The piriformis muscle is a small, deep muscle in the buttock that rotates the hip outward and sits in close proximity to the sciatic nerve, making it a frequent contributor to hip and radiating leg pain.
Where your piriformis muscle is and what it does
Your piriformis sits beneath the gluteus maximus in the deep layer of the buttock, running from the front of the sacrum to the top of the femur. Its primary function is external rotation of the hip — turning the leg outward — but it also helps with hip abduction when the hip is flexed.
Because the sciatic nerve passes either beneath, through, or just adjacent to the piriformis depending on the individual's anatomy, tension or spasm in this muscle can compress or irritate the nerve and produce symptoms that travel down the back of the thigh, into the calf, or even into the foot. The piriformis often becomes tight or overloaded in people who sit for long periods, have weak hip abductors, or have altered gait mechanics that shift more demand onto the deep hip rotators.
Why piriformis-related pain is frequently missed
Piriformis syndrome — pain and sciatic-like symptoms driven by the piriformis muscle rather than spinal nerve compression — is often mistaken for a lumbar disc problem or sciatica originating from the spine. When imaging of the lumbar spine comes back normal or doesn't match the symptom pattern, the piriformis muscle is frequently the overlooked explanation.
Why treating the spine doesn't resolve it
When the piriformis is the actual source of nerve irritation, lumbar-focused treatments — traction, lumbar mobilization, spinal injections — don't address the problem. A physical therapist can perform a clinical assessment that distinguishes piriformis syndrome from spinal radiculopathy and treat the right structure.
How Sword Health can help
A physical therapist can assess whether your deep buttock or leg pain is driven by the piriformis muscle and build a targeted plan to address it. Sword makes that specialist-level assessment and rehabilitation available from home, so you get clear answers and a plan that actually matches your diagnosis.
About the author
Carolina Moreira
Medical Director of Clinical Development at Sword Health
