Piriformis Syndrome or a Herniated Disc?
Fzt. Kemran Hafız · 18 June 2026 · 2 min read · Last updated:
A large share of people who come in with pain travelling from the buttock into the leg open with "I have a herniated disc". Yet the same pattern can come from piriformis syndrome, and the treatment for the two differs.
Where is the piriformis?
The piriformis is a small but important muscle deep in the buttock. The sciatic nerve passes just beneath it — in some people straight through it. When the muscle tightens or spasms it can compress the nerve.
What separates the two
Where the pain starts. With a disc, pain usually begins in the back and travels down. With the piriformis, the back may be pain-free and the pain starts deep in the buttock.
Sitting. Piriformis pain clearly increases on a hard seat. People often sit leaning onto one buttock.
Coughing and straining. Increases disc pain; usually makes no difference with the piriformis.
Bending forward. Usually increases disc pain; often unchanged with the piriformis.
Pattern of numbness. With a disc it follows a specific nerve root's territory and travels to the foot. With the piriformis it is more diffuse and vaguer.
These point the way but are not enough on their own. Assessment interprets hip internal rotation tests, straight leg raise, reflexes and strength together. The two can also exist in the same person at once.
Why does the distinction matter?
Because the programmes differ. A disc calls for an approach that limits forward bending and builds trunk stabilisation. The piriformis calls for releasing the deep hip muscles, regaining hip range of motion and strengthening the hip abductors.
A programme built on the wrong diagnosis turns into months of work that looks right but does not settle the pain.
What is applied in piriformis syndrome?
- Manual therapy and soft tissue techniques for the deep hip muscles
- Stretching for the piriformis and surrounding hip musculature
- Strengthening the hip abductors and extensors
- Sitting habits: breaking up long spells on hard seats, taking the wallet out of the back pocket — small changes with real effect
- A graded walking programme
How long does it take?
It depends on how long the complaint has lasted and on hip strength. Recent cases usually progress quickly; in complaints of many months the strength component has to be completed.
Fzt. Kemran Hafız makes the distinction first and only then builds the programme.