Massage & Piriformis Syndrome: Symptoms, Causes, and Relief Strategies

Body Massage

July 15, 2025

Piriformis Syndrome and Massage

What Is Piriformis Syndrome?

Piriformis syndrome is a neuromuscular condition in which the piriformis muscle—located deep in the buttock—compresses or irritates the nearby sciatic nerve. This can cause pain, tingling, or numbness along the path of the sciatic nerve, which extends from the lower spine down the back of the leg.

The piriformis muscle plays a key role in stabilizing the hip and rotating the thigh outward. However, if the muscle becomes tight, inflamed, or spasms, it can aggravate the sciatic nerve underneath or alongside it.

While often confused with sciatica caused by spinal issues, piriformis syndrome is considered an extra-spinal cause of sciatic pain and requires a different treatment approach.

Symptoms of Piriformis Syndrome

Symptoms typically develop gradually and are often one-sided. Common signs include:

  • Deep, aching pain in the buttock
  • Pain that radiates down the back of the thigh (sciatica-like)
  • Increased pain when sitting, climbing stairs, or rising from a chair
  • Pain relief when lying on the back
  • Numbness or tingling along the sciatic nerve

The pain may worsen after prolonged sitting or physical activity, especially running or cycling. In some cases, people feel relief by lying flat or walking.

Causes and Risk Factors

Piriformis syndrome can stem from a variety of causes:

  • Muscle overuse or strain: Repetitive movements (e.g., long-distance running or cycling) can lead to inflammation or spasm of the piriformis.
  • Prolonged sitting: Desk jobs or long drives can chronically shorten and tighten the piriformis.
  • Anatomical variation: In 15–30% of people, the sciatic nerve passes through or around the piriformis muscle in a way that makes compression more likely [1].
  • Trauma: A fall on the buttocks or direct impact can lead to swelling and irritation.

Women are more likely to develop piriformis syndrome than men, possibly due to differences in pelvic anatomy and biomechanics [2].

How It’s Diagnosed

There is no definitive test for piriformis syndrome, which makes diagnosis a challenge. Doctors often arrive at it by ruling out other causes of sciatica, such as herniated discs or spinal stenosis.

Tests may include:

  • Physical examination of hip range of motion and strength
  • Palpation of the piriformis muscle to reproduce symptoms
  • Imaging (MRI or CT scan) to exclude other conditions
  • Diagnostic injections to assess pain relief when anesthetic is applied to the piriformis area

Because symptoms overlap with other lumbar or nerve root issues, diagnosis often involves a process of elimination.

Treatment Options

Treatment for piriformis syndrome typically begins with conservative (non-surgical) approaches. The goal is to reduce muscle tension, calm nerve irritation, and restore normal movement.

1. Massage Therapy

Massage is highly effective in treating piriformis syndrome. Techniques that target the glutes, hip rotators, and sacroiliac joint help:

  • Release muscle tension
  • Increase blood flow to the area
  • Decrease pressure on the sciatic nerve

Deep tissue massage, trigger point therapy, and myofascial release can all help. Massage should be done by a trained professional who understands sciatic nerve anatomy and can work gently but effectively in the region.

Study Note: One study found that patients with piriformis syndrome who received massage therapy reported significant improvements in pain and mobility [3].

2. Stretching and Physical Therapy

Gentle piriformis and hip stretches can help release tension in the muscle. A physical therapist may also recommend exercises to:

  • Strengthen the hip abductors and external rotators
  • Improve posture and gait
  • Correct muscle imbalances contributing to irritation

Key stretches include the supine piriformis stretch, pigeon pose, and seated spinal twist.

3. Heat and Cold Therapy

Applying a heating pad to the gluteal area can ease muscle tightness, while ice packs may reduce inflammation after flare-ups.

4. Anti-Inflammatory Medications

NSAIDs (e.g., ibuprofen) can temporarily relieve pain and inflammation. Muscle relaxants may also be prescribed in more severe cases.

5. Injections

In some cases, corticosteroid or botulinum toxin injections are used to calm inflammation or reduce spasm in the piriformis muscle.

6. Surgery (Rare)

Surgical intervention is considered only when all other treatment options fail. Surgery involves cutting the piriformis muscle or relieving pressure on the sciatic nerve. This is extremely rare and usually a last resort.

Self-Care and Prevention

Once symptoms improve, long-term management focuses on prevention. Consider the following:

  • Stay active: Regular movement prevents muscle stiffness. Avoid prolonged sitting.
  • Warm up: Prior to workouts, warm up with dynamic stretches targeting the hips.
  • Work ergonomics: Use a seat cushion, adjust posture, and take breaks from sitting.
  • Stretch regularly: Include piriformis and hip stretches in your daily routine.
  • Massage maintenance: Occasional massage therapy sessions can keep the area supple.

When to Seek Help

If your pain persists beyond a week, or worsens despite rest and self-care, professional help is warranted. You should also seek medical evaluation if:

  • Pain radiates below the knee
  • You experience numbness or weakness in the leg
  • Sitting becomes intolerable
  • The symptoms disrupt your sleep or daily life

These signs could indicate other causes, such as disc herniation, that require different treatment.

The Role of Reflexology and Massage

While traditional reflexology focuses on pressure points in the feet, it can also be a complementary treatment for piriformis syndrome. Reflexology may help:

  • Encourage nervous system relaxation
  • Improve circulation to the glutes and hips
  • Reduce systemic stress that contributes to muscle tension

At massage spas that specialize in both reflexology and deep tissue massage, clients often benefit from a combined approach—starting with reflexology for general relaxation and progressing to targeted gluteal work.

Final Thoughts

Piriformis syndrome is a frustrating but manageable condition. With the right combination of massage, movement, and self-care, most people recover fully without invasive treatments. Early intervention is key—don’t wait until the pain becomes chronic.

If you're dealing with deep gluteal pain or sciatic symptoms, consult a qualified therapist who understands neuromuscular anatomy. Massage therapy, in particular, has proven to be one of the most effective, drug-free tools for resolving piriformis-related discomfort.

Reflexology Plus offers customized massage treatments for piriformis syndrome and other muscular conditions. Book your session today to start feeling relief where you need it most.

Citations:

  1. Beaton, L. E., & Anson, B. J. (1937). The relation of the sciatic nerve and of its subdivisions to the piriformis muscle. The Anatomical Record, 70(1), 1–5. https://doi.org/10.1002/ar.1090700102
  2. Papadopoulos, E. C., & Khan, S. N. (2004). Piriformis syndrome and low back pain: a new classification and review. Orthopedic Clinics of North America, 35(1), 65–71. https://doi.org/10.1016/S0030-5898(03)00106-1
  3. Cummings, M., & White, A. R. (2001). Needling therapies in the management of myofascial trigger point pain: a systematic review. Archives of Physical Medicine and Rehabilitation, 82(7), 986–992. https://doi.org/10.1053/apmr.2001.23896