What Is the Piriformis Muscle? How Does It Cause So Much Pain?
If you read our post on shooting pain down the leg, you already know the piriformis muscle is one of the most overlooked sources of sciatica-pattern pain. But most people have never heard of it until it starts causing these problems.
Here’s what it actually is, why it’s so prone to trouble, and why it’s one of the harder muscles to treat effectively without the right approach.
Where the Piriformis Muscle Lives
The piriformis is a small, flat muscle that sits deep in the gluteal region. It runs from the sacrum – the bone at the base of your spine – to the top of the femur, at the notch called the greater trochanter, the large bone in your upper leg.
Its main job is rotating the hip outward, think of external rotation. Every time you turn your foot out, step to the side, or stabilize your pelvis while walking, the piriformis is doing the work.
Since it sits underneath the gluteal muscles, it’s not a muscle you can easily feel or stretch on your own. That depth is exactly what makes it so difficult to treat.
Why It Causes So Much Trouble
The piriformis sits in close proximity to the sciatic nerve – and in some people, the nerve actually passes through the muscle itself. When the piriformis becomes tight, overworked, or goes into spasm, it compresses the nerve nearby. Often times, there are other nerves impacted, but we’ll get into that in another blog:)
The result is pain that travels exactly the same path as disc-related sciatica: d33eep aching in the glutes, burning or shooting sensation down the back of the leg, sometimes numbness into the foot.
A few things commonly drive piriformis tightness:
Prolonged sitting. When you sit for long periods, the piriformis is held in a shortened position for hours at a time. Over weeks and months of this chronic overuse, it adapts to that shorter length and starts pulling on the sacrum and hip with every step.
Hip compensation patterns. If another structure in the hip or low back isn’t moving well, the piriformis often picks up the slack. It’s a small muscle doing a job too big for it.
Repetitive lateral movement. Runners, hikers, and anyone doing a lot of side-to-side movement can overload the piriformis if their hip stability isn’t strong enough to distribute the load properly. Colorado Springs residents putting serious miles on trails are a good example of this pattern.
Why It’s Hard to Treat
The challenge with piriformis syndrome is that you can’t effectively treat a muscle you can’t reach.
Standard massage work on the glutes addresses the superficial gluteal muscles well. But the piriformis sits underneath those layers. To actually change tissue at that depth, you need sustained, heavy pressure that most han33ds-based work can’t maintain for long enough to make a real difference.
This is where ashiatsu changes the equation. Foot-based pressure can penetrate through the gluteal layers with the kind of sustained, consistent weight that hands simply can’t hold without fatiguing. A well-trained ashiatsu therapist can spend real time on the piriformis specifically – not just compressing tissue above it and hoping for the best.
What Relief Actually Looks Like
Piriformis syndrome that has been building for months doesn’t resolve in one session. The tissue has adapted to a shortened, guarded state over a long period of time, and it takes consistent, repeated work to change that pattern.
Most clients dealing with this see meaningful improvement within four to six biweekly sessions. The first session reduces acute compression. Subsequent sessions can go progressively deeper as the tissue begins to release its chronic holding pattern.
Between sessions, targeted stretching of the piriformis – particularly the figure-four stretch – helps maintain what the massage work achieves. But stretching alone, without the manual work to actually change the tissue quality, rarely resolves the pattern on its own.
If your glute pain and shooting leg symptoms haven’t responded to stretching, foam rolling, or lighter massage work, the piriformis is worth investigating as the primary driver. It’s one of the most commonly missed sources of lower body pain, and one of the most satisfying to resolve when it’s treated correctly.
Ready to address piriformis pain at the source? Book your appointment online or call/text 719-459-0780. Inspire Movements Massage Therapy is located at 1295 Kelly Johnson Blvd, Suite 250 in Briargate, Colorado Springs 80920. Open Monday, Tuesday, Friday, and Saturday 9am-7:30pm.
By appointment only.