Why Does It Hurt Deep in Your Buttock, and Is It Sciatica?

Why Does It Hurt Deep in Your Buttock, and Is It Sciatica?

Deep buttock pain that travels down the leg is often mistaken for sciatica, but it may actually be piriformis syndrome, caused by a small muscle in the buttock compressing the sciatic nerve rather than nerve compression in the spine. The key difference is where the pain starts: piriformis syndrome typically begins in the buttock with little to no lower back pain, while sciatica usually originates in the lower back. Getting this distinction right matters, because physiotherapy for the two conditions targets different structures.

Why That Pain in Your Buttock Might Not Be Sciatica

Experiencing a deep, nagging pain in the buttock that sometimes travels down the back of your leg? You're not alone.

This type of discomfort is often linked to piriformis syndrome, a condition associated with deep gluteal pain. It's commonly mistaken for sciatica, but the underlying cause is different and getting the diagnosis right is key to effective treatment.

What Is Piriformis Syndrome?

Piriformis syndrome occurs when the piriformis muscle, a small muscle located deep in the buttock, irritates or compresses the sciatic nerve. This can lead to:

• Pain in the buttock
• Tingling or pins and needles down the back of the leg
• Numbness in the thigh or lower limb

This condition falls under the umbrella of deep gluteal pain syndrome, where structures in the gluteal region compress or irritate the sciatic nerve.

Piriformis Syndrome vs Sciatica: What's the Difference?

Although symptoms can feel similar, there are key differences:

Piriformis Syndrome:

• Pain typically starts in the buttock
• Often no associated lower back pain
• Caused by muscle tightness or irritation

Sciatica (Lumbar Spine Origin):

• Pain often starts in the lower back
• Caused by nerve compression in the spine (e.g. disc herniation)
• May include more widespread neurological symptoms

Because symptoms overlap, it's important to have a proper assessment to determine the true cause.

What Are the Common Symptoms of Deep Gluteal Pain?

You may be dealing with piriformis syndrome if you experience:

• Deep aching pain in the buttock
• Pain radiating down the back of the leg
• Pins and needles or numbness in the thigh
• Discomfort when sitting for long periods
• Pain during walking, running, or climbing stairs

What Causes Piriformis Syndrome?

Several factors can contribute to this condition:

• Prolonged sitting (common in office workers)
• Muscle tightness or imbalance in the hips
• Overuse from running or sport
• Poor movement mechanics
• Previous injury to the hip or pelvis

In many cases, it develops gradually due to a combination of these factors.

How Does Physiotherapy Treat Piriformis Syndrome?

Physiotherapy is the most effective first-line treatment for piriformis syndrome and deep gluteal pain. The goal is to:

• Reduce nerve irritation
• Release muscle tension
• Improve mobility

Restore strength and movement patterns

Our Treatment Approach at Relive Physiotherapy

Hands-On Treatment

We use manual therapy techniques such as:

• Myofascial release to reduce muscle tension
• Soft tissue work targeting deep gluteal muscles
• Joint mobilisation (including the lower back and sacroiliac joint)

This helps relieve pressure and improve movement.

Targeted Rehabilitation Exercises

Exercise is essential for long-term recovery. Your programme may include:

• Stretching of the piriformis and surrounding muscles
• Strengthening of the glutes and hip stabilisers
• Movement retraining to reduce strain on the area

Acupuncture / Dry Needling

Dry needling can be particularly effective for deep gluteal pain. It helps to:

• Release tight muscle knots
• Improve blood flow
• Reduce nerve irritation
• Provide fast pain relief

This is especially useful for muscles that are difficult to reach with traditional techniques.

How Long Does Recovery Take?

Recovery time depends on the severity and duration of symptoms.

• Mild cases: a few weeks
• Moderate to chronic cases: 4-8 weeks with consistent physiotherapy

Most clients experience noticeable improvements early in treatment when the correct diagnosis is made.

When Should You Seek Treatment?

If you're experiencing:

• Persistent buttock pain
• Pain radiating down the leg
• Difficulty sitting or exercising

...it's important to get assessed early. Accurate diagnosis ensures you receive the right treatment and avoid prolonged discomfort.

Don't Ignore Deep Gluteal Pain

Piriformis syndrome and deep gluteal pain can feel similar to sciatica, but they require a different treatment approach. With the right physiotherapy plan, you can reduce pain, improve mobility, and prevent recurrence.

At Relive Physiotherapy in Chester, we take a whole-body approach to treatment by addressing not just the symptoms, but the root cause of your pain.

Book your appointment today and start your journey back to pain-free movement.

Frequently Asked Questions

How do I know if it's piriformis syndrome or sciatica?

The main difference is where the pain starts. Piriformis syndrome typically begins in the buttock with little or no lower back pain, while sciatica usually starts in the lower back due to nerve compression in the spine. A proper assessment is the best way to confirm which one you have.

What does piriformis syndrome feel like?

Common symptoms include deep aching pain in the buttock, pain radiating down the back of the leg, pins and needles or numbness in the thigh, and discomfort when sitting for long periods or during activities like walking or climbing stairs.

What causes piriformis syndrome?

It's often linked to prolonged sitting, muscle tightness or imbalance in the hips, overuse from running or sport, poor movement mechanics, or a previous hip or pelvis injury, often developing gradually from a combination of these factors.

Can physiotherapy treat piriformis syndrome?

Yes, physiotherapy is considered the most effective first-line treatment. It focuses on reducing nerve irritation, releasing muscle tension, improving mobility, and restoring strength and movement patterns.

How long does it take to recover from piriformis syndrome?

Mild cases may improve within a few weeks, while moderate to chronic cases typically take 4-8 weeks with consistent physiotherapy. Most people notice improvement early on once the correct diagnosis is made.

About the Author:

Shivani Darira

Senior Specialist Physiotherapist

As a Senior Specialist Physiotherapist at Relive Physiotherapy, Shivani has a particular interest in treating musculoskeletal and sports injuries. She holds an MSc in Sports Medicine from the University of Chester and brings a strong clinical foundation to her work with athletes and active clients alike.

Shivani's approach is guided by the principle that movement aids healing, and she takes a dynamic, personalised approach to every client's recovery journey.

Outside the clinic, Shivani enjoys HipHop and Bollywood dance and is currently learning to swim and play tennis.