Piriformis syndrome is a condition that hides in the deep layers of the hip.
The piriformis muscle is small, but it plays an important role in stabilising the hip and coordinating leg rotation. When it becomes tight, overworked or irritated, it may compress the nearby sciatic nerve, causing buttock pain, radiating discomfort down the leg.
Because this condition does not always show up on imaging, many people spend months searching for the cause of their pain, unaware that a small muscle buried deep in the buttock is the main contributor.
The discomfort is often vague—deep, tight, radiating or hard to pinpoint—yet persistent enough to affect sitting, walking, driving and daily routines.
Why does the piriformis become tight?
The piriformis works quietly behind the scenes.
It stabilises your hip, balances your pelvis, and helps you move efficiently.
But when you sit for long hours, frequently cross your legs, drive for extended periods, run with poor mechanics, or rely too much on one side of the body, the piriformis gradually becomes overloaded.
Sometimes it is compensating for weak hip muscles;
sometimes it tightens to stabilise the pelvis during stress or fatigue;
sometimes it simply does not get enough opportunities to relax.
A tight piriformis sits closer to the sciatic nerve, and nerves do not tolerate pressure well.
As a result, discomfort may travel from the buttock into the thigh or even the lower leg.
What does piriformis syndrome feel like?
Descriptions vary from person to person:
A deep ache in the buttock;
A pulling sensation down the back of the leg;
A tight band that appears when walking;
Numbness after sitting too long;
Difficulty crossing legs or getting out of a car.
The discomfort is often triggered by:
- Prolonged sitting
- Driving
- Running
- Bending or lifting
- Transitioning from sitting to standing
- Standing on one leg
- Long walks
Even without sharp pain, the persistent deep discomfort can be frustrating.
Why doesn’t rest or massage solve it completely?
Because piriformis syndrome is rarely about a single muscle.
It is usually a result of how the whole lower body works together.
Some common contributing factors include:
- Weak or underactive gluteal muscles
- Poor load transfer through the pelvis
- Sitting habits that overload one side
- Gait patterns that rely too heavily on the posterior chain
- Reduced hip mobility
- Uneven weight-bearing
Massage may loosen the muscle temporarily, but once you return to the same posture or movement pattern, the tension returns.
The root issue is not the muscle itself—
it is the way the body distributes load during everyday activities.
How does Occupational Therapy help?
Occupational therapy looks not only at muscles and joints, but at how you move through daily life.
An OT will would like to know:
How you sit at work;
How you get out of the car;
How you walk and stand;
How you lift, bend and transition;
Which side of the body you rely on more;
How your hips and core share forces.
Instead of focusing only on loosening the piriformis, OT helps you build a pattern of movement that no longer overloads it.
Small adjustments such as shifting sitting posture, improving hip stability, reducing compensations, and redistributing forces during daily tasks can significantly reduce symptoms and prevent recurrence.
When should you seek a professional assessment?
Consider an evaluation if you experience:
- Deep buttock pain lasting several weeks
- Numbness or tingling after sitting
- Pain that radiates down the leg
- Difficulty walking or climbing stairs
- Discomfort when turning in bed
- Symptoms interfering with driving or work
Early assessment helps identify the behavioural and biomechanical triggers behind your symptoms.
Piriformis syndrome is not a sign of damage—it is a request for balance
Your body is not failing you, just the piriformis is simply doing more than it should.
With balanced hip mechanics, improved movement patterns and a more supportive daily routine, the piriformis can return to its natural role instead of constantly compensating.
OT helps to rebuild that balance so peop can sit, stand, walk and move with comfort and confidence.
