Piriformis syndrome, sometimes called false sciatica, means that the piriformis, a small, deep muscle in the buttock that rotates the hip outwards, is so tight or irritated that it presses on the sciatic nerve where the nerve passes under or through the muscle. It gives a deep, dull or burning pain in the middle of the buttock that is worse with prolonged sitting, especially on hard surfaces, with stairs, running and crossing the legs, and that can radiate down the back of the thigh. Unlike sciatica from a disc herniation, the lower back rarely hurts, and coughing and sneezing make no difference. It usually resolves with stretching, hip strength, less sitting and relaxation of the muscle. Here is how to recognise piriformis syndrome, what helps, when to see a doctor and how to cup the gluteal muscles, one of the places where cupping does the most good.
What is piriformis syndrome?
The piriformis runs from the sacrum to the top of the thigh bone and lies under the large gluteal muscle. The sciatic nerve passes just below it (in a minority of people straight through it). When the muscle becomes short, tight or swollen, from prolonged sitting, running with weak gluteal muscles, a fall on the buttock, a wallet in the back pocket or a period of unfamiliar load, it can compress the nerve. The symptoms: deep tenderness in the middle of the buttock (you find the spot when you sit on a ball), pain when sitting more than 20–30 minutes, pain with stairs, running and rotating the hip, sometimes tingling or radiation down the back of the thigh, rarely below the knee. The diagnosis is clinical, by excluding other causes and with tests that stretch or contract the piriformis.
The difference from sciatica from a disc herniation: there, back pain is common, the radiation often reaches below the knee, coughing and bending forward hurt, and numbness and weakness are more common. Many people have a mixture, though: an irritated sciatic area makes the piriformis tight, and a tight piriformis irritates the nerve. The self-care below helps in both cases, as long as the warning signs are excluded.
When to see a doctor
Call emergency services or go to A&E if you get numbness in the groin or around the back passage, difficulty passing urine or controlling your bladder or bowels, or rapidly increasing weakness in the leg or foot. See a doctor the same day if the pain came after a fall or accident, if you have a fever, if you have or have had cancer, or if you are losing weight without trying. Contact your doctor if numbness or weakness is increasing, if the pain clearly radiates below the knee, if you have pain in the hip joint or groin (may be a hip problem), if the pain is severe at night, or if you are not better after six to eight weeks of self-care. A physiotherapist can confirm the diagnosis and give you a programme.
Self-care that helps
- Sit less and softer. Get up every 20–30 minutes, alternate sitting and standing, use a soft cushion or seat pad, and take the wallet out of the back pocket. Do not sit with crossed legs.
- Stretch the piriformis daily. Figure-4: lie on your back, place the ankle of the sore side on the opposite knee and pull that knee towards the chest until it stretches deep in the buttock; 30 seconds, three times, two to three times a day. Seated version: ankle on the opposite knee, lean the upper body forward with a straight back.
- Strengthen the hip's external rotators and gluteal muscles. A weak gluteus medius makes the piriformis work too hard. Clamshells (side-lying, knees bent, open the top knee), side-lying leg raises, hip bridges with a band around the knees, single-leg standing. Three sets of 12–15, every other day. Strength is what stops the problem coming back.
- Trigger point work. Sit or lie on a tennis ball or massage ball placed on the tender spot in the buttock, 30–60 seconds, breathe, shift slightly. Daily.
- Heat on the buttock for 15–20 minutes before stretching and in the evening.
- Movement rather than rest. Walks on flat ground and swimming are good. Pause running, deep squats and lunges until the pain has eased, and return gradually with shorter steps.
- Pain relief as advised by your pharmacist if needed to get going. Medical options for prolonged problems: physiotherapy, in some cases an injection into the muscle.
Cupping the buttock, step by step
The buttock is one of the areas where cupping works best: the muscles are large and deep, hard to reach with your own hands, and respond well to static cups left in place for a while. The aim is to get the piriformis and the surrounding gluteal muscles to let go and to increase circulation in the area. You need the dynamic cup, static cups and body oil. You can do some of it yourself lying on your side; it is better with help. The ground rule: the muscles, not the nerve. If you feel radiation, tingling or numbness under a cup, move it.
- Warm up the buttock with a heat pad or shower for ten minutes.
- Oil the whole buttock from the sacrum to the outside of the hip and the upper back of the thigh.
- Dynamic, light to moderate suction. Glide the cup in slow strokes from the sacrum diagonally down and out towards the large bump of the thigh bone (you feel it on the outside of the hip), five to eight strokes, and in large circles over the whole buttock. The piriformis lies exactly along that line, under the large gluteal muscle.
- Pause on tender points with light suction for ten seconds while slowly moving the hip (turn the foot in and out).
- Static. Place two to three static cups with light to moderate suction over the middle of the buttock and the most tender point, three to five minutes. Lie still and breathe. Not on the tailbone or on the hip bump itself.
- The back of the thigh can be cupped lightly if it radiates there and is muscularly tight, but skip it if it causes tingling.
- Finish with the figure-4 stretch; it often goes considerably deeper after cupping.
Two to three times a week in the first weeks, then as needed. The basics of static and dynamic cupping are in Cupping at home, the whole back and buttock in Cupping on the back, and if you sit a lot, Cupping for people who sit a lot is a good daily routine.
When not to cup
Not if you have any of the warning signs above, not where you have numbness or reduced sensation, not on the tailbone, not on wounds, rashes, bruises or varicose veins, not straight after a fall before the injury has been assessed, and not without medical advice if you are pregnant, take blood thinners or have osteoporosis. If the radiation increases with cupping, stop and discuss it with your physiotherapist.
Frequently asked questions
How do I know if it is piriformis syndrome or sciatica?
With piriformis syndrome the pain sits deep in the buttock, is worse with sitting and rarely radiates below the knee; the lower back does not hurt and coughing makes no difference. With sciatica from a disc herniation, back pain, radiation below the knee, numbness and pain on coughing are more common. A physiotherapist can tell them apart with simple tests.
How long does piriformis syndrome last?
With daily stretching, hip strength and less sitting most people are clearly better within a few weeks and well within six to twelve weeks. Without addressing the sitting and the strength, it often comes back.
Does cupping help with piriformis syndrome?
Yes, it is one of the areas where cupping works best: static cups on the buttock get the deep muscle to let go and increase circulation, so the stretch goes deeper. Always combine it with strength training for the hip, which is what keeps the problem away.
Can I run with piriformis syndrome?
Pause running until you can sit and climb stairs without pain, then return gradually with shorter steps and stronger gluteal muscles. Walking, swimming and cycling with a high saddle are usually fine in the meantime.
Why does it hurt when I sit?
When sitting, the piriformis and the sciatic nerve are pressed against the sitting bone and the surface, and the muscle is held shortened. A soft surface, frequent breaks and not crossing the legs reduce the pressure.
Sources
- 1177 Vårdguiden (Swedish national health guide), search for "ischias" for medical information and when to seek care.
- Curam's FAQ and cupping programmes, developed together with trained massage therapists.
Written by Curam. Last updated 17 October 2026. This is general self-care information and does not replace medical care. For sudden, severe or unusual symptoms, contact your doctor. Talk to your doctor before cupping if you are pregnant, take blood thinners or have a condition affecting skin, blood vessels or blood.
