One Common Culprit for Your Client’s Pain in the Butt

CEU Article Title: Assessing Piriformis Syndrome

By: The NCCPT Education Staff

In evaluating any injury or condition, like Piriformis Syndrome, there are some common protocols one must follow before making an assessment: evaluating past medical history, evaluating the history of the present condition and inspecting the area.

When evaluating past medical history it is important to see if the patient has any prior medical conditions related or unrelated to the issue. Along with any medical conditions, it is important to obtain a full list of current or previous medications to make a correlation between the medications and the current issue. When evaluating the history of the present condition, it is important to pinpoint the origin of the pain, find out when it started and what makes it hurt. The patient may have changed their normal routine recently that could have led to an acute injury to the area. If the pain is radiating from the hip region, the injury may be Piriformis Syndrome.


Piriformis Syndrome is a neuromuscular disorder that occurs when the sciatic nerve is irritated or compressed by the Piriformis muscle leading to pain and tingling in the leg and buttocks. Piriformis syndrome usually is accompanied by pain in the posterior aspect of the hip, radiating down the posterior hip region which may decrease when lying supine with the knees in a flexed position (Starkey, Brown
& Ryan, p. 449).

When you’re looking for suspects…

When Piriformis syndrome is suspected, first visually inspect the area where the pain occurs. In many instances, specifically with chronic pain (Piriformis syndrome often falls under this category), other issues or biomechanics may mimic the signs of Piriformis syndrome, but instead may be symptoms of another condition. Many times a lumbar nerve root compression, sciatica or hamstring syndromecould cause the same symptoms as Piriformis Syndrome (Starkey, Brown & Ryan, p. 448).

It is important to inspect if there is atrophy of the gluteus maximus by comparing one side to the other. Also, make sure to check what position of the hip aggravates the pain. To assess the muscle, a positive straight-leg-raise test or resisted hip abduction in the seated position may indicate Piriformis syndrome (Starkey, Brown & Ryan, p. 449).
As the femur approaches 90 degrees of hip flexion, the Piriformis can act as an abductor. If it is tight, it might cause pain. With Piriformis Syndrome, gait exercises may alleviate the pain, but cycling may aggravate it. The treatment for Piriformis syndrome could entail decreasing, stopping and/or changing the activity that may have caused the condition. Stretching the Piriformis, strengthening the hip extensors and internal rotators are recommended. In some cases a surgical release of the Piriformis may be needed; however, if the stretching and strengthening alleviate the condition, the diagnosis was correct (Starkey, Brown & Ryan, p. 449).


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Starkey, C., Brown, S., & Ryan, J. (2010). Examination of Orthopedic and Athletic Injuries 3rd edition, Philadelphia, F.A Davis Company, pgs. 448 – 449v