Understanding Piriformis Syndrome: Causes, Similar Conditions, and Chiropractic Treatment

Piriformis syndrome is a neuromuscular condition where the piriformis muscle, located deep in the buttock, compresses the sciatic nerve, leading to pain, numbness, or tingling along the back of the leg. This condition is often confused with other musculoskeletal and neurological disorders, making proper assessment crucial for effective treatment. As sports rehabilitation chiropractors, we take a comprehensive approach to diagnosing and managing piriformis syndrome, utilizing techniques such as dry needling, Active Release Technique (ART), spinal manipulation, and rehabilitation exercises.

What Is Piriformis Syndrome?

The piriformis muscle plays a key role in stabilizing and externally rotating the hip. However, when it becomes tight or irritated—often due to prolonged sitting, overuse, or biomechanical imbalances—it can put pressure on the sciatic nerve. This leads to symptoms similar to sciatica, including:

- Deep gluteal pain, sometimes radiating into the hamstring or calf

- Numbness or tingling in the leg

- Increased pain with prolonged sitting or specific movements like running or squatting

Since the sciatic nerve runs underneath (or in some cases, through) the piriformis muscle, any inflammation or dysfunction in this area can mimic other conditions, making accurate diagnosis essential.

Other Conditions That Mimic Piriformis Syndrome

Several conditions present similarly to piriformis syndrome, including:

- Lumbar Disc Herniation – A bulging or herniated disc in the lower back can compress the sciatic nerve, producing nearly identical symptoms.

- Sciatic Nerve Entrapment – The sciatic nerve can be irritated at multiple points along its path, not just at the piriformis.

- Sacroiliac (SI) Joint Dysfunction – Dysfunction in the SI joint can cause gluteal pain that mimics piriformis syndrome, often with more localized discomfort.

- Hamstring Strain or Tendinopathy – Muscle injuries in the hamstring can cause referred pain in the same region.

- Hip Labral Tears or Femoroacetabular Impingement (FAI) – Structural hip issues can cause deep hip and buttock pain that is mistaken for piriformis syndrome.

Because these conditions overlap in symptoms, a thorough assessment is key.

Chiropractic Assessment of Piriformis Syndrome

As rehab based chiropractors, we take a movement-based approach to diagnosing piriformis syndrome. Our assessment includes:

- Orthopedic and Neurological Testing – Evaluating sciatic nerve tension, lumbar spine function, and SI joint involvement.

- Palpation and Soft Tissue Evaluation – Identifying piriformis muscle tightness, trigger points, and referral pain patterns.

- Functional Movement Analysis – Assessing hip mechanics, gait, and muscle imbalances contributing to dysfunction.

- Postural Assessments and Movement Analysis - A thorough postural assessment helps identify misalignments and movement dysfunctions. Tools such as gait analysis, functional movement screening, and muscle testing provide insights into the root cause of postural imbalances. In addition, diagnostic ultrasound can be used to assess muscle activation, identify soft tissue abnormalities, and detect structural changes that may contribute to pain or dysfunction. This real-time imaging allows for a more precise evaluation of muscle imbalances, tendon injuries, and joint abnormalities, helping clinicians develop targeted rehabilitation strategies.

Once diagnosed, treatment is focused on relieving pain, improving mobility, and restoring proper function.

Chiropractic Treatment for Piriformis Syndrome

1. Dry Needling

Dry needling helps release trigger points in the piriformis muscle, reducing muscle tension and decreasing nerve irritation. This can be particularly effective in chronic cases where traditional stretching and manual therapy are not enough.

2. Active Release Technique (ART)

ART is a hands-on treatment that targets adhesions and tight fascia around the piriformis. By applying tension while the muscle is lengthened, ART helps restore normal movement and reduce sciatic nerve entrapment.

3. Spinal and Pelvic Manipulation

Misalignments in the lumbar spine or SI joint can contribute to piriformis dysfunction. Chiropractic adjustments help restore proper motion in these areas, reducing compensatory strain on the piriformis muscle.

4. Rehabilitation and Corrective Exercises

Rehabilitation is essential to preventing recurrence. We prescribe exercises to:

- Strengthen the glutes and core to improve pelvic stability.

- Improve hip mobility to reduce compensatory tightness.

- Enhance neuromuscular control to prevent over-reliance on the piriformis for hip stabilization.

Common exercises include glute bridges, clamshells, lateral band walks, and nerve glides to free up sciatic nerve mobility.

Piriformis syndrome can be frustrating, especially when misdiagnosed. As sports chiropractors, we focus on a whole-body approach, addressing the root cause rather than just the symptoms. With a combination of dry needling, ART, spinal manipulation, and targeted rehabilitation, we help patients recover efficiently and return to activity pain-free. If you’re struggling with sciatic-like pain, a comprehensive chiropractic evaluation can determine whether your piriformis is the true culprit—or if another condition is at play.