Muscles
Piriformis Trigger Points
Symptom Area: Lower Torso
Piriformis Trigger Points are explored here through their location and referred pain pattern. Muscle knots is an everyday term used for tender muscular spots; myofascial pain describes pain involving muscle and its surrounding connective tissue. A common mimic of true sciatica — buttock pain radiating down the leg, sometimes with neural symptoms.
Where you feel it
When the Piriformis holds active trigger points, you usually notice it as appendicitis-like pains, buttock pain, impotence due to nerve entrapments, lateral thigh & hip pain and painful intercourse. Where the pain spreads: Deep buttock pain, sacroiliac region, sometimes down the posterior thigh in a sciatica-like pattern but typically stopping above the knee. What often sets it off: Prolonged sitting on hard surfaces, sudden change in running volume, hip impingement, sacroiliac dysfunction.
Overview
Runs from the anterior sacrum to the greater trochanter. External rotator of the hip in extension, abductor in hip flexion. The sciatic nerve passes beneath (or in some people, through) the muscle, which is why trigger points and tightness can produce neural-like symptoms.
Trigger point locations
Belly of the muscle deep in the buttock, midway between the sacrum and the greater trochanter.
Referred pain pattern
Deep buttock pain, sacroiliac region, sometimes down the posterior thigh in a sciatica-like pattern but typically stopping above the knee.
Palpation & testing
Side-lying with the hip flexed and adducted, palpate deep to the gluteus maximus. FAIR test (flexion, adduction, internal rotation) often reproduces symptoms.
Common causes
Prolonged sitting on hard surfaces, sudden change in running volume, hip impingement, sacroiliac dysfunction.
Self-care & clinical treatment
Figure-4 stretch, ball release, hip control work. Clinically: needling, soft-tissue release, address contributing pelvic mechanics.
Treatment protocol
For Piriformis, the general protocol applies: sustained pressure release on the taut band, then stretch and active movement in the newly gained range.
Position and palpation: Side-lying with the hip flexed and adducted, palpate deep to the gluteus maximus.
Regional precaution for clinicians: In the flank and abdominal wall the kidney (behind the twelfth rib and the quadratus lumborum), the abdominal viscera and the lower lung fields are the structures at risk.
Primary Symptoms
Secondary Symptoms
Often confused with
These muscles cause the same primary symptoms, so they are checked together:
Related muscles in this region
Related articles
- The piriformis: the muscle that imitates sciatica from deep in the buttock
- Low back pain that flares when you stand: a step-by-step quadratus lumborum treatment plan
- Hip pain when you lie on your side: the gluteal trigger points behind it
- Buttock Pain: which trigger points cause it and how to treat them
- Lateral Thigh & Hip Pain: which trigger points cause it and how to treat them
- Appendicitis-like Pains: which trigger points cause it and how to treat them
References
- • Travell & Simons, Vol. 2
- • Effectiveness of dry needling for upper-quarter myofascial pain: a systematic review and meta-analysis — J Orthop Sports Phys Ther 2013;43(9):620-34
- • The effectiveness of trigger point dry needling for musculoskeletal conditions by physical therapists: a systematic review and meta-analysis — J Orthop Sports Phys Ther 2017;47(3):133-49
- • Effectiveness of trigger point dry needling for multiple body regions: a systematic review — J Man Manip Ther 2015;23(5):276-93
- • A systematic review of manual therapy techniques, dry cupping and dry needling in the reduction of myofascial pain and myofascial trigger points — J Bodyw Mov Ther 2019;23(3):539-46
- • Physiologic effects of dry needling — Curr Pain Headache Rep 2013;17(8):348
- • Trigger point dry needling for the treatment of myofascial pain syndrome: current perspectives within a pain neuroscience paradigm — J Pain Res 2019;12:1899-911
- • Myofascial trigger points then and now: a historical and scientific perspective — PM R 2015;7(7):746-61
- • Pertinent dry needling considerations for minimizing adverse effects — Int J Sports Phys Ther 2016;11(5):651-62
- • Adverse events associated with therapeutic dry needling — Int J Sports Phys Ther 2020;15(1):103-13
- • Lidocaine injection versus dry needling to myofascial trigger point: the importance of the local twitch response — Am J Phys Med Rehabil 1994;73(4):256-63
- • Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.) — Williams & Wilkins, Baltimore
Medically reviewed by: Marco Aruffo — physiotherapist since 2006, specialised in myofascial pain · Last reviewed:
