If you’re dealing with deep buttock pain, don’t fall into the “piriformis syndrome trap.” Most likely, it’s your gluteal tendons asking for better load management, not a rogue muscle strangling your sciatic nerve. Treat it like tendinopathy — because that’s what the evidence says it is.
🙅🏻♂️Don’t Fall for the Piriformis Syndrome Trap
Perhaps one of the most misunderstood injuries that an athlete may encounter, why? It’s full of myths, but has an explanation that allows a person to latch onto the false understanding.
The general explanation goes a little like this: “There’s a muscle deep in your buttocks called the piriformis. The sciatic nerve runs underneath this small deep muscle, so when this muscle becomes tight, it presses on the sciatic nerve, creating the discomfort you feel.”
The hilarious aspect of the proposed solution for piriformis syndrome, from a generalized perspective, is a combo of “stretching” the piriformis and “elbow dropping” the buttocks to “release” this muscle. Why is this hilarious?
Because if the hypothesis is that pressure on the nerve is creating the discomfort, then wouldn’t deep pressure and stretching cause MORE pressure on the nerve? Also, if pressure is helpful via muscle release (whether it be from a lacrosse ball or rehab provider), then wouldn’t sitting be helpful in alleviating symptoms? Yet, this is one of the more common complaints from an athlete with piriformis syndrome.
The initial hypothesis of piriformis syndrome is misunderstood, which then leads to a misunderstanding of how to treat it.
👉What Piriformis Syndrome Truly Is
Recent evidence suggests that it’s likely not even piriformis syndrome, the more accurate diagnosis is: Gluteal Tendinopathy: irritation of the gluteal tendons at their insertion on the greater trochanter of the femur.
MRI and ultrasound studies frequently demonstrate tendinopathic changes or tears in the gluteus medius/minimus in patients presenting with so-called “piriformis syndrome” symptoms.
Tenderness over the greater trochanter, weakness in hip abduction, and positive findings on tests like the Trendelenburg sign or FABER test are more consistent with gluteal tendinopathy.
Interventions targeted at tendinopathy (e.g., progressive loading, addressing movement patterns, and avoiding compression of the lateral hip) yield better outcomes than treatments aimed at piriformis “release” or sciatic nerve decompression.
😲What NOT to do for Piriformis Syndrome
TO DON’T: Outdated or Non-Evidence-Based Interventions
| Intervention | Why It Doesn’t Hold Up |
| Piriformis Stretching (aggressive deep gluteal stretching) | Often aggravates the tendon by compressing it further, especially in adducted positions. |
| Massage or Foam Rolling “Trigger Points” in the Piriformis | Provides temporary relief at best, but doesn’t address the tendon pathology or load issues. |
| Piriformis “Releases” or Injections without Imaging Confirmation | Poor diagnostic accuracy; may misdiagnose and delay appropriate tendon-focused treatment. |
| Blaming “Sciatic Nerve Entrapment” Without Clear Neurological Signs | Nerve compression by the piriformis is rare; most cases are tendon-related and not neuropathic. |
| Passive Modalities (e.g., ultrasound, TENS, cupping) | Lacks strong evidence for long-term benefit and does not promote tendon adaptation. |
| Generic Rest Without Active Rehab | Leads to deconditioning and doesn’t solve the underlying issues. |
🙌What To Focus On:
Ready to learn what really works for long-term relief from piriformis syndrome and other common sports injuries? [Click here to discover what to focus on instead.]
Author:
Dr. Dillon Caswell, PT, DPT, SCS
Hope Evangelist | Top-Selling Author & Speaker | Human Performance Expert