If you’ve been struggling with deep buttock pain, tingling down your leg, or a stubborn ache that just won’t go away, piriformis syndrome might be the cause — and you’re not alone. As a chiropractor in Charlotte, NC, I see many patients who have been misdiagnosed or have suffered for months thinking their pain was “just sciatica” or low back strain. In reality, when the piriformis muscle irritates the sciatic nerve, a very specific pattern of discomfort emerges — and thankfully, there are effective, evidence-based treatments available right here at Simply Move Chiropractic.

What Is Piriformis Syndrome?

The piriformis muscle is a small muscle deep in the buttocks that helps rotate the hip and stabilize the hip joint. In some people, the piriformis can become tight, inflamed, or develop trigger points (knots), which compress or irritate the sciatic nerve as it runs underneath or through the muscle. This irritation results in symptoms that can mimic sciatica — from buttock pain to pain radiating down the back of the thigh, sometimes with numbness or tingling. Unlike true sciatica from a herniated disc, piriformis syndrome is a muscle and soft-tissue problem, so the treatment approach must address the muscle itself.

Common Symptoms I See in My Charlotte Practice

  • Deep ache or sharp pain in the buttock
  • Pain when sitting, especially for prolonged periods
  • Pain that may radiate down the back of the leg
  • Tingling or numbness in the thigh or calf
  • Discomfort with certain movements like climbing stairs or crossing the legs

These symptoms often overlap with other conditions, which is why a thorough exam and assessment — including orthopedic tests and muscle evaluation — is important in making the right diagnosis.

How I Diagnose Piriformis Syndrome

There’s no single definitive test for piriformis syndrome, but I use a combination of:

  • Detailed history and symptom patterns

  • Physical examination (assessing hip motion, muscle tightness, trigger points)

  • Provocative tests that stretch or compress the piriformis

  • Neurological checks to rule out true nerve root compression

Red flags that signal a need for more advanced medical evaluation include significant weakness, loss of bowel/bladder control, or progressive neurological deficit — in those cases, I’ll work with or refer to appropriate specialists.

My Approach to Treatment — What Works and Why

At Simply Move Chiropractic in Charlotte, I combine manual therapies, functional exercises, and advanced modalities to address piriformis syndrome at its root — muscle dysfunction and sciatic nerve irritation.

1. Functional and Therapeutic Exercises

Exercise is the foundation of long-term recovery. I prescribe tailored exercises that:

  • Strengthen the glutes, hips, and core to reduce strain on the piriformis

  • Improve hip mobility and neuromuscular control

  • Reduce muscle imbalances

Examples include glute bridges, clamshells, hip rotations with resistance bands, and targeted stretching routines focusing on the piriformis and surrounding hip muscles. These help promote proper movement patterns and decrease nerve irritation.

Piriformis syndrome looks different from person to person, so I always start with a custom movement assessment and design an individualized exercise program to support long-term relief and prevention.

2. Active Release Technique (ART)

Active Release Technique (ART) is a hands-on soft tissue treatment that breaks up tightness and adhesions in muscles and fascia. For piriformis syndrome, I use ART to release the piriformis and surrounding gluteal muscles. This helps:

  • Reduce muscle tension

  • Restore normal muscle length and function

  • Improve circulation and nerve mobility

ART works particularly well because it targets the actual tissue dysfunction rather than just masking symptoms.

3. Dry Needle Therapy

One of the most effective treatments I offer is dry needling, especially for tight or trigger-point-laden piriformis muscles. Dry needling involves inserting very thin, sterile filiform needles into muscle trigger points to release tension and reset muscle tone.

Clinical research supports dry needling for piriformis syndrome: a randomized trial found that ultrasound-guided dry needling significantly reduced pain intensity compared with no intervention after one week. Another study comparing dry needling to exercise programs found both to be beneficial at reducing pain and disability.

I typically combine dry needling with corrective exercises to maximize outcomes.

4. Shockwave Therapy

Shockwave Therapy (Extracorporeal Shockwave Therapy or ESWT) is another advanced option I use for patients who need extra help. Shockwave delivers acoustic waves that stimulate tissue healing, improve blood flow, and reduce chronic muscle and tendon pain. Studies have shown radial shockwave to be effective for reducing pain and stiffness in piriformis syndrome, improving function compared to baseline therapy alone.

Shockwave is non-invasive, quick and typically quite effective for piriformis syndrome. 

Bringing It All Together — Your Recovery Plan in Charlotte, NC

At my office, I combine these treatments into a personalized plan based on your presentation and goals. Most patients experience significant reduction in pain and improved function within a few weeks, with continued improvement as we rebuild strength, mobility, and muscle balance.

If you’re tired of living with buttock pain, burning sensations, or nerve-like symptoms that just won’t quit, don’t wait any longer. Piriformis syndrome is highly treatable, especially when addressed early and with a comprehensive approach.

Come see me in Charlotte.