Piriformis syndrome can be painful, and it often times keeps you from exercising and staying active. If you think you might be experiencing piriformis syndrome, I’d recommend visiting a chiropractor. Chiropractic care for piriformis syndrome as well as using dry needling to the piriformis muscle can relieve pain and get you active again.

In this content, I’ll we’ll look at some of the common questions related to piriformis syndrome such as:

  • What are the symptoms of piriformis syndrome?
  • How do I know if I have piriformis syndrome vs sciatica from a lumbar disc herniation or bulge?
  • Why does piriformis syndrome cause sciatica?
  • Does dry needling for piriformis syndrome help?

What are the Symptoms of Piriformis Syndrome?

Piriformis syndrome is a condition where your piriformis muscle tightens up and goes into muscle spasm. Piriformis tightness and spasm can then cause sciatica symptoms. Sometimes piriformis syndrome begins after an injury, overuse, or lack of activity, but it also often happens for no specific reason that can be identified. Some of the hallmark signs of piriformis syndrome are:

  • Dull and aching pain deep in your buttocks, typically only on one side.
  • Pain down the back or side of your leg that can extend to your calf and foot (sciatica.)
  • Pain when you’re walking up stairs or an incline.
  • Increased pain while you’re sitting.
  • Tenderness when pressing deep in your buttocks.

The best way to confirm or deny your suspicions is to make an appointment with a chiropractor for piriformis syndrome. Our Cary NC chiropractors are experienced in diagnosing and treating piriformis syndrome with chiropractic care, dry needling, and a therapeutic exercise routine. I’ve had patients get relief for piriformis syndrome in as few as 3-4 treatments as long as they’re compliant with their home exercise strategy.





The piriformis muscle is deep to your gluteal muscles and acts with other muscles as an external hip rotator (pointing your toe to the outside).

Piriformis Syndrome Diagnosis

Sometimes piriformis syndrome can be difficult to diagnose because symptoms can be similar to that of a lumbar disc herniation. A lot of times providers see that you’re having pain down the back of your leg (sciatica symptoms) and assume it’s from a lumbar disc herniation or lumbar disc bulge. Diagnosing piriformis syndrome takes a comprehensive exam to reveal differences from a lumbar disc issue.

Here’s a quick chart that shows some of the differences in between lumbar disc herniation or lumbar disc bulges and piriformis syndrome

Piriformis Syndrome vs Sciatica from a Lumbar Disc Issue

  • The primary point of tenderness and pain is originating in the buttocks vs primary tenderness and pain in the lower back.
  • Extremely tight or spasming buttocks region vs more tightness and/or spasm in the lower back muscles.
  • Normal or mildly reduced range of motion in the lower back vs significant range of motion loss, especially when bending forward.
  • Stretching your buttocks may produce more pain down the leg vs stretching the buttocks may provide some relief.
  • Cobra position (extension of the lower back) doesn’t change symptoms vs extension providing relief of symptoms (often.)
  • Pushing on or massaging the piriformis muscle intensifies pain vs working the muscle doesn’t change the radiating pain much.
  • No difference when coughing or sneezing vs worse discomfort with coughing, sneezing or sitting on the toilet.
  • More common in pregnancy women vs not more common in pregnancy.

Keep in mind these are generalizations regarding piriformis syndrome and sciatica from a lumbar disc herniation or bulge. There are also a number of other conditions that can cause similar discomfort, so it may not be either. That’s why I recommend you see a chiropractor for piriformis syndrome instead of diagnosing yourself.

Why Does Piriformis Syndrome Cause Sciatica?

Piriformis syndrome causes sciatica because of it’s proximity to the sciatic nerve. The piriformis muscles unique, because there’s a lot of variability in the relationship between the muscle and the sciatic nerve.

  • In 90% of people, the sciatic nerve passes underneath the piriformis muscle. When the piriformis is tight or spasming it can create compression or entrapment of the sciatic nerve which causes sciatica symptoms.
  • In 7% of people, the sciatic nerve passes directly through the piriformis muscle. This is a normal variant but can make the sciatic nerve more susceptible to compression or entrapment.
  • In an even smaller percentage of people, the sciatic nerve passes above the piriformis muscle. This variant means the sciatic nerve is more superficial and can be more sensitive to sitting or other compressive forces.

Unless you have an MRI there’s really no way to see the relationship between these two in your case of piriformis syndrome. Also, it’s not really that important. No matter your specific anatomy, chiropractic treatment for piriformis syndrome is going to be the same.

Here’s a cool and successful case of a patient with an anatomical variant (confirmed via MRI) who saw a chiropractor for piriformis syndrome –> Chiropractic management of a US Army veteran with low back pain and piriformis syndrome complicated by an anatomical anomaly of the piriformis muscle: a case study




Heres a general diagram of your sciatic nerve traveling under the piriformis muscle (the 90%). We know from cadaver studies that there is some variability with regards the piriformis and sciatic nerve.

Dry Needling for Piriformis Syndrome

Dry needling for piriformis syndrome is an effective treatment at relieving pain in the buttocks, pain in the leg, and sciatica symptoms.

Treating piriformis syndrome with dry needling is a great primary treatment and chiropractic adjustments (chiropractic manipulation), post-isometric relaxation (PIR) stretching, low volt electrotherapy, and a home exercise and rehabilitation program may also provide relief. Our Cary chiropractors are familiar with effectively treating piriformis syndrome.

Here’s what’s happening when our chiropractors use dry needling for piriformis syndrome:

  • Small acupuncture needles are used to target myofascial trigger points (muscle knots) in the piriformis and release them.
  • Stimulation of the knot from the dry needling creates a muscle twitch reaction.
  • The needle may be moved around a little bit, and the piriformis muscle twitch will stop.
  • During dry needling for piriformis syndrome, the needles may be left in for a few minutes or taken out right away.
  • Your chiropractor will dry needle other muscles that have active or inactive trigger points that are contributing to your pain.

In my opinion, chiropractors for piriformis syndrome are the best treatment option. Our chiropractors see back pain, sciatica, hip pain, and muscle pain on a daily basis. Because of this, we’re familiar with how to distinguish if the piriformis is the cause or if it’s something else.

Dr. Jason Williams DC is a chiropractic physician practicing at AccessHealth Chiropractic in Cary, NC. He treats neuromusculoskeletal pain and injuries using chiropractic manipulation, dry needling, acupuncture, rehab exercise strategies, and other supportive therapies. Primary areas of focus include back pain, neck pain, muscular pain, extremity pain, and orthopedic injuries. Dr. Williams is experienced in treating athletes, especially those in the CrossFit, Brazilian Jiu-Jitsu, Muay Thai, and MMA community.

If you’re interested in whether he or another AccessHealth provider can help you, navigate to our contact page or follow this link to request an appointment.