Piriformis Syndrome & Pilates: What You Need to Know

Let’s talk about Piriformis Syndrome - a common but often misunderstood cause of pain in the buttocks and down the leg. It’s often mistaken for sciatica, but the cause is actually muscular rather than spinal.

What Is Piriformis Syndrome?

Piriformis Syndrome happens when the piriformis muscle, a small, deep muscle in your bottom, compresses or irritates the sciatic nerve.

This can lead to aching, tingling, or numbness in the buttock and sometimes all the way down the leg, following the path of the sciatic nerve.

What Causes It?

There are a few possible causes—some lifestyle-related, others mechanical:

Muscle Imbalances or Overuse

• Sitting for long periods

• Poor posture or the way you walk

• Weak glutes and core muscles

Repetitive Movements

• Activities like running, cycling, or climbing stairs—especially if you’ve increased your training suddenly or don’t have great mobility

Injury or Trauma

• A fall or direct trauma to the buttocks

• Misalignment in the hip, pelvis, or lower back

Common Symptoms

• A deep, aching pain in the buttock

• Pain that radiates down the leg, similar to sciatica

• Pain that worsens with sitting, climbing stairs, or rotating the hip

• Tightness or reduced range of motion in the hip

How Can You Treat Piriformis Syndrome?

Start with Conservative Options

• Rest and ice to calm inflammation

• Anti-inflammatory medication (if needed)

• Gentle stretching and mobility work

• Massage or myofascial release

• Foam rolling the glutes and hips

Then Build Strength & Mobility

• Work on correcting muscle imbalances

• Focus on hip alignment and posture

• Strengthen the core and glutes

Medical Help (If Needed)

• Corticosteroid injections can help if pain is persistent

• Surgery is a last resort and only considered in rare, severe cases

Pilates: What Helps and What to Avoid

Pilates can be incredibly helpful - when done right. It’s about gently releasing tension, improving hip mobility, and activating the right muscles (not just the tight ones).

Recommended Pilates Exercises

These moves help improve mobility, glute strength, and reduce irritation:

Supine Piriformis Stretch

• Lie on your back, cross one ankle over the opposite knee, and gently draw the thigh in.

• A great release for the piriformis.

Glute Bridges

• Strengthens the glutes and takes pressure off the piriformis.

• Try adding a ball or band between the knees for more control.

Clamshells (Side Lying)

• Targets the glute medius to help stabilise the hip.

Pelvic Tilts / Imprinting

• Supports pelvic control and core engagement without irritation.

Hip Rolls (Modified)

• Encourages gentle spinal movement while keeping the pelvis steady.

Supine Leg Slides / Toe Taps

• Strengthens the core without overloading the hips.

What to Avoid During Flare-Ups

When symptoms are active, avoid anything that compresses the sciatic nerve or overuses the piriformis:

• Deep external rotation stretches (e.g., strong “figure four” holds)

• Long lever leg lifts (like straight leg raises)

• Aggressive piriformis stretching

• High-impact moves like jumping or hopping

• Seated spinal twists with crossed legs

If you’re dealing with Piriformis Syndrome, the right Pilates approach can make a big difference—gently building strength, improving mobility, and reducing pain.

Want to learn how to move safely and feel better? Get in touch to find out more about our Pilates classes.