Buttock Pain When Sitting: Piriformis or Something Else?
By Nova Physical Therapy, an outpatient physical therapy clinic in North Hollywood, CA | Published October 2026
You sit down for a meeting, a long drive, or a movie, and a deep ache starts in one buttock. Maybe it creeps down the back of your thigh. Shifting in your seat helps for a minute, then it comes back. Search online, and "piriformis syndrome" comes up again and again.
Piriformis syndrome is real for some people, but it's also one of the most over-used labels for buttock pain. This article explains the common causes of buttock pain when sitting, what piriformis syndrome is and isn't, how it differs from sciatica, and when to see a doctor.
The short answer
Deep buttock pain when sitting has several possible sources. These include the lower back, the hamstring tendon where it attaches to your sit bone, irritation of the sciatic nerve as it passes through the buttock, and the piriformis muscle itself. Piriformis syndrome is debated: there are no validated, reliable tests for it, so it's often a diagnosis made only after other causes are ruled out, and some researchers consider it over-diagnosed (Sharma et al., Hip & Pelvis 2023). That's why an evaluation matters more than the label. In California, you can see a physical therapist without a referral.
Why does my butt hurt when I sit?
Sitting puts pressure on the buttock and holds the hip bent for long periods. That can bother several different structures, each with its own typical pattern:
• The lower back: pain from the lumbar spine is often felt in the buttock, sometimes more than in the back itself. It may come with back stiffness or pain that changes with bending or sitting posture.
• The hamstring tendon: pain right at the sit bone, worse sitting on hard surfaces, and often worse with bending forward or running. This is called proximal hamstring tendinopathy (Goom et al., JOSPT 2016).
• The sciatic nerve in the buttock: deep buttock pain, sometimes with tingling or pain down the back of the leg, often worse with long sitting. Clinicians sometimes call this deep gluteal syndrome.
• The piriformis muscle: a small, deep hip muscle that sits close to the sciatic nerve and may contribute in some people.
• The joints of the pelvis or hip: the sacroiliac joint or the hip joint can also refer pain into the buttock.
These are possibilities, not a diagnosis. Two people with the same buttock pain can have very different causes.
What is piriformis syndrome?
The piriformis is a small muscle deep in the buttock that helps rotate the hip. The sciatic nerve passes just beneath it, and in some people it runs through or around the muscle in unusual ways. The idea behind piriformis syndrome is that the muscle irritates or compresses the nerve, causing buttock pain and sometimes pain down the leg.
Commonly reported features include buttock pain, pain that gets worse with sitting, tenderness deep in the buttock, and pain with certain hip positions (Sharma et al., 2023).
But here's the catch: there's no single test that reliably confirms it, and an MRI may look normal. Researchers have also found that other deep hip muscles near the nerve may be involved, which is why the broader term "deep gluteal syndrome" is increasingly used. In practice, many people told they have "piriformis" turn out to have pain coming from the back, the hamstring tendon, or elsewhere.
Is it piriformis or sciatica?
"Sciatica" describes symptoms that travel along the sciatic nerve, usually pain, numbness, or tingling down the back of the leg. It's a description, not a cause. Most often, sciatica is linked with irritation of a nerve root in the lower back, such as from a disc. Less often, the nerve may be irritated deeper in the buttock.
Some general patterns that may help you describe your symptoms to a clinician:
• Pain that starts in the back and travels below the knee, especially with numbness or weakness, is more often linked with the lower back.
• Pain mostly in the buttock that's worse with sitting and better when standing or walking may involve the deep buttock or hamstring tendon.
• Pain right at the sit bone that's worse on hard chairs points more toward the hamstring tendon.
These patterns overlap a lot. Only an in-person evaluation can sort them out, and some cases need a physician's input or imaging.
What can I do in the meantime?
• Break up sitting. Stand and move every 20 to 30 minutes if sitting brings on your pain.
• Try a cushion. A softer seat or a cushion that takes pressure off the painful side may help. Take your wallet out of your back pocket.
• Keep walking. Many people with buttock pain feel better when they stay active.
• Go easy on hard stretches. Aggressive stretching can irritate a sensitive nerve or hamstring tendon. Gentle movement that feels good is usually a better choice until you know the cause.
Questions about medication, injections, or imaging are best directed to your physician.
How can physical therapy help?
The most useful thing a physical therapist can do is figure out where your pain is most likely coming from, because treatment differs depending on the source. An evaluation may include:
• When the pain started and what makes it better or worse, especially sitting
• A screen of your lower back
• Hip motion and strength testing
• Hamstring tendon loading tests
• Gentle nerve mobility tests and a check of leg sensation, strength, and reflexes
• Screening for signs that need a physician's evaluation
Depending on what's found, a plan may include:
• Exercises for the lower back if pain is coming from there
• Progressive strengthening for the hip and hamstring muscles
• Gentle nerve mobility exercises when a nerve is sensitive
• Hands-on treatment, when it helps you move more comfortably
• Practical changes to sitting, driving, and work setup
• A home program you can keep doing on your own
Physical therapy doesn't guarantee a specific result or timeline, and some causes of buttock pain need a physician's care.
At Nova Physical Therapy in North Hollywood, back and neck pain is one of our core services. Because buttock pain so often starts in the lower back, every plan starts with an evaluation so treatment fits what we find.
When should I see a doctor?
Call 911 or go to the emergency room if buttock or back pain comes with (NHS):
• Numbness around your genitals, buttocks, or inner thighs
• New trouble controlling your bladder or bowels
• Pain, weakness, or numbness in both legs
• Pain after a serious fall or accident
See a physician promptly if you have:
• Leg or foot weakness, or weakness that is getting worse
• Fever, unexplained weight loss, or a history of cancer
• Pain that's constant, including at night or at rest
• A sudden pop and bruising at the back of the thigh after a sprint or slip, which could be a hamstring tear
• Pain that keeps getting worse despite care
We screen for these signs during every evaluation and refer you to a physician when findings call for medical assessment.
Do I need a referral for physical therapy in California?
Not to get started. California allows direct access to physical therapy. A physical therapist can evaluate and treat you without a referral for up to 45 calendar days or 12 visits, whichever comes first. After that, a physician or podiatrist needs to sign the plan of care for treatment to continue. Your insurance plan may have its own referral rules, so check your coverage.
Frequently asked questions
How do I know if I have piriformis syndrome?
You can't tell for sure on your own, and there's no single reliable test. Buttock pain has several possible causes, so an evaluation that checks the lower back, hip, hamstring, and nerves is the best way to sort it out.
Why does my buttock hurt only when I sit?
Sitting puts pressure on the buttock and keeps the hip bent. That can irritate a sensitive nerve, the hamstring tendon at the sit bone, or tissues referring pain from the lower back.
Should I stretch my piriformis?
Gentle stretching helps some people, but hard stretching can make a sensitive nerve or hamstring tendon worse. It's worth knowing the likely cause first.
Can a wallet in my back pocket cause buttock pain?
Sitting on a thick wallet for long periods can press on the deep buttock and may aggravate symptoms. Moving it to a front pocket is an easy change.
Is buttock pain the same as sciatica?
Not always. Sciatica describes symptoms along the sciatic nerve, usually down the leg. Buttock pain can come from the nerve, the back, the hamstring tendon, or the hip.
Do I need an MRI for buttock pain?
Not usually at first. Imaging decisions are made by your physician, often when there are warning signs or symptoms aren't improving.
Do I need a referral to see a physical therapist?
No, not to start. California allows direct access within the limits described above.
About Nova Physical Therapy
Nova Physical Therapy is an outpatient physical therapy clinic in North Hollywood, California, led by a Doctor of Physical Therapy. We help people recover from back and neck pain, sports injuries, work injuries, auto accident injuries, knee pain, and shoulder problems, and we also work with balance problems and rehab after surgery. Patients come to us from North Hollywood, Burbank, Studio City, Toluca Lake, Valley Village, and across the San Fernando Valley. Learn more about Nova or see our services.
Schedule an evaluation
If buttock pain is making it hard to sit through work, drives, or meals, an evaluation can help sort out where it is coming from and which next steps fit you.
Nova Physical Therapy
4795 Vineland Ave #E, North Hollywood, CA 91602
Call (818) 639-3402 | Book an appointment online
Disclaimer
This article is for general education only. It is not medical advice, a diagnosis, or a treatment recommendation for any individual. Buttock pain has many causes, and only an in-person evaluation can determine what is right for you. No treatment guarantees symptom resolution, and results vary. Physical therapists evaluate movement and function within their scope of practice and refer to physicians when findings warrant. Physical therapy in California is regulated by the Physical Therapy Board of California.
References
1. Sharma S, Kaur H, Verma N, Adhya B. Looking beyond Piriformis Syndrome: Is It Really the Piriformis? Hip Pelvis. 2023;35(1):1–5. Link
2. Goom TSH, et al. Proximal Hamstring Tendinopathy: Clinical Aspects of Assessment and Management. J Orthop Sports Phys Ther. 2016. Link