Piriformis Syndrome: Causes, Sciatic Pain, and Holistic Movement for Relief

Piriformis syndrome is often misunderstood as just a "tight muscle" problem, but in reality, it can disrupt nerve function, alter fascia dynamics, and contribute to chronic pain that extends beyond the glutes. If you’ve ever felt sciatic pain that worsens in certain positions—particularly lying on your front—or experienced an unexplained burning sensation in your buttocks, legs, or even vulva, this might be the missing piece of the puzzle.

In this post we will explore why piriformis syndrome happens, how it affects the body (including its impact on fascia), why it can make lying on your stomach unbearable, and why traditional methods like the McKenzie approach may not be effective. We'll also dive into exercise modalities that actually work—including Hypopressives, a technique that promotes whole-body engagement to alleviate sciatic pain.

What Is Piriformis Syndrome?

The piriformis muscle is a small, deep muscle located in the buttock region, running from the sacrum (base of the spine) to the top of the femur (thigh bone). It plays a crucial role in hip rotation, stabilisation, and movement.

In piriformis syndrome, this muscle becomes tight, inflamed, or spasmodic, leading to compression of the sciatic nerve, which runs nearby (or in some cases, directly through it). This compression can cause:

✔ Pain in the buttocks
✔ Sciatic pain down the leg
✔ Tingling/numbness in the thigh or foot
✔ Burning pain in the vulva (if the pudendal nerve is affected)

What Causes Piriformis Syndrome?

Piriformis syndrome can develop due to several factors:

• Scarring (Fibrosis) & Adhesions
  Scar tissue can form in the piriformis muscle after injury, surgery, or repetitive strain. This reduces muscle flexibility and may entrap the sciatic nerve.

• Post-Surgical Scarring (Including After a Hysterectomy)
  After a hysterectomy or other pelvic surgeries, scar tissue can alter pelvic floor muscle function, increasing tension in the piriformis. In some cases, post-surgical adhesions may directly restrict the sciatic nerve or irritate nearby structures.

• Inflammation
  Overuse, muscle strain, or an immune response can trigger inflammation in the piriformis muscle, which can swell and press against the sciatic nerve.

• Muscle Spasms
  Prolonged sitting, incorrect movement patterns, or fascial restrictions can cause the piriformis muscle to go into spasm, tightening around the sciatic nerve.

• Fascial Restrictions
  The piriformis doesn’t work in isolation—it’s part of the larger fascial system. Restrictions in pelvic, hip, or lower back fascia can create tension imbalances, worsening pain.

• Pudendal Nerve Irritation & Burning in the Vulva
  In some cases, piriformis syndrome can affect the pudendal nerve (which supplies the perineum and vulva). This can cause burning pain in the vulva, perineum, or inner thigh, often misdiagnosed as something else.

Why Lying on Your Front Can Make It Worse

Many people with piriformis syndrome find that lying on their stomach worsens sciatic pain. Why?

1️⃣ Increased Lumbar Arching: This position forces the lower back into excessive extension, tightening the piriformis and increasing pressure on the sciatic nerve.

2️⃣ Fascial Compression: The weight of the upper body presses into the pelvis, locking in fascial adhesions and restricting nerve glide.

3️⃣ More Sciatic Nerve Irritation: If the sciatic nerve is already compressed, lying on your front can exacerbate symptoms instead of relieving them.

💡 This is why the McKenzie method—commonly used for sciatica caused by disc issues—is NOT the best approach for piriformis-related sciatic pain. Instead, we need targeted myofascial release, muscle balance, and whole-body activation strategies.

Exercises That Can Help

Targeted Stretches for Piriformis Syndrome

These stretches help release tension in the piriformis and improve fascial glide to reduce nerve compression:

1️⃣ Seated Piriformis Stretch

✔ Sit with both feet on the floor.
✔ Cross your affected leg over the other, resting your ankle on the opposite thigh.
✔ Keep your back neutral and gently lean forward from your hips.
✔ Hold for 30–60 seconds, then switch sides.

2️⃣ Supine Figure-4 Stretch (Reclined Piriformis Stretch)

✔ Lie on your back and bend both knees.
✔ Cross one ankle over the opposite knee, creating a figure 4 shape.
✔ Hold the thigh of the supporting leg and gently pull it towards your chest.
✔ Hold for 30–60 seconds, then switch sides.

3️⃣ Standing Piriformis Stretch

✔ Stand near a sturdy surface for balance.
✔ Place one foot on a waist-high surface (like a bench), keeping the knee bent at 90 degrees.
✔ Slowly lean forward to feel a stretch in the glute and hip.
✔ Hold for 30 seconds on each side.

Strengthening Exercises for Support

These movements build strength around the hips, glutes, and core, reducing strain on the piriformis:

✔ Clamshells – Strengthens the hip stabilisers to offload the piriformis.
✔ Glute Bridges – Activates the gluteus maximus, which supports pelvic stability.

How Hypopressives Can Help

Hypopressives are a game-changer for piriformis syndrome because they:

✅ Engage the entire deep core, including the pelvic floor and diaphragm, reducing compensation patterns that tighten the piriformis.

✅ Create an active stretch through fascial chains, helping release adhesions that contribute to sciatic pain.

✅ Encourage optimal spinal and pelvic alignment, taking pressure off the sciatic nerve.

Conclusion

Piriformis syndrome isn’t just about one muscle—it’s about how muscle tightness, nerve compression, and fascial dysfunction create a knock on effect. Scar tissue, inflammation, and even hysterectomy-related adhesions can all contribute to sciatic pain.

Instead of relying on disc-based approaches like McKenzie, a combination of myofascial release, targeted strengthening, and Hypopressives can break the pain cycle and restore natural movement.

Have you struggled with piriformis syndrome or sciatic pain? Let me know what’s worked for you! 👇