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Buttock pain - piriformis syndrome?

Are you suffering from buttock pain that feels deep and may sometimes cause radiating pain down the leg or into the lower back? Piriformis syndrome is a term that originated from the idea that the piriformis muscle, located deep in the buttock, could compress the sciatic nerve and thus cause pain in the buttock, lower back, and lower limbs. However, nowadays we know that there are many other muscles and structures in the deep gluteal space besides the piriformis that can irritate the sciatic nerve. Therefore, the condition is now commonly referred to as deep gluteal syndrome (DGS). DGS simply means that some structure in the buttock area is causing irritation to the sciatic nerve. Studies suggest that about 6-17% of sciatic pain cases may be caused by DGS, making it a relatively rare condition. You can read more about sciatic pain here. (1,2,3)


Diagnosing DGS is often challenging because its symptoms can be very similar to those of lumbar disc herniations, for example. Therefore, the client needs to be interviewed and examined carefully. If the pain feels more on the outer edge of the hip, it may also be a tendon-related condition (gluteal tendinopathy). Here are some typical symptoms:

  • Buttock pain, often felt deep (usually one-sided)

  • Stretching the buttock or lifting the leg often provokes pain

  • Buttock pain often worsens after prolonged sitting

  • The buttock muscles may feel tender when pressed

  • Night pain is possible; the buttock may also feel tight during hip movements

Piriformis syndrome


In the treatment of DGS, conservative approaches are usually the first line of action, which practically means exercise therapy. For some patients with a more difficult situation, injections such as cortisone or botox may also be tried alongside rehabilitation. Patient education is also essential - for example, efforts are made to reduce provocative movements, which often leads to a reduction in symptoms. Significant effects can often be achieved with small everyday changes. Currently, there is a lack of high-quality research available on the treatment of DGS. Like almost all other musculoskeletal disorders, the treatment of DGS often follows a similar pattern; minimizing aggravating factors, followed by a progressive increase in loading in the area. If desired results are not achieved through rehabilitation for some reason, which is rare, surgery is the last resort. However, there is also no high-quality research data available on the effectiveness of surgical treatment. (1,2,3)

What causes buttock pain?

There can be many different reasons behind buttock pain, but usually, it is completely harmless. Suddenly onset buttock pain may be due to muscle overuse or some nerve-related reason.

Where does piriformis pain occur?

What helps with buttock pain?

Joonas Virtanen

Osteopath, sports massage therapist & fitness coach

Ilari Keckman

Osteopath, sports massage therapist & educator



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