You feel it deep in one buttock. Sometimes it travels down the back of the thigh. Sitting for too long makes it worse. Driving makes it worse. You’ve been told you have sciatica. But nothing you’ve tried for sciatica is working.
There’s a good chance you don’t have classic sciatica at all. You have piriformis syndrome — sometimes nicknamed the “fake sciatica” because the symptoms overlap, but the cause is completely different. And treating it like classic sciatica is why it isn’t getting better.
At Actus Chiropractic in Brentwood, CA, Dr. Val Tompkins helps patients sort classic sciatica from piriformis syndrome — because the fix depends on knowing which one you actually have.
What Piriformis Syndrome Actually Is
The piriformis is a small, deep muscle in your buttock that helps rotate the hip. The sciatic nerve runs right next to it — and in many people, right through or under it. When the piriformis gets tight, irritated, or overactive, it can compress or irritate the sciatic nerve at that spot.
The result: buttock pain, sometimes shooting or aching down the back of the leg, that mimics sciatica but originates from a completely different place. Classic sciatica starts at the lumbar spine (usually a disc). Piriformis syndrome starts in the buttock.
How to Tell the Difference (Roughly)
These aren’t diagnostic — a proper exam is — but they’re helpful clues:
- Classic sciatica often includes low back pain, symptoms below the knee, tingling, and sometimes weakness. It’s frequently worse with bending forward or coughing.
- Piriformis syndrome is usually centered in the deep buttock, may travel down the thigh but often not below the knee, is much worse with sitting (especially on a hard surface), and improves with walking or standing.
- The “wallet test”: if sitting on a wallet or hard surface flares your buttock pain within minutes, piriformis is a strong suspect.
- The stretch test: pulling the affected knee across the body toward the opposite shoulder reproduces the pain in piriformis cases.
Why Piriformis Syndrome Gets Misdiagnosed
- MRI shows a disc bulge (very common in adults without pain), and the pain gets blamed on the disc
- Symptoms overlap with sciatica
- The piriformis isn’t tested carefully
- Treatment focuses only on the low back — where the pain isn’t actually coming from
That’s why patients often say, “I’ve been doing back exercises for months and my buttock still hurts.” It’s not a low back problem.
What Causes the Piriformis to Act Up
- Prolonged sitting — especially on a wallet or hard surface
- Sudden increases in activity — long hikes, new sports, ramping up mileage
- Weak glute medius — the piriformis overworks to compensate
- Hip joint stiffness — restricted rotation forces the piriformis to grip
- Old injuries — falls onto the buttock, past surgeries
- Anatomical variation — some people have the sciatic nerve running through the piriformis
How a Brentwood Chiropractor Approaches Piriformis Syndrome
- Careful exam. Sort classic sciatica from piriformis syndrome from other sources of buttock pain (SI joint, hip joint).
- Targeted soft tissue work. Release the piriformis and surrounding deep glute muscles.
- Hip joint mobilization. Improve internal rotation to unload the piriformis.
- Glute medius activation. Wake up the muscles that should be doing the piriformis’s job.
- Sitting strategy. Change surfaces, change positions, break up sitting.
- Home program. Specific stretches and strengthening you can do in a few minutes a day.
For related site content on sorting nerve-related leg pain, see our posts on chiropractic care for sciatica in Brentwood CA and chiropractic care for pinched nerves.
Home Strategies That Actually Help
- Figure-4 stretch. Gentle, 30 seconds per side, 2–3 times daily.
- Tennis ball release. Lie on a tennis ball or lacrosse ball on the deep buttock, slow pressure for 60–90 seconds.
- Side-lying clamshells. 2 sets of 15 per side to build glute medius.
- Get out of the wallet. Move it to a front pocket or bag.
- Walk breaks. Every 30–45 minutes when sitting.
- Heat before, ice after. Whichever feels better works.
FAQs: Piriformis Syndrome
How long does piriformis syndrome take to resolve?
Many cases improve significantly within 3–6 weeks with a targeted plan. Chronic cases may take longer, especially if sitting habits are contributing.
Can I keep exercising?
Usually yes — you’ll modify. Walking, light strengthening, and mobility work often help. Avoid what flares it (long runs, deep squats) until it calms.
Do I need imaging?
Not usually. Imaging can help rule out other causes but doesn’t reliably diagnose piriformis syndrome — the exam does.
What if I have both piriformis syndrome and disc problems?
It’s common. A good plan addresses both — but knowing which is driving the most symptoms determines what gets prioritized first.
Will just stretching fix it?
Rarely. Stretching helps but doesn’t address the hip mobility and glute medius weakness that keep the piriformis overworking.
Find Out Whether It’s Really Sciatica in Brentwood
If your “sciatica” hasn’t budged after weeks of back-focused treatment, an exam that specifically sorts piriformis syndrome from disc-driven sciatica is a smart next step. Dr. Val Tompkins at Actus Chiropractic can make that distinction — and treat what’s actually driving the pain.
📞 Call (925) 516-2363 or book online to schedule your evaluation at Actus Chiropractic, 9030 Brentwood Blvd. Suite D, Brentwood, CA 94513.