Advil and went to bed with heating pad. When I woke I could feel it coming back. The minute I sit I can feel it. It is hard to describe pain, just like labor and aching deep inside of my upper butt, below the belt line and into my legs. A little pain in my upper back when I cough too.

  220. Deven

    Hello. I have some kind of pain related to the piriformis (or there-abouts). I’m 27, male, healthy weight. I have a deep pain in my left glute that comes about only when I either lie on my left side (or sometimes my back) or when I shift my weight from one leg to the other while walking or twist in certain ways. If I walk slowly and don’t twist fast there isn’t much (if any) aggravation, but I work assembly in a manufacturing plant so that isn’t always possible.

    There’s no lasting pain (constant), only pain when I lie on my left or shift weight/twist sharply. The pain is a sharp twinge but goes away pretty quickly. Sitting doesn’t hurt, and driving my car doesn’t hurt. Nor sure if it’s in the sciatic nerve as I don’t have any pain shooting up or down my body. Just in the left glute (only left) and sometimes inner left hip. When I first got it I slept on my left side and it hurt so much I could barely walk. But moving around made the symptoms subside that morning/afternoon until it mostly went away (that day).

    Also, walking around more seemed to help alleviate the symptoms the first week, now not so much. Ibuprofen kills the pain entirely after about 1 hr of taking 400mg. I did some piriformis stretches the first week and all pain was completely gone with all motion. Then a couple days later it came back during work (felt like I stretched something too far and “jarred it loose”). Not sure if I should see someone or what. It’s not a pulled muscle (I don’t think) because moving around seems to help. At least it did.

    I’ve never had any kind of glute, hip, or back pain/problems before now.


  221. Bryan

    I’m a male, door to door sales person . lifting 60lbs regularly, driving for ten plus hours daily, in and out and up and down on this truck. Ben dealing with chronic butt pain just what u described in the article what can i do to find relief ?

  222. tiffany

    I don’t know if this is what i have but 4 weeks ago while i was sleeping i woke up in pain as if i pulled a muscle. and no it was not a leg spasm as i had those a lot growing up. but it comes and goes from my right butt to my knee. sometimes i cant bend my knee or walk for long periods of time. biofreeze doesn’t seem to be working nor ibuprofen. I’ve also been going to the chiropractor and the adjustments nor massages have helped… what should i do?

  223. Gilbert

    It is a very good article. I think it is the piriformis muscle is responsible for lower back problem that most police officers are encountering nowadays. The weight they carries on thier hips are enormous( belt- use of force gun etc) is the source of the piriformis syndrome. Is there any exercise that some can do to reduce this problem? Thank you.


  224. Judy Weintraub

    I don’t believe i’ve had this before. I’m 64. it started 5 days ago after i had done some vacuuming and mopped the kitchen floor. I was a little sore in the right lower back during and after mopping, didn’t think anything of it at first, i hadn’t mopped in a long time. i vacuum often and it hasn’t caused any pain. The soreness steadily worsened and seemed to be in the right butt area and lower right back. Before long, it hurt so much that i thought of taking a Vicodin. The vicodin i have is from 2006 (prescription for my daughter) so you can see i don’t often think of taking Vicodin, that is just how bad this new pain was hurting. I never take NSAIDs or aspirin, i think they are harmful. I put a heating pad on the area but unlike when i get a muscle spasm in my lower back, the heating pad didn’t help. it felt good while it was on but no helpful improvement. The next day after sleep it was just as bad, terrible. I am fine as long as i lay still or sit. It only hurts when i walk and only on the right. I dread walking. One other thing, for many years i’ve been pretty sedentary, the only exercise i have gotten other than normal walking around and irregular chores, has been a short session of yoga stretching and breathing in the mornings before going to work. i’ve continued to do that gently since this pain started and it doesn’t seem to affect the pain one way or the other. About two months ago, i started going for daily half hour brisk walks in the mornings for exercise. I mostly walk on concrete sidewalks. I’ve enjoyed doing it. Since this pain started, i can’t walk, walking seems to make it worse and walking is the main thing that causes the pain, other than walking, i don’t feel it. I did a little more careful floor mopping (two small bathrooms) a couple of days after this pain started and that did not seem to aggravate it at all, but any walking hurts. On the third day i thought it seemed slightly better, but the fourth day, yesterday, it seemed no better and maybe worse. i dread walking from my couch to the kitchen to get a drink of water. When the pain first started, i thought of it as ‘lower right back.’ By yesterday, i mainly think of it as right buttock pain. Also, i noticed when i bent my right leg up to put it into a pants leg when getting dressed, it hurt to raise my leg, in the area where the leg meets the body in the front. I looked up sciatica on the internet a couple of days ago and learned it’s a symptom, not a diagnosis. Everything i read mentioned pain that goes down the leg. So far, mine does not do that. It seems concentrated in my right butt and low right back, and mainly only hurts when i walk. the left side seems fine, no pain. I have only read what is on this web page and will read the other links today. Related to other issues i’ve had over the years, i have almost no condidence in conventional medicine and i don’t tend to want to see doctors, expecting anything from no help to things being made worst. My experience has been that inflammation is very important to understand and to treat holistically, but after doing that nutritionally for years with unbelievably good health results (i think of it as general detoxification), due to some lifestyle and work related changes, i let a lot of things go holistically, and i believe i wouldn’t be having this problem if i were still living the way i did for over 10 years when all symptoms fell away, replaced by the best health i could ask for. i recently retired from my unhealthy job, but haven’t gotten back into the healthy lifestyle yet, haven’t felt up to the discipline, but know that it’s the best and only way to be really well. I also have a chronic pain in my neck on the left side that began about a year ago (Fall of 2012). I retired in January but the pain didn’t go away. Web searching led me to think it’s myofacial. my doctor referred me for physical therapy through my HMO but whatever they did worsened the pain so much, i only went to three sessions. I don’t get too much pain with it because it mainly hurts only if i turn my head to the left so i just avoid doing that, but i know that’s not the answer. I am preparing to get a line of credit on my house so i can afford things like myofascial release therapy paying out of pocket. i appreciate all the information here.

    • Whoa Judy; hold your horses.

      You likely do not need to take out a line of credit against your house to get this thing fixed. Just last week on my http://www.DoctorSchierling.com blog, I did articles titled HOW MANY VISITS FOR PIRIFORMIS SYNDROME and HOW MANY VISITS FOR CHRONIC NECK PAIN. Not sure a credit line is necessary. Get back on your healthy diet though.

      Dr. Russ

  225. A. Mobley

    I have no symptoms of the PCOS. However, I did do the stretches for piriformis syndrome and the two places I felt were my right hip and the center on the right side of my butt. It actually hurt to do the stretches. Should i feel pain while doing them? I have an appt tomorrow with a massage therapists.

  226. A. Mobley

    I have been having pain for over a year. The pain is deep on the right side of my butt and my right hip area. I also have sciatic pain that radiates down my leg all the way to my foot. I have started having numbness and tingling in my right foot also. I thought the pain was from ovulating on my right side or that I had a cyst. I have been to numerous doctors and they all want to take my uterus out. The last doctor I went to wants me to have an MRI because she is not convinced that a hysterctomy will solve it. She referred my to another doctor and he said I had weakness on my right side and ordered me to have two MRI’s. One of the lumbar area and the other of my pelvis area. I am really concerned because I really feel like Piriformis Syndrome is what I have and I am afraid of being misdiagnosed. It feels like someone has tied a knot in the muscle in my butt and it is connected to my hip area. Most of the time walking helps the pain, however, this last month has been horrible and lying down seems to make it feel better. i am very active and I exercise daily even with the pain that I have. Also, the pain started after having my husband pull a boot off. Any suggestions would greatly be appreciated.

  227. Cheryl

    I can’t tell you how happy I was to find your page as I feel like it’s the first thing that makes any sense of the excruciating pain I’ve been in for the past few months. Been bed ridden for 5 weeks only getting up for small walks around the house and other essential things. Which has been incredibly hard with three boys and a husband to take care of. Luckily I have a husband that is absolutely amazing.
    Only bad thing to finding your page is realizing you are so far away. I’m in Utah and a car ride to the dr or sitting for that matter is so painful I cry the entire way. I’ve researched this tissue remodeling and am hoping I can get some more info on this via email. I think I’ve found someone locally that does this but would like more info. Thanks!

    • Hello Cheryl,

      Last evening I had a call from my best friend who thinks he has developed Piriformis Syndrome. He said that he understood why people talked about ending it all. If you go to my other site (DOCTOR SCHIERLING) and look at our FAQ page for Tissue Work, you’ll find just about everything you could ask for.

      Dr. Russ

  228. Jessica

    Hello my name is Jessica,
    I have these same pains in my left butt cheek. It hurts when I sit for too long and then stand up. I have had 3 miscarriages. Is this because of the pain?

    • Hello Jessica,

      It is doubtful it is caused by the pain. The lower part of the spine is not only where the nerves that travel into the buttock and Piriformis region originate, it also happens to be where the nerves that control your female organs originate. While I think that this is an over-simplification of your whole problem, it could certainly be a contributing factor. Simple fact; irritate a nerve, and irritate anything along the pathway of said nerve. Just be aware that nerves do far more than provide sensory input. If I were you, I would do two things to start with. Even though this post is about misscarrying, you can read about them HERE.

      Dr. Russ

  229. michele

    I have similar pains – worse after sitting – when I get up I have to stretch and then the pain is less – what must I take ? Will exercise and losing weight help?

    • Hello Michele

      Stretching is usually a good thing, although not always (HERE). Unfortunately, “taking” something is rarely the answer for Piriformis Syndrome — or any health-related problem for that matter. As far as beneficial supplements, the first thing you must do is understand INFLAMMATION. Grasp the importance of Inflammation and all else follows.

      Dr. Russ

  230. carole

    I’ve been suffering from butt pain for almost 2 years now. Dr’s specialist have run all the tests in the book. they are now at the point of giving up on me as they do not know what else to do.

    I’m very excited to have found your site. wondering if this in fact could be my issue. i had a car accident and was for months sleeping in a lazy boy and couch due to severe pain in neck and torn shoulder capsule.
    i could feel pressure from my butt area but thought it was due to always lying down and sitting for very long periods of time.
    but the pain kept increasing till about 3 months later i started getting numbness in the legs and cramps in the feet that would twirl my toes right out. it came to a point were one morning i woke up to numbness in the lower leg and feet and my right leg started blocking sideways and has been ever since. I’ve done MRI’s Cat scans every tests in the book yet they still cannot find the cause of my issue to the point were they are making me feel its all in my head. well i know its not as i have been dealing with severe pain for almost 2 years now. i was a active mother of 2 before the accident and was living a normal healthy life until the accident.

    my question to you, could this also cause feet to discolor when sitting almost feeling like there is not enough circulation being done? and could this also cause a leg to remain sideways making it feel like every step something is pulling in the upper butt crack area? they have checked tail bone sacrum discs etc… nothing showed except a very small cyst along the lower spine left side.

    • Hello Carole,

      Anytime you irritate a nerve, you potentially irritate anything innervated or controlled by that nerve. This could certainly cause neurovascular issues such as discoloration, blanching, etc. This is seen all the time with neurovascular issues such as Raynaud’s Disease. Also, any time a muscle has tension or Scar Tissue, it will shorten. Shorten a muscle and you can certainly pull limbs or other body parts out of normal alignment.

      Dr. Russ

  231. Dap

    Hello I am 55 and approximately 7 years ago I was diagnosed with Chronic inflammatory demyelinating polyneuropathy (CIDP). I have been having infusions for this issue which at one point I was told it was in remission but still couldn’t walk without a tremendous amount of pain in my feet. I am on my second set of infusions which will last for 6 months this time rather than a full year and there doesn’t seem to be an end to this pain in site. Well the other day out of the blue my butt started hurting so badly that I can not only sit anymore which is the only thing I could do up to this point for a very long time but when I go to stand it just is such a sharp pain down my leg until I can get my leg situated to walk. I am now limping non stop which is making the CIDP in my feet hurt worse and I am just beside myself. Is there anything I can do to make this stop?? I cant sit I cant sleep I cant walk I just about at my wits end with all of this. This is just no way to live I hurt pretty much 99% of the time now. Any ideas at this point would be greatly appreciated. :) I could really use some insight.

    • Hello Dap,

      While Tissue Remodeling will not help with the CIDP, I know a couple of things that probably will. Firstly, since the name of the problem contains the word, INFLAMMATION, you have to understand what this really is. My experience tells me that very few people actually understand Inflammation, even though the word is bantered around constantly. Secondly, make sure to read THIS POST on the relationship between neurological problems, gluten and uncontrolled blood sugar.

      Dr. Russ

  232. Robert

    Is there any particular age group this affects? Or is it all from different walks and times in life? Can this be stress related? My wife is currently suffering from a lot of the similar symptoms you described. We are both overweight would this also have play a role? I have sciatic pain caused from a work injury on my L4 L5 but the way she describes it, it sounds very familiar to my own injury. Since she is overweight she has a hard time using the restroom and when she tries to clean herself she often presses or twists her back slightly to do so. Would appreciate anything you can tell me about this, I am concerned.

  233. Ana

    Can it happen simoultaineously on both hips, legs, front and back? Thank you.

    • Hello Ana,

      In a word, yes. I have written extensively that there are lots of different reasons people get Piriformis Syndrome. The Fascial Adhesions can occur at any number of places, but it is the Piriformis Muscle where the Sciatic Nerve actually gets ‘pinched’ or irritated.

  234. Jody Kenyon

    This is a reply for Tina. Strengthening what is weak will help, as piriformis is tight. This includes the adductor magnus, longus and brevis. A fantastic exercise I can recommend is Dr. Eric Goodman’s The Founder. This strengthens what is weak, and thus draws the femurs back and straight where they belong and this lessens the irritation of the sciatic nerve. I am a massage therapist and have had great results with trigger point therapy and clients doing the founder. You can google it; there is a youtube video.

    • Thanks Jody,

      Another great piece of self-help advice! I am familiar with Dr Goodman’s work (need to read his book). I had forgotten about this exercise but am going to play with it some more. By the way, Jody is a Princeton-educated massage therapist practicing in the Ft Lauderdale area. Again, thanks Jody.

      Dr. Russ

  235. Hello,

    For years i have felt like i have been sitting on a golf ball with pain in my butt i recently have had arthroscopy hip surgery and the pain on my butt is much worse, making my piriformis go into spasms. But my dr thinks it is SI problems. I am tired of this pain!

  236. Diana

    Hello Dr Russ
    I was diagnosed with Severe Left sided stenosis about a year ago. I have had a series of 4 nerve blocks that have not been successful other than a lot of pain from the shots!! I have recently seen a spine doctor who sent me for yet another block and again no results. I went to see him today as my leg is so very painful!! I cannot sit for long periods of time nor stand for long periods of time. My leg burns yet it feels like tiny needles are sticking me. After walking a short time my foot starts to go numb and feels like it is flopping along. I have resorted to using a cane when I am out on long trips such as grocery shopping or walking the mall as I cannot stand the pain. However, today my doctor said seeing that the blocks are not working it has to be priiformis syndrome and he is not sending me off to another doctor to get a shot in the hip!! I am deathly afraid of going to yet another doctor who wants to pass me off to someone else! I have already had a total of 5 blocks completed in my spine and I am now looking at another one in my hip. I am confused on what to do next…please help!!!!

  237. Raymond

    Mine started with a hip [left] pain. I’ve had a stroke that mildly effects that side. Now there’s a nasty pain in my buttock dead center. This Sciatic type pain seems to be a result of reacting to the hip pain. I had a bone scan and C.A.T. scan which says I have very mild osteoarthritis of the hip joint but is much worse in my other hip which is pain free. A physio fellow wants me to sit on a tennis ball and for 2 minutes roll around on the “sore spot”
    I can barely walk. I need home care to help with all sorts of things. Stairs are not worth the agony to descend. 300 mg. doses of Tylenol help a little bit and my life is not worth living. My cat is my only family.

    • Hello Raymond,

      I feel for you. However, don’t give up hope. I had a Medicare-aged woman come see me last week for her chronic buttock pain — this after lots of chiro adjustments and therapy. She was 100% out of pain immediately. Make sure you check our the INFORMATION AND VIDEOS at my other site. BTW, do you live close to me?

      Dr. Russ

    • Andrea Carpenter

      Hang in there Raymond! I’m laying here right now in the same pain with my cat by my side:) I’ve been in so much pain that, I too am ready to give up. I seemed to have some relief after I took a muscle relaxer, so I’m going to keep reading here and hopefully it will give me some answers. Try to stay strong, your kitty needs you as much as you need it:)

  238. Asha Govender

    I have read up on piriformis syndrome that you have indicated on this site and would definitely want more information.Both my husband and I hav the same “butt pain” and I especially have been afraid to go to the dr and was wondering how can I describe someone kinda pushing a long sword into me,We would like to know our way forward to improve the pain,Its extremely excruciating

  239. Teresa

    I was doing a cartwheel and as I went over something pulled in my groin area and ever since, I have had pain in my right butt cheek, down the back of my thigh and sometimes my entire leg will ache. I was given anti-inflamatory and muscle relaxant drugs to help with the pain. Could this be Piriformis Syndrome?

  240. diyflunkie

    I have been diagnosed with piriformis syndrome. I injuried myself in a fall almost 2 years ago and started having pain in my right leg..which at the time was diagnosed as ITBand syndrome and SI joint dysfunction. My leg was full of knots shooting pain from my hip to my knee and knee to foot. After working on releasing the knots in my leg…my lower back was starting to hurt moreso. MRI was performed..showing 2 bulging disks and annular tear L4-S1.but no impingements which could of caused leg pain…although EMG showed mild neuropathy at S1. Here I am 2 years later after having bilaterial medial branch block and FLUOROSCOPICALLY GUIDED CONTRAST ENHANCED RIGHT S1TRANSFORAMINAL EPIDURAL STEROID INJECTION…hoping to eliminate the sharp stabbing pain that I was getting in my legs (both legs are affected now). Just recently my Dr. (being confused with the 2nd MRI showing no nerve impingement also) is thinking I have piriformis syndrome. I am really concerned about this diagnoses…as all of the research that I have done on piriformis syndrome shows that the pain runs down the back of the leg and is in the buttock area. My pain starts at my hip running down the side of the leg moving over the top of the lower thigh near the top of knee..side of knee down over the shin…down the side of the foot. I have a numb feeling the the side of my lower leg, Occasionally I will get these pains behind my knees…and different areas on the back of my legs…but not very often. I am wondering if piriformis syndrome can cause this pain or if it is strickly down the back of the leg. I am scheduled to have piriformis injections and because it is a W/C injury will have to go through with them. I am just tired of the pain I get in my legs especially after standing, walking and sitting for any length of time.

  241. sally

    Helo name is Sally, I am 49 amd over the years i have suffered with back pain to the point of not being able to move. However in the last week from nowhere my buttocks ache bad specially of a night i cant lie in a position for very long it starts to hurt really bad i am in constant discomfort. Also when sitting i have to keep moving position. Also i have pain in my right leg which is very sharp an seems deep as if it is in my chin bone. I wasnt sure if i should visit my GP do you think i should go. Many Thanks Sally

  242. Laura

    I have had either Scatica or piriformis syndrome since February. It started as foot pain and I thought I had a neuroma. I would have pain at my desk job everyday by 3:00 or if I drove 45 minutes or longer. Pain is in right butt cheek, down back of led to the knee. I also feel a sharp pain on the side of my hip and it is very tender. I would wake up with numb toes and it hurt to walk. I have tried the chiropractor and a massage therapist. The only thing that took the pain away was a week of Methylprednisolone. This means inflammation was the problem. I have switched to an anti inflammatory diet but still have the pain. Thinking of trying a doctor next but will not do shots.

    • Hello Laura,

      A few thoughts. Although the ANTI-INFLAMMATORY DIET will not ‘cure’ many of these specific problems, it will help you with your overall health. Continue this. The decision to forgo the SHOTS is also smart. They are very degenerative and rarely help over the long haul. As far as the whole “is it Piriformis Syndrome or Sciatica?” argument, you need to read THIS.

      Dr. Russ

  243. Emily

    I have the worst pain (mainly on the right side but left has started as well) in this exact area of the butt. It also travels down the muscle on the side of my leg down into my knee. I’ve had many chiropractic adjustments to correct several areas in my neck, back, and hips. However, the chiro apts have not helped this area, even with weekly massages (which are always only focused on this area). I’ve tried incorporating a foam roller, stretches, leg and butt exercises as well as daily vitamins and fish oil. Nothing has helped! Driving, sleeping, sitting, walking have all come excruciatingly painful. I’m not sure what to do but these pains have been constant for 14 months. I am 29 years old and do not have children.

  244. Anne

    This has been my experience as well. I have Spondylolisthesis, fibromyalgia, and after researching the pains in my butt, suspect Piriformis Syndrome also. I feel these are all connected. Tried meds, had injections into the lower spine, went on anti-depressants, etc, but felt no better. After Googling Dr. Schierling’s fibromyalgia webpage, I realized that there needed to be some changes in my lifestyle. The changes I found most helpful were swimming, doing stretches, and jogging in the pool. Don’t overdo the stretches and start off easy and build it up. I hope this helps you like it did me.

    • Right you are Anne. Everything is connected on some level. I strongly suggest that people exhaust all self-help options before trying anything more invasive (yes, the drugs are invasive). Glad it worked for you — great advice.

      Dr. Russ

  245. B.C.

    Does taking calcium supplements like Calicfood help with Piriformis Syndrome?

  246. Jody Kenyon

    Trigger points in piriformis, glutes, TFL, can all cause extreme pain in the butt as well. There is a great book available called “The Trigger Point Therapy Workbook” by Claire Davies. This book teaches the reader about trigger points and shows the best ways to treat them yourself. I am an LMT and I have learned much from the book that is helpful for treating my clients with TPs. This therapy is an important tool for getting well and being pain free.

    • Thanks for the comment Jody,

      I have seen this book as well as many others which are similar. Although I see many people who have trigger points, the majority of those I treat; trigger points are not their major problem. Many people dealing with chronic Fascial Adhesions do not have severe primary trigger points —- they have Scarred Fascia. Most of the people who make trips to see me have tried just about every self-help technique (not to mention all sorts of other things, some of which are very invasive) trying to find some relief.

      Dr. Russ

  247. Dannielle

    I was diagnosed with piriformis syndrome 10 months after having my daughter and months of tests. I was on a high mg of gabapentin. 4x a day. After I became pregnant again and tried pt for the third time since being diagnosed I was put on pain medication. It has been 7 months since I had my second child and the pain is almost unbearable. The pain went from increasing intensity every few months to now I notice it weekly. Percocets do little help and my doctor pretty much told me to deal with it after cutting off all my medication. I have no idea what to try now since I’ve done everything short of surgery. I’m only 25 and can barley take care of my 2 year old and 7 month old. Any suggestion would be greatly appreciated.

    • I believe you Dannielle,

      You wrote to me at 1:00 am. My question to you is this; what tests did they use to arrive at the diagnosis?

      Dr. Russ

      • Dannielle

        After xrays,MRI, ultrasounds,and a nerve test they finally did a range of motion and pressure test they diagnosed me. My last physical therapist told me I definitely have piriformis but she thought there is some other issue as well, but unfortunately I can’t afford to have more tests done at the moment.

  248. Joe

    Unfortunately, no. I am near Nashville, TN. I happened across the website while digging for information. I’ve had low back pain in the past (2010) and an MRI showed a bulging disc. Surgeon recommended PT only and that worked well. This pain is somewhat similar, although I didn’t have any pain in my foot before and the pain in my back was more centralized. What I have now feels more to me like a strain, but I’m aware that sciatic nerve pain can be very deceiving so I’m not sure. Could the pain that started presenting in the heel only at the begining have been sciatiaca? I need to get in to the MD, but with medical costs (even with ins.) so high, I hate the prospect of chasing down the cause, much less the treatment. I had success using the McKenzie method before but with this, it only seems to work at the time I’m doing it. Walking is supposed to help, as I recall, but in my case it hurts.

  249. Joe

    It began about 4 weeks ago, acute pain in my right heal when I walked. Worse in the morning, but not much better throughout the day. Although I’ve never experienced it before, DIY research seemed to point toward plantar fasciitis. I started performing some suggested stretches, heal inserts, night splint, etc… Within a week my heal pain became much less, BUT…I now have SEVERE pain in my low back/hip area. I can sometimes get comfortable lying on my stomach or even sitting, but it comes back with a vengeance within a few steps when walking/standing. I have been performing back extension (McKenzie Method) stretches for 3 weeks with no results. More or less pain free until I get up and start walking. The pain comes rushing back. Very discouraging.

  250. Tracy

    In addition to the pain in my butt that you have described I also have started getting pains high up on the back of my leg that feel like someone has put a tazer gun on my leg,, lasts for a few seconds than goes away. Could this all be from the Piriformis muscle? Will stretching help?

    • Absolutely your sciatic-like sensations could be from Piriformis Syndrome. Yes, try stretching. But be warned that if severe enough Fascial Adhesions are present, you can actually make things worse — sort of like pulling on the ends of a rope that has a loose knot in the center, and hoping it is going to free it up.

      Dr. Russ

      • Tracy

        I have read your info on Fascial Adhesions and have been diagnosed with Plantar Fasciatis on the same side of my body,,, Is this all related? What do I do?

        Thank You

      • Tracy,

        I have a page on Plantar Fasciitis. Be sure to check it out. It could very well be related. If not, you will have to get some sort of orthotic device. Do you have high arches. High arches tend to run together with Piriformis Syndrome and Plantar Fasciitis.

        Dr. Russ

    • Lucas

      Hi. Yes I felt the exact way you felt except mine was said differently.On the left buttocks than ran down the backside of my leg, the inside felt as if I was packaged meat cooking on a hot stove. The pain was intense and after physical therapy sessions I felt much better and stayed off work and took my meds. Though the pain has gone away, it is limited and minor pains only come after bad posture I noticed.

  251. Kristin

    I went to new chiropractor and he diagnosed this as my piriformis muscle. He gave me some stretches to do but since I am very flexible, they didn’t help. I did find that yoga helps a great deal. In fact, I haven’t had any pain for 6 months now.

    • It is all about movement. Not just the fact that people need to be active, but the fact that every single cell and tissue in your body must move properly in relationship to the cells and tissues around them. Yoga stretches promotes movement and will help will all sorts of physical problems, including many cases of Piriformis Syndrome. Be aware though that this approach will not work for everyone — particularly those who are dealing with major Scar Tissue / Fascial Adhesions. Thanks for your input Kristin.

      Dr. Russ

  252. Alice

    I have also been fighting pain in the butt that feels like someone is jamming an icepick in my right butt cheek. Sometimes I can barely sit which is bad as I am a Customer Service Rep and sit most of the day. Doctor says it is a muscle in my back that is causing the butt/hip pain. He doesn’t seem interested in it.

  253. Carolyn Edel

    I did that same scenario almost 7 years ago. I did not nor ever will go for shots as they are temporary. I did, however, learn that the glut muscles were weak as well as the leg that the piriformis was in was extremely weak. I do not have any more issues since I have strengthed the glut muscles and the actual leg…Shots are only temporary!

    • You are correct Carolyn; muscle weaknesses or misfiring muscles can be a huge problem. Be aware that for many people, this approach is impossible due to either scar tissue, neurological issues, or other considerations. If simple strengthening exercises fixed your problems, count your blessings. For most hardcore Piriformis Syndrome sufferers, trying to solve the problem simply by strengthening muscles will end up making them worse.

      Dr. Russ

  254. teresa

    This was diagnosed from my doctor as my pain would not go away. I had fallen down the stairs and suffered heavy deep bruises and thought that was it, I would heal in a month or two. After a month I was not getting better my doctor sent me to physical therapy and massage therapist then a chiropractor. That’s when I was diagnosed. Now waiting for shots in that muscle so I can get some relief.

  255. Mary-Iris Taylor

    Dr. Russ, I have just begun experiencing incredible pain deep in both my butt cheeks (however one is worse than the other). I initially thought it was our mattress (which we’ve had for a year but this pain started this week) because it is especially bad in the morning when I get out of bed. I can hardly walk — and lying flat on my back when sleeping seems to make it worse. If I sleep on my stomach or side it lessens the pain. My back and thighs don’t seem to be involved — at least not yet. Stretching and walking seem to help. I thought the sudden onset was really odd. Does this sound like piriformis syndrome to you?

  256. Trina

    This information was so helpful. I have been researching my pain since it began on 7/18/2011. My pain started very sudden and very severe from head to toe and progressively worsened as the months passed. But it also changed. The pain became centralized in my lower pelvic area, hips, thighs and buttocks. Now its mostly in my right thigh to the tip of my knee & buttocks. The pain is excruciating!
    I have had many MRI’s, nerve tests, CAT scan, xrays. All normal. I’ve basically been diagnosed with Chronic pain. I take gabapentin and morphine every 8hours and for breakthrough pain I take oxycodone. I believe that I may have what you describe in your article as piriformis syndrome.
    I will share this information with my doctor next week. Thank you

    • Hello Trina,

      You could be correct, but you may very well have some sort of systemic inflammatory autoimmune issue as well. Make sure you read my blog post (DoctorSchierling.com) on Systemic Tendinosis. Great information for you.

      Let me know what your doctor thinks.
      Sincerely, Dr. Russ

      • Trina

        Hi Dr. Russ I initially blogged you around 8/19/13. After reading your article on piriformis syndrome I spoke with my doctor about it she printed out some exercises that I could do to strengthen that muscle. But I haven’t tried it yet because as I continued to read your article along with other blogs, if the muscle is seriously scarred or there are fascial adhesions present, those exercises can actually make the pain worse. My question to you is how can piriformis syndrome be diagnosed? Are there any tests to determine this? And what is ultimately the cure to rid me of this horrible pain? I don’t want surgery nor do I want to be on strong narcotics for the rest of my life.

      • Hello Trina,

        Piriformis Syndrome is extremely difficult to actually ‘diagnose’. In fact, most cases are made simply via clinical findings because it will not show up on standard tests such as MRI. There is new technology MRN (which is MRI of the nerves overlayed over a MRI) and special new kinds of EMG (standard EMG will not do it). Some people run into problems with their insurance paying for brand new technology.

  257. Tammy

    i have been suffering with this since 1997. I am currently seeing a neuromuscular doctor that is great. We believe that my problems started when I got an injection in my right buttock and I do not believe that the nurse knew what she was doing. I have already had an MRI of the lumbar spine and pelvis (to include the butt cheek) and will have a follow-up with contrast. They really believe that it is piriformis syndrome and I believe it is too.

  258. Kathleen Pierman

    Thank you for your explanation of the exact pain you have indicated. I have been down the route as many and have been misdiagnosed. However, with today’s technology, I cannot believe there is not something that can be done.

  259. Cheryl Keefer

    I am so glad to have found this info!! After having this exact described pain for approx 7 months, I haven’t found anything to alleviate the pain. And my doctor is starting me on some testing that I fear will be to no avail. Definitely gonna show him this article!! Can’t thank you enough!’n

  260. michelle

    After reading this I know exactly what I’m suffering from. No Dr will listen I have just had a complete hip replacement because they swore that was the problem and 6 weeks After surgery I’m still in just as much if not more pain then I was .It’s going on 7 yrs I can’t get treatment for it. Pain of course because nothing is showing on the hundreds of tests ran already. And because half the nation abuses them so we who need can’t have. I need your help so bad as to what to so to help the pain. This has finally broke me I don’t enjoy life anymore and I should I have everything to be happy for except this. I feel like I’m losing my mind looking for relief. hope to hear from you.

  261. cassey

    This was very informative. I have been trying to explain this pain I am feeling for 7 years and all the doctors have done is take Xrays that come back normal. I have another appointment and I will be taking a copy of this article with me. Thanks a million

  262. Joan Nishite

    Piriformis syndrome, I have never heard of it before, but I have had these symptoms for most of my life. Thank you for the information. Great job!

  263. Ljay

    Funny I’ve read this post probably 5-10 times and I think that each time something will jump out and magically fix me. I’ve suffered from excruciatingly chronic pain for 13 years. Had two hip ops, 15 injections and pretty much broke from all the weekly treatments I have in an attempt to keep me sain. Like others it has sucked the life out of me, I’ve quite my job and suffering from depression. If there is ANY advice you can offer I’d appreciate it. Apparently my piriformis looked ok under the knife but my nerve was severely swollen and irritated- my question, well something caused that so why didn’t ou wok that out while ou had a 12cm incision in my butt open!!!?? I am basically begging for help- ain meds and Pilates don’t help :(

    • vinod

      there are medicines in homeopathy for this chronic pains and its effective. But the MD doctors dont suggest you that becuase they dont know how the homeopathy works. BUt it works. god bless u :-)

      • Hello Vinod,

        Right you are about homeopathy working for many cases of Chronic Pain. And it should come as no surprise that the medical community does not embrace homeopathy or other forms of natural healing. As we all know, the Pharmaceutical Industry rules the day when it comes to the practice of medicine. Just be aware that if someone has Piriformis Syndrome due to Scar Tissue or Nerve Entrapment, homeopathic remedies are probably not going to be much help. The beautiful thing is that they are inexpensive, with no downside (side effects). Try them and see? Absolutely! The truth is, most people I see for Piriformis Syndrome have tried just about everything under the sun.

        Dr. Russ

  264. Shalene Harriss

    THANK YOU!! I am going to take this article with me to my doctor who says nothibg is wrong with me! I am so glad i came across this!!!!!!

  265. Lynn L.

    This is very interesting. I’ve been experiencing pain in the exact areas as described for several years now. I’ve attributed my pain to my scoliosis, thinking it’s something I have to “live with.” Now that the pain has gotten progressively worse, I’ve been trying to get a diagnosis for over six months. First doc said it was a pinched nerve. Second doc said it was SI Joint dysfunction. I’ve had MRI’s, CT scans, x-rays and ultrasounds, and just found out yesterday I have “tendenosis” in my gluteus medius tendon (aka dead butt syndrome?). I can’t help but think I also have piriformis problems, along with “snapping hip syndrome.” I’ve tried PT, pain killers, ice packs, warm packs, hot tubs, acupuncture and SI joint injections – and I have no relief for any of this. I’m desperate to know what I can do to relieve the pain, both short term and long term. I can’t sit for very long and standing/walking for more than about 5 minutes is wildly painful. I also find my right leg (below the knee cap) and right foot start to perspire when my piriformus/dead butt syndrome is acting up. I’m going to a teaching hospital tomorrow to meet with a “top doc” intervention radiologist. Hopefully, he can do something to help me. This chronic, intractable pain is excrutiating and is sucking my will to live. Thanks for this post. It’s very helpful. :-)

  266. Laura

    Thank you so much for this great article. I was misdiagnosed with fibromyalgia yesterday and I had to laugh when I read what the symptoms are. I haven’t had chronic pain for more than 3 months, it is acute and happens when I bend or twist, then that piriformis muscle goes crazy spasming and I can’t get it to unlock. It then squeezes my piformis so hard that I can’t sit, drive a car, or stand for long periods of time. My own mother, a registered nurse, did not buy that I had FM either. I have suffered from low back pain and shoulder pain on my right side since I was a child. The earliest children are usually diagnosed with FM is in their teens. The doctor also did not do a tender points test. I had to laugh when he gave me 4 bottles of Cymbalta for free. I guess he had his MO. Make me wait an hour to see him, then slap me with some blanket chronic pain diagnosis rather than take a full medical history. Well I have flat feet, and my right leg is slightly shorter than the other, which causes all the problems and sciatica like symptoms on my right side. When I saw a podiatrist for orthotics in 2009, he informed me that the flat feet would cause my lower back pain if I didn’t wear the orthotics every day with a quality shoe. My chiropractor said it was a muscle in my back that was shorter in women than in men, but she didn’t tell me what muscle it was. This article helped me to put all the pieces together. Thank you so much for writing this article, I only wish more doctors were as knowledgable so I didn’t have to waste my time.

  267. Anna

    Dear Dr. Russ-
    I am a 20 year old female and occasionally (2x a month maybe..) have a very deep pain in my left butt cheek (very rarely in my right). It’s not to the point where I can’t function but it is a pain that is noticeable. If I press down on my buttcheek, it feels tender and sore, like I’ve fallen on it but that’s never the case, it’s just a pain that comes and goes for no real reason. What you’ve written above sounds like it could be what my problem is but I’m just wondering if women my age get this? Am I too young to have this? I have had a child and understand this could’ve controbuted to my issue… Will it continue to get worse? Thanks for reading and for writing this interesting and informative article!

  268. Pauline Atkin, Chester England

    At last…..a diagnosis!!! I cannot begin to tell you how much peace of mind I feel having read your ‘Pain in the Butt’ website.
    Since 2008 I have attended different clinics within our local hospital to no avail. I have spinal stenosis, apparently my lumbar facet joints are ‘rubbish’, & all forms of treatment thus far have failed, i.e. spinal & root nerve injections, medications etc.. Despite all my hip area pain, no osteo arthritis manifests itself. Now I know why!!
    I feel I can cope now I know what is causing the pain.

  269. Val2081

    Thank you for such an in depth and interesting article on butt pain. The pics could be exactly where my pain is. I feel I now know what I am up against and understand better how I can cope with it.

  270. Thank you for the your remarkable comments and opinions on Piriformis Syndrome. My closest relative, my Uncle Donald (we are both English) he’s now retired and close to 80 years, (but as mentally sharp and physically active as ever) like myself, I’m still chasing news, he spent most of his life as a War War Correspondent. In 1971 after suffering a concussion after a land mine explosion in Vietnam, he had a Laminectomy performed in Tokyo where fusion lower lumbar fusion was used.He appeared to fully recover and was left with his ‘left leg’ shorter than the other. It never stopped him from playing sports and being very active and pursuing his career until retirement.

    As his eyesight is failing (Glucoma) he had a few falls,nothing dramatic, but in the last year. Result seems to have been all the symptoms of sciatica in his right hip radiating down the front of his leg.

    Unlike many cases of Piriformis Syndrome, his symptoms occur when lying down – in any position – walking or sitting upright in a chair removes the pain.

    Xrays and MRI show little but the slight lower lumbar deterioration – an area he has had minor aches in. for 20 years.

    Apropos treatment, strong pain killers bring little or no relief. Many Physiotherapists along with countless doctors seem stumped. Cortisone injections failed. All Surgeons talk surgical exploration. into the Piriformis muscle. An old friend of his a former MASH surgeon advises him against it at his age. Biggest problem he has is he can’t lie down to get sleep. Obviously he can’t sit up all night or walk to removed the pain.

    I worry about this dilemma as every specialist has had a different opinion?

  271. Przedłużanie Rzęs Warszawa

    I have been surfing online greater than 3 hours today, yet I never discovered any interesting article like yours. It is lovely price enough for me. In my opinion, if all site owners and bloggers made excellent content material as you did, the internet might be a lot more helpful than ever before.

  272. Margie Achman

    After 14 years of wildland firefighting, working in and running a commercial greenhouse’s for many years, volunteering, becoming an employee with the Red Cross, and being a very busy Mom, Wife and person in general, I started having a pain in my butt. We moved to Missouri over a year ago from Alaska where I had a great Chiropractor, Heather — hard shoes to fill. I asked around and found Dr. Schierling – heard he was the best! My large family in Missouri all go to him and even family outside the state when they come visit. Anyway he had been doing adjustments and I, as usual, complained to him about my pain in the butt. The pain was so bad I could not sit, stand or lay on my side. Driving would make me cry! We set up an appointment for the Tissue Remodeling Treatment. Trust me the first 3 minutes were not fun, but immediately it stopped hurting. The bruising wasn’t pretty, but boy I would walk, sit, stand and yes, drive! Best thing I ever did. Haven’t had the pain back since and that was 8 months ago – Thanks Dr. Schierling!

  273. I had a pain in my butt that ran down to my knees. It got so bad I was taking pain meds every day and sitting or standing was painful. Even though I had been to going to Dr. Schierling for adjustments and had him do the remodeling for my neck, I did not realize that he could do anything about the sciatic nerve that was causing me so much pain. After just one soft tissue treatment I was pain free and did not need a second treatment. I am now going back to see if Dr. Schierling can relieve the pain in my heel from my fallen arches. I am so thankful our family has Dr. Schierling in our lives!

  274. Elysieum

    Thanks Doc. What advice would give in reducing the pain around my lower back (the chief source of associated buttock pain). Your advice is greatly appreciated.

    Thank you

  275. I would strongly suggest that you read THIS POST in its entirety — including watching the videos.

  276. joseph

    I’ve been having that “pain in the butt feeling” but it doesn’t travel… it’s hard to sleep due to shift bedtime positions and sometimes when I’m standing I get a shocking sensation that nearly causes me to fall… do you think this is PS

  277. Hello Joseph,

    Piriformis Syndrome, at least at first, does not necessarily have to be associated with Sciatica. PS often starts with an inflammation, adhesion, or trigger point that eventually fires things up to the point of Sciatica. Go over to Doctor Schierling dot com and check out the blog post I put up today concerning the various things you can do to help heal PS yourself — if in fact that is even what you are dealing with.

    Dr. Russ

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