Piriformis Syndrome in College Station, TX: Deep Buttock Pain

Piriformis syndrome is pain, numbness or tingling in the buttock that happens when the piriformis muscle presses on the sciatic nerve. The piriformis is a flat, narrow muscle that runs from the base of the spine to the top of the thigh, and the sciatic nerve usually runs right underneath it. According to Cleveland Clinic, it can affect one side or both, with symptoms in the butt, hip or upper leg.

People usually describe:

• A deep ache in one buttock, sometimes with a tender spot you can press on
• Pain, tingling or numbness that runs into the back of the thigh
• Pain that builds the longer you sit, especially on a hard seat or a long drive
• Discomfort climbing stairs, running, or getting up from a chair
• Relief when you stand up and walk around

It’s less common than most people think. Cleveland Clinic notes that piriformis syndrome accounts for only about 0.3% to 6% of low back pain. That matters, because the same symptoms often come from somewhere else, and treating the wrong source keeps people stuck.

We see it most in runners and active adults, people who sit for long stretches at work, and drivers who spend hours behind the wheel. Patients around College Station often come in after weeks of stretching the area without much change.

The difference is where the sciatic nerve is being irritated. With true sciatica, the problem usually starts at the spine, often from a herniated disc or narrowing around a nerve root. The AANS on herniated discs describes that pain as radiating from the buttock into the leg and sometimes into the foot. With piriformis syndrome, the pressure happens in the buttock, so symptoms tend to center there.

A few clues lean toward the piriformis:

• Little or no low back pain
• A tender spot deep in the middle of the buttock
• Pain that flares with sitting and eases when you stand and walk
• Symptoms that stay mostly in the buttock, hip and upper leg

Those are tendencies, not rules. The sacroiliac joint sits right next door and can cause very similar buttock pain, so the exam checks all three areas. Pressing hard on the sore spot at home to test it usually just leaves it more irritated without answering the question.

Cleveland Clinic lists these as the most common triggers:

• Long periods of sitting, such as desk jobs or driving
• Running, walking or climbing stairs without enough strength in the hip muscles
• Skipping a warm-up before activity
• Overuse and repetitive motion, like long-distance running

Sitting deserves extra attention. A long workday in a chair keeps pressure on the buttock and holds the hip muscles in one position for hours, which is why pain that builds while sitting so often involves more than one area.

There’s no single test that confirms piriformis syndrome, so it’s identified by ruling out other sources. Dr. Hansen starts with a detailed history, then checks your low back, SI joint and hip with orthopedic tests, tests strength, reflexes and sensation in both legs, and presses and moves the hip to see what brings on your pain. Digital X-rays are taken in-house only when the findings call for them. Getting the source right is why we examine before we adjust.

When the piriformis is the main driver, care follows three steps. Prime uses guided breathing to help your body settle out of a guarded state. Facilitate is a gentle, specific adjustment to the low back, pelvis or hip based on your exam. Integrate is what happens between visits. Soft tissue work on the deep hip muscles often helps, and strengthening the hip muscles matters as much as stretching, since weak hip muscles are a common trigger and the condition tends to come back without follow-through.

Cleveland Clinic notes most episodes settle within days or weeks with rest and simple care. If yours has lasted longer, keeps coming back, or started after an injury, it’s worth a closer look.

Some buttock and leg pain needs medical care first. Go to the ER or see your physician right away if you have:

• Numbness in the groin or inner thighs, or new trouble controlling your bladder or bowels
• Sudden weakness in the leg, or frequent trips and falls
• Fever along with back or buttock pain
• Pain that started after a fall or crash

We see chiropractic patients from Bryan, Navasota and Caldwell for buttock and leg pain. If none of the warning signs apply, schedule your first appointment and we’ll find out where it’s coming from.

Is piriformis syndrome the same as sciatica?

Not exactly. Both involve the sciatic nerve, but sciatica usually starts at the spine, often from a herniated disc or narrowing around a nerve root, while piriformis syndrome happens when the piriformis muscle presses on the nerve in the buttock. The symptoms can look almost identical, which is why the exam checks the low back, SI joint and hip before settling on an answer.

Why does my butt hurt more when I sit?

Sitting puts direct pressure on the buttock and keeps the hip muscles in one position for a long time, which can squeeze an irritated piriformis against the sciatic nerve. Cleveland Clinic lists long periods of sitting among the most common causes. Getting up regularly, sitting evenly instead of on a wallet or one hip, and walking during breaks often help.

Should I keep stretching my piriformis?

Stretching helps some people, but it usually isn’t the whole answer. Weak hip muscles are a common driver, so strengthening matters as much as stretching. And if the pain is actually coming from your low back or SI joint, stretching the piriformis won’t change much. If a few weeks of stretching hasn’t helped, get it examined so your exercises match the real source.

Can running cause piriformis syndrome?

It can. Cleveland Clinic lists long-distance running and other repetitive motions, along with skipping warm-ups and running without enough hip strength, among the common causes. Runners often notice it on hills or longer runs. Easing off for a few days, warming up, and building hip strength usually help, and an exam can check whether your low back or SI joint is part of the picture.

How long does piriformis syndrome last?

Most episodes settle within days to weeks with rest and simple care, but it does tend to come back, especially if the habits that triggered it don’t change. Care plans here are built around your exam, and progress is judged by your symptoms, what you can do, and how your joints and muscles move. If you’re not improving the way we expect, Dr. Hansen will tell you and talk through other options.

Do you see Texas A&M students and runners for buttock pain?

Yes. We see Texas A&M students, faculty, runners and weekend athletes from across College Station and the Brazos Valley. Many come in after a hard training block or a semester of long study sessions. Your first visit includes a full history and exam, so we can tell whether it’s the piriformis, your low back or your SI joint before care starts.