Sciatica, More than a Pain in the Butt, and Why It’s Often Misdiagnosed; Real Culprit is Piriformis Syndrome

Dr. Stephen Gangemi, aka the “Sock Doc” discusses some natural and effective ways to deal with low back, hip, and leg pain as well as what is known as piriformis syndrome. Also, Dr. Gangemi discusses sciatica – how it is often misdiagnosed and how it can be treated.– NRC


In this video I discuss piriformis syndrome, low back pain, and “sciatic pain”, which is often not true sciatica, but another type of pain known as sclerotenogeous pain. Many athletes suffer from hip pain and back pain. Hip flexion problems are very common in runners and those who use their bodies to jump and kick. Extension-type pains can be an issue with these athletes too, and especially with cyclists.

Your sciatic nerve is a thick nerve originating from many fibers in the lower back and sacral area. Actually it’s the sensations in the lower leg & foot – weakness, pain, numbness – that are typically true signs of “sciatica” symptoms as the sciatic nerve comes out from behind the knee and branches out into the tibial nerve and common peroneal nerve where they supply movement and sensations to much of the lower leg and foot. Pain above the knee – usually referred to as sclerotenogeous type pain – is pain originating from a muscle, tendon, or ligament. That is usually what is causing pain in the lower back and hamstring/thigh area, if not a local muscle or tendon strain. Though there may be disc involvement as well as other nerve related problems, (other than sciatica), most lower back, thigh pain, and hip pain is from muscular imbalances as well as inflammation in the body.

The muscles discussed in this video have significant involvement in the stability, strength, and movement of the lower back, hip, and legs. Piriformis – this muscle  extends from under the front side of the sacrum and attaches to the greater trochanter in the upper leg. The major action is to laterally rotate the hip as well as turn the foot out. The sciatic nerve actually comes out right under the piriformis, but in 15-20% of people, it goes through it. “Piriformis syndrome” irritates the sciatic nerve. An imbalance in the muscle often causes pain and  can cause the foot to turn outwards. Since the pirformis muscles stabilize the sacrum and therefore the base of the entire spine a person can have pain all the way up to their neck or down to their foot from a piriformis issue.

Gluteus maximus – this powerful muscle extends the hip and rotates the thigh laterally a bit too,  just like piriformis. Many people think they’re having hamstring pain or hip pain from a bad disc, when really it’s because they have a glut max that isn’t functioning properly. Also, a lot of knee pain is because of a strained glut max. This muscle also makes up a significant amount of the ITB – another common injury I discuss here. On the front side of the body are the  psoas and abdominals muscles and they are often involved in low back pain, hip pain, sciatica, and disc problems.

Leg flexion, hip rotation, and the ability to reach down and touch your toes is made possible by the action of these two muscles. So pain performing these movements means that they are not working correctly. Can’t sit up because of pain or weakness from laying on your back? Pain putting on your shoes or flexing forward to pick something off the ground? Pain running, jumping, or kicking?  Psoas and abdominal involvement.

No stretching! No orthotics!

51 Responses to “Sciatica, More than a Pain in the Butt, and Why It’s Often Misdiagnosed; Real Culprit is Piriformis Syndrome”

  1. what exercises do u do if pain radiates from buttocks to upper hamstring

    • Dr. Gangemi says:

      Mike, pain from the butt to the upper hamstring is either a glut max or piriformis problem. So if it’s the glut max then you look for the trigger points in the glut as I demonstrate and if it’s the piriformis, same thing for that muscle. I don’t recommend or advise any exercises when there is still pain in the muscle because that means the muscle is still neurologically inhibited (essentially it is weak). Exercising the muscle(s) will not get it to fire. Once it does though, I like Russian Kettlebell Single Leg Deadlifts, or even Russian Single Leg raises w/o the kettlebell are great too for strengthening the glutes and overall stability.

  2. Sandy says:

    Please discuss how to make the glut max function properly then – Thanks

    • Dr. Gangemi says:

      Hi Sandy, pretty much same answer as I left Mike. Check for trigger points both sides, that’s how you get it to fire again (most often), and then you can try some Russian SLRs (good demos on YouTube). Also note the hormonal relationship I mention in the video. There is a strong correlation between the glutes and piriformis muscles and sex hormones. Many women are estrogen dominant and progesterone deficient, and many also take birth control pills or some other form of HRT. These will often cause muscle imbalances in those pelvis muscles. So if you have hormonal imbalances the trigger points won’t work – you have to address the hormonal issues.

  3. Jim Hansen says:

    I enjoyed the video and have a question. You said this about the piriformis: “Piriformis – this muscle extends from under the front side of the sacrum and attaches to the greater trochanter in the upper leg. The major action is to laterally rotate the hip as well as turn the foot out.” I am a long time competitive runnner and my left foot turns out so it is not pointing the same direction as the knee. Could this be related to the piriromis? I do have a lot of problems on the left side including a pain in the butt post runs, I had arthroscopic surgery to repair a torn labrum in the hip this summer, but the foot twising out is always there (sometimes worse than others). I am curious about the pirifrmis’ effect on this or does the twist create the pain in the butt?

  4. Dr. Gangemi says:

    Hi Jim, yes I’d say that is exactly what is happening to you. The left foot would be the tight piriformis (could be your psoas too), with the right side being inhibited (“weak”). The twist is really not what is causing the pain, but the piriformis being too tight is causing both the pain and the lateral rotation – that puts a significant amount of stress on your labrum, hence your surgery.

    • Jim Hansen says:

      Thanks (and sorry for so many spelling errors). I just had an MRI for the lower back and was told yesterday that my back looks very good. I will be sent to another musculo-skeletal doctor who will look a little deeper into what my body is doing and one thing they mentioned was possible trigger point injections. I might guess they would find something in the piriformis area. It was also recommended by someone else to see a doctor called Thomas Michaud who just wrote a book called “Human Locomotion” which all about stuff like this. He is quite busy as my appointment won’t be until April! It is all very interesting to learn how the body works.

  5. Rick Bruess says:

    I have butt pain, and also lower leg and foot pain, numbness from the knee down, and foot drop. It came on suddenly one month ago, while taking a break from running. I have been a competitive runner for 30 years. My MRI shows no compression of the nerve root. My pelvis MRI was also unremarkable. Is it possible to have compression of the peroneal nerve at the knee that would cause pain in the butt? Would an MRI of the knee be helpful? Thanks!

    • Dr. Gangemi says:

      Rick, I usually joke with patients that if the first MRI didn’t fix the problem then the second one won’t either. Of course MRI’s don’t treat, they are meant for diagnosis, and I’m all for using them when appropriate, but they’re way over-used and many people are misled by their findings. After all, if your MRI says you have a nerve entrapment that doesn’t tell you how it happened, or how to fix it – and many times, especially in the case of low back disc problems, patients have the bulge decompressed or removed and see zero improvement.

      You’re looking for a nerve problem but it’s probably more of a muscular problem. Did you check the piriformis trigger points as I show in the video? The foot drop could be from a local muscle weakness or, as you note, from a nerve entrapment. And yes, the foot issue could be causing the glute pain.

      (sorry I did not see this comment 2 months ago)

      • Carl says:

        Hello, I see Rick’s foot drop was not caused by a disc injury.I was lead to believe foot drop indicated a definate disc injury – is that not so? I currently have foot drop and sciatic pain diagnosed as L4/L5 disc herniation (no MRI). Initially I couldnt lift my foot against gravity, one week after its onset I can now lift my foot against gravity still have no strength in my big toe. I have been suffering sciatic pain and foot drop following two accidents, the first of which gave me back pain, the second of which gave me excruciating sciatic pain, the foot drop, but my back pain disappeared. (I cannot bend more than about 10 degrees at the waist, or put my left foot out more than about a foot in front of me before shooting sciatic pain comes in. If I approach that painful area slowly, I can also feel a fuzzy numb feeling in my foot).My question, is might my foot drop be caused by something other than a disc injury?

  6. Renee Fischer says:

    Thank you for your informative video. I am suffering from piriformis syndrome and have noticeable lack of flexibility/range of motion in one hip compared to the other. I experience low back pain and pain that shoots down my leg into my foot. I’ve been prescribed stretching exercises which only seem to exacerbate the problem. I noticed you pushed on the pressure points. Is this something to do on a regular basis to “loosen” up the the muscle and is there anything else I could do to help with this issue? Thank you!

    • Dr. Gangemi says:

      Renee, the trigger point(s) could be on either hip – the tight side or the “looser” side. So you have to check them both. Yes, you may have to treat them more than once but if it’s over and over again then you would need to figure out (or see someone to figure out) why they are there and the muscles are not working properly. Correct, I would never stretch them out.
      (sorry I did not see this comment 2 months ago)

  7. Linda Siesky says:

    I fell on ice two years ago, and after 5 weeks of PT had an MRI (no disc problems)which revealed an ovarian cyst and resulted in a total hysterectomy due to endometriosis. To deal with my piriformis and SI pain (and pain/numbness in my foot) I have subsequently tried chiropractic, PT for pelvic dysfunction, therapeutic massage, injection into my SI joint, more PT, and another round of chiropractic. Unfortunately, I am one of the twenty percent whose sciatic nerve runs through my piriformis. I have been told repeatedly to stretch the piriformis. Now the pain is on both sides. I will definitely stop stretching and see if things will improve.

  8. Linda Siesky says:

    Okay – no stretching the piriformis. Is it okay to stretch other areas that have tightened up (despite being hypermobile) such as hamstrings, quads, QL, ITB and psoas?

  9. Dr. Gangemi says:

    Linda – no, I don’t think you should ever static stretch to treat these areas. Natural movement of the muscles is fine, but if you have to hold and stretch to feel better then you’re simply blocking some pain temporarily and probably delaying the healing. Sorry to hear you’ve seen so many docs and therapists without any success. You’re welcome to come to the Sock Doc office. It is most likely not a coincidence that you have hip and lower back problems and have had significant hormonal problems. There is a direct muscle relationship between the uterus/ovaries and all the muscles of the pelvis. Sometimes, even with a total hysterectomy, the pain just doesn’t disappear as quickly as the surgery removes the problem organs.

    • Linda Siesky says:

      Thank you so much for your reply. (I’m disappointed in myself – that I didn’t listen to my body months ago when I felt better after a short period of not stretching.) Found your bio very interesting as I have said repeatedly that my body – from foot to neck – hurts more as soon as I put my shoes on. (Including those that are “good” for my feet – not high heels, pointy toed shoes, etc.)

      I didn’t have the pain in my foot, back. hip and SI joint until I fell (getting out of the car – direct force to my right buttock)- felt that the trauma caused my pain. But hormonal changes could be contributing to my problem?

      Certainly wish I lived near Chapel Hill. Haven’t been able to find anyone who can get me back on track – and I would love to be able to road cycle again.

      Thank you again!

      • lorelei says:

        Hello Linda:)Has it ever been mentioned to you that you may have fibromyalgia? The symptoms seem similar.This condition is usually brought on by a traumatic experience and/or (oddly enough) trauma to the cervical(neck) area of the spine.I hope your health is improving.:)

  10. Sarah says:


    I got myself into a fitness regime a few months ago. About a month ago, I was in a gym class when something happened to my right knee. I couldn’t move it any further and ended up limping out of the class. It felt like the knee was going to dislocate any moment. (I’ve had a knee problem about 2 years ago which was better after 2 weeks of cuprofen.)

    The knee got better after a few days of hot and cold treatments and rest.

    Just a few days ago, I got myself into another bother again. I went back to the gym routine again. My right lower back started feeling very painful and since yesterday the pain has developed and found itself shooting through to the right glute, back of the thigh, towards the back and outer side of the knee and following to the ankles and bottom and top of the feet. The pain is very strong and hurts even when I’m in bed. I’ve noticed in Pilates that I can’t straighten my right leg all the way. I do find it hard to bend my back to pick up something from the floor. I am only 26 and worried that this might a bigger problem. I visited the docs just yesterday and she examined both my knees because that’s where the problem started and she said it’s because my muscles have been over stretched etc. I asked her to refer me to a specialist but she refused saying that they will reject the referral. Now, I’m in pain and I feel like a 50 year old. I need to continue with my gym routine as I plan on running a marathon in a couple of months. I also need to stay fit. At the moment, I need someone to point me in the right direction. I could go for physiotherapy but now I’m wondering whether that’s gonna be a waste of time?

  11. Amy P. says:

    For the past 2 years I have been struggling with piriformous and SI joint pain on my left side. I have a hard time sitting for long periods of time. My left hamstring is also tight. I went to get a massage this week and she told me my sacrum does not move, so I should get an adjustment. I have been going to a chiropractor and PT and it is not helping. I was able to manage the pain a year ago for 3 months then after a 22 mile run the pain came back and I have not been able to run since. Durning the past year I have tried Prolothearpy and I also had a bunion on my left foot repaired…. That is now healed. I have my husband put his elbow in the trigger points in my glute on a regular basis and I get some relief for a short period of time, but it does not heal enough to allow me to run. Any suggestions on what I can do to heal? Also do you know anyone in Minneapolis MN that specializes in this issue? Any advice is appreciated. Thanks!

  12. Sdomingo says:

    Hi Doc,

    I found your video above very enlightening. I have been suffering from what i finally deem to be the Piriformis syndrome after numerous visits to orthopedics and Neurologist/Neurosurgeons. I had 2 MRI’s which showed my spine and back to be in good shape and condition. I assume the piriformis syndrome cannot be seen on a MRI scan? I guess that’s why they were not clear of my situation, except termed it as sciatica. However i have only experienced pain on glutes most of the time. Perhaps only once has it gone all the way down to my legs. The pain is always around my glutes. It gets worse if i am sedentary and have nil physical activity. If i sit for too long, especially on soft surfaces. And even when i drive. I assume this would be the Piriformis muscle? But it is not a muscle like pain rather a pinched nerve, so i also assume, like you mentioned im in the 20% group whose sciatic nerve runs through the piriformis muscle.
    I have been to 3 different physiotherapists but have not recovered yet. The episodes of pain keep returning every few months.
    Please advise what would be the best form of treatment to get rid of this misery once and for all.
    Thank you!

  13. john power says:

    In my personal and professional experience piriformis syndrome and chronic buttock pain is often a symptom of SI joint hyper mobility. The piriformis muscle does not directly cross the SI joint but it is the closet, spasm and pain is directly related to an attempt to stabilize the SI joint (similar to a back spasm stabilizing the vertebrae with a disc/nerve injury). Lumbar spine pathology can also be experienced in the buttock region so ruling out lumbar disc, stenosis, spondylolisthesis, facet arthritis is important. SI joint hypermobility can cause symptoms that range from the upper back to the foot (on the injured side). I have worked with many clients with SI joint injuries and buttock pain. The goal is to stabilize the SI joint and strengthen the muscles to facilitate pelvic stability. Joint manipulation, stretching, heat, ice, ultrasound, massage may help but will not fully address the complexity of this injury.

  14. karen says:

    I have pain deep in my left hip. Some days I don’t even notice it. But, I have definitely notice that it is aggravated by a lot of walking. I teach a strength and endurance weight class, where we do 5 minutes of squats and 5 minutes of lunges. I don’t have pain while doing these two exercises, however, after sitting it is all I can do to stand up. I did notice that if I turn and take a step when it is bothering me, the pain shoots up into my glut and stops me dead in my tracks. Usually, resting it for several hours helps it not be as severe. Do you think this could be Piriformis syndrome?

  15. sharon says:

    Hi, I was in car accident over 2 years ago, I do have prolapsed and bulging disc’s but no one can explain why both my feet are numb, Mri showed the disc’s weren’t pressing on any nerve roots. I ended up going to a gyn a coupleof months ago who specializes in PNE as I have constant pain in my hips, buttocks, groin feet and ankles. I also have sciatica in both legs and my right foot turns out. As this has been going on for over 2 years my arch in my foot has dropped. The MRI with the gyn showed the sciatic nerve pierces though the piriformis muscle. They suggested nerve blocks and botox. Would any of this treatment correct my right foot and could this relieve the constant pain.The gyn said the muscles on the left side are in spasm as well. I’m concerned as it has been so long before they found this that it would be to late to fix it. Thankyou for any assistance.

  16. Jay says:

    Hi. I had an attack about 2 weeks ago and it was excruciating! Lost feeling in my right leg and 2
    Small toes! Under my foot feels as if it fell asleep and numb! My back has stopped hurting but my leg goes and comes with pain but feels tight. The doctor prescribed ibuprofen, tylenol and muscle relaxants. It eases it much! What can I do Doc/anyone? Should I exercise? Lose weight? To ease? I’m so lost and frustrated with hopping around though its better than before! I’m 36 and can’t live like this with 5 kids! Helo anyone! Thanks a lot! Peace and blessings! 1 Love!

  17. Justine Buckley says:

    I have had what I thought was a weak right knee for years. Only becomes a problem with excersise. Two years ago I tore the inside cartridge of my right knee…. This hasn’t helped with the pain which comes on bad and then becomes bearable. The pain is awfull in my right heel, I have to limp when I get up in morning or after sitting. When I drive distance the pain shoots down my leg from hip to knee to foot. I have had heaps of tests, nothing wrong with my back and I am fit with strong core. What can I do to fix it.

  18. Acadia says:

    Dr Gangemi,

    I can’t thank you enough for this video. I started yoga a year ago and rather immediately started feeling a deep pain in my left butt. Then a combination of a fall (where I landed with a thump on my feet) and flat shoes have caused constant foot pain. It’s been a year and the pain in my butt and feet have not gone. There’s no lower back/disc problem, and nerve tests have turned out negative. I am currently undergoing ultrasound therapy for foot, since i am finding it hard to walk for more than a couple of blocks. I am at a loss for what to do next. None of the doctors I have visited can even confidently tell me what the issue is. Going by your video, I am sure I have both a piriformis and a Psoas issues, as I can’t flex my leg/hip as you show in the video. Also I am aware when I am walking that I tend to put more pressure on my left-foot and hence all my problems are on the left-side of the lower body. In addition, I am 36 and apparently have been diagnosed with ovarian cysts. Do you think everything is related to my piriformis and Psoas? What do you advise? I will take Vitamin E as you’ve mentioned. But I feel let down by the advise to not stretch (though it makes sense). How much longer for the issue to get corrected since I have been suffering now from a year with other issues manifesting. Your help and advise will be most appreciated. Thank you once again for posting this video.

    PS: I live in New Jersey and any suggestions on whom I can visit here will be hugely beneficial.

  19. I have had pain for over 2 1/2 years and haven’t been able to work as a nurse since December of 2011. I just recently underwent a total left knee replacement in November, 2012 and I am still experiencing excruciating pain from the back & inside of my knee down to the bottom of my foot. I have always had lower back pain and shoulder pain which was diagnosed as a child to be from scoliosis and lordosis. I had sustained a massive fall in 2010 upon exiting my truck and falling backwards hard onto my back in a supine position and have experienced the left knee pain since then. My ortho is confused and doesn’t understand why I am still having such pain to the point of taking away my narcotic pain medication and referring me to PT which has only made the problem worse to where I am crying with the pain before the end of the sessions. I have never been able to lay in a supine position without pain and have always experienced problems with attempting to get up from a laying down position. Prior to the total knee replacement I had experienced multiple falls and would result in multiple bruising and at times it would result in open wounds due to the falls. I have always experienced head aches that I have always just learned to deal with. My ortho dropped me from 7.5/500 percs 1 to 2 tabs q 4 hours to 5/325 percs 1 tab every 6 hours and now wants me off the narcotics completely. I will be honest I have been taking lots of ibuprofen on top of the decreased dosage of the percs to try to keep the pain to a tolerable level. My ortho says that I should be with full ROM now since I am over 2 months post-op, but I am not and actually am using a dog lease to move my left leg when I need to change positions. I am still utilizing a walker to ambulate and it is at a very slow pace and currently am only able to tolerate about 2 stairs at a time. I am unable to lift my leg at all without the assistance of the dog lease that I put around my left foot to move the leg. I cant sit for long periods without the pain increasing and movement aggravates the situation. I really thought that I would be pain free at this stage and was hoping that the knee replacement would have solved the problems. The ortho did inform me that when he did the knee replacement that my knee cap had actually fell apart when he went in to the surgery. He said he didn’t realize that it was actually as bad as it was until he went in to the do the surgery. I am only in my 40s and cant imagine having to live with this pain for the rest of my life. I even at one time had a doctor try to tell me that he thought I was abused and thought that the bruises were from an abusive situation instead of a medical problem, of course this was prior to being scene by the ortho that performed the knee surgery. My MRI prior to the knee surgery did show lots of arthritis and a few degenerative disks in my back as well, but these problems have always been associated with the scoliosis and lordosis of my spine. I am confused as to why this pain is still happening and happened to do a search on my symptoms and came across your website. I have a digital disk and a copy of the MRI report that was done in 2010 and also can access partial records of the current condition and treatment of the knee if you would like to look at them and possibly point me in a direction that may assist my situation. I have gained lots of weight over the last few years due to the decreased mobility and was looking forward to being able to be active again with my family. We used to be very active and would do lots of camping, swimming, hiking, and water sports such as skiing and horse back riding and bike riding. We used to ride bike trails all the time, but seriously I haven’t attempted it in over 2 years now. I also prior to the surgery and still at times have noticed that my left foot will turn outwards and I am still unable to straighten my leg out completely without pain and discomfort. The ortho performed the total knee replacement due to the wear and tear on the joint and degenerative arthritis and osteoarthritis. I have also had a total hysterectomy back in 2008, not sure if this has anything to do with this or not, but according to your information looks like my female problems and past problems with my pregnancies and multiple miscarriages before I finally gave birth to 2 children might be connected with some of these issues. Thanks in advance for taking the time to look at my posting and to try to assist me it is greatly appreciated.

  20. Sandy Wood says:

    I have been suffering for several years from low back pain which I believe is caused by the position I sit to peform my job as a manicurist and pedicurist. Most recently I am experiencing neck and shoulder pain as well. At 50 years old, I spend my day working and taking pain pills, and my nights on the couch with more pain pills. I have always had deep pain in my butt and outer thighs, and I thought I was crazy! I had always had most massage therapists focus on my low back and butt muscles. After 46 weeks of physical therapy and what I feel are excessive amounts of pain pills, I still am no better. Surely there must be a better way to live my life. If stretching is not the answer, what would you suggest so that I may continue to work and support myself and ditch the pain pills every doctor assures me is the only option. I would be so greatly appreciative for your opinion.

    • MarkC says:

      where do you live….you really need an assessment from someone like my friend the Sock Doc who has rehabbed countless folks. yes goal is to get off the pills.


  21. Mary Anne says:

    Having sciatic pain (numbness & pain in foot on sitting) 6 months after having surgery to repair a torn proximal hamstring. What to do now?

  22. Pamela says:

    When I found this article, it was the first time I felt I knew what was wrong with me. I stopped running this week, after trying to eek out 2 miles just 2 days after my last long run of 16 miles – butt & leg pain made me decide to stop- in the midst of training for an ultra. Several days later I’m not really feeling better. Granted, looking at past events with new eyes, I now see that symptoms I was experiencing as long ago as last May (or even earlier) were likely the signs of things going wrong that ultimately led me to where I am now. I’ve been running for 3 years now – starting in my mid-40’s, and have now run 4 marathons – 3 of which were in 2012. So, a few days rest isn’t going to fix almost a year of running through injury.

    As of a month ago, I have started going to a PT, referred by my doc at Rothman who was unsure what was wrong with me. I think this is because I didn’ have all the symptoms of piriformis and/or sciatica when I saw him at the beginning of January. And the MRI showed nothing to explain it. In the past 2 weeks, I’ve developed more lower back pain as well as numbness down into my right foot. I ran a 5mile race a couple weeks ago – on a hilly course where I fell and rolled on my back – tripped with my right foot – again (like the 3rd time in a year) – and I know this didn’t help.

    My question now is how do I know how long I need to wait to resume activity and/or what type of activity should I be doing while I’m not running? I am afraid to even do the PT exercises (backward lunges, hip flexor stretches, spine mobility) because I don’t know if I’m really making things worse.

    I’m seeing the doc again tomorrow, so I’ll tell him about the new developments, but I wonder what’s the best resource for a runner to use to develop a comeback plan and not re-injure myself?

    In the meantime I am reading all of the material presented here and finding it to be a revelation. Thank you for developing such a wonderful site and clearly pouring so much work into it!

  23. Greg says:

    I think I may have something similar to what’s shown in your video, but not sure. This started a couple of months ago laying in bed on my back in bed at night. My left thigh started to tingle and go numb (happens with right thigh on occasion). The sensation, which started as more pins and needles (but just goes numb at this point, no pins and needles) is alleviated by:

    * bending leg 45 degrees or so (remaining on back)
    * turning on to one side, left or right
    * rubbing the thigh
    * sitting upright, walking around, being vertical

    I’ve had x-ray of spine–clear. MRI of spine and sacrum, diagnosed as perfectly normal (no compressed or herniated discs, etc.). When I press into my upper glute, on both sides, it’s a little painful, but only in a very specific spot.

    I’ve been to several specialists here in Vermont and no one can tell me what’s happening.

    Thanks very much.


    Dr. G, apologies, I also posted this on your website (which is pretty informative).

  24. karen says:

    I have been suffering from bottom back ache, numbness in hip, sore right foot, pain in my leg at the bottom when i bend it or lean on it and pain in my bum at the top. I havent seen a doc yet but just wondered if anyone could help me. The buttock pain has just started but the rest has been going in for a while.

  25. john JT says:

    My problem start when I had a fall,land on my butt and admitted to the hospital.No injuries ,no broken bones according to the doctor.After few years goes by,suddenly I feel the pain at the butt where I have landed previously and it will go down to my calf if I don’t stop running or walking.

    Dr.G,pls advise what is the cause of the pains.

  26. GAIL says:

    JULY 25, 2013


  27. Paul says:


    I’ve never suffered from Piriformis issues until a few months back. I’ve been learning yoga since then, I was wondering if this is contributing? I have a good teacher, and my general flexibility has increased, and my muscle tone.

    though I also think it could be posture issue at work.

    It’s little frustrating because I’ve rebuilt myself from the ground up with minimalist running, pose technique, movnat and yoga and bang… my piriformis kicks in. HA!

    I personally think it could be sitting stress.



  28. Diarmuid says:


    I injured my glute playing soccer a month ago (I also have a job that involves m sitting most of the day). This is causing huge sciatic pain, to the extent that I am only getting 2 hours sleep some nights as the pain constantly wakes me up. A physio I went to gave me a stretch that seems to help ease the pain but it seems you are saying that stretching is bad.
    If I was to just use the trigger point method, is there a rough length of time one would expect it to take before starting to heal? (Obviously I understand that all cases are different and it depends on the muscle damage but I’m just wondering ball park if it’s normally a week / month /6 months). Any advice greatly appreciated.


  29. karen says:

    In your video you say not to stretch the piriformis, but both my chiros and message therapist say its a must on top of exercise and foam rolling. Can you confirm? I have tilted pelvis, and lots of tightness in piriformis, glutes, adductors, IT band…10 pkus years, but have realized all the above in the last year, and working to finally get bettet.

  30. april says:

    Hi I’ve been going to the chiropractor for my siatica, it will soon be my third appointment, but will stretching help, the doc said it was just my vertebrae, same with a massage therapist, but once it the pain goes away would I be able to bend down like I used to? Without pain or the inability to be able to bend over twist or sit right?

  31. janie says:

    I am a hairstylist standing all day. I have all these pains with a knee that swells a bit and planter in the bottom of my heal. Should I wear orthotics at work? Thanks so much Janie

  32. Tonya says:

    Hi I just read your post to Linda who had a hysterectomy and you stated there is a direct correlation to pelvic muscles and hormones . Who helps with this issue or what do you do to correct . I have also been to a pelvic floor therapist for 7 months who has used trigger point release with no results. She sent me to a pain center to inject the SI joint which gave me no relief . I’ve seen a chiro and am also been treated now in PT for 4 weeks no relief . I’ve seen a bio identical hormone specialist but he tested me when my gyn had given me a patch hrt after begging him because I also have insomnia which I thought was from my hormones being out of whack but when the tested me said I was normal range. But my gyn doesn’t test estrogen / progesterone ratio. My bio identical hormone specialist did but I had been on estradiol a week so the estrogen tested way high he was trying to adjust those levels . Anyway I m lost how do you figure out if this is hormonal mine was directed related to hystrectomy after 3 weeks off the pain meds from hysterectomy I ve been in pain with no help no relief I continue dr to dr searching for answers and relief . I am scheduled for steroid injection in isch tuberosity bursitis next . What’s your suggestions how would you go about treating a patient ?

  33. Tonya says:

    Also the drs all tell me to stretch saying my Pelvic floor therapist was keeping my muscles immobilized because she had me in a stabilizer belt for 7 months and didn’t want me to do anything so now all I’ve been doing is stretching. I’m coming up on a year with this pain I don’t want to add to it and do these stretched and strengthening are causing my other leg to feel the same . So you say no stretches for how long ? I read a post you responded to saying as long as the muscle hurts and it does and has for a year . When they push on the piriformis it’s extremely painful also my glut and hamstring are too but most the pain ends up where my isch tuberosity is ?

  34. gail mackey says:

    I read all of the above comments and I realize I am not alone in dealing with a
    difficult problem with the left side of my body.

    Could you please let me know where your are located. I would like to visit
    The Doc, but I am not sure where he is located.
    Also, how do you purchase the video. I did not see it on the article.

    Thank you.

  35. liberty Perez says:

    Dr. Gangemi,

    I have leg pain for over a decade and I am only 31 yo. I can’t sleep at night. I have to walk to relieve the pain and move it continuously. My hip pain started before I had kids 4 years ago. I can accept that my hip pain may be caused by my weight gain but how about my leg pain. I went to 5 doctors already and the last one told me that I am over worked, that every people experience pain and if I don’t want to experience pain then I should stop working! I think he believes that I am only over reacting to the pain I am experiencing. With his remarks, i think he wants me to accept that my case is closed. Why? I asked him about my scolio and he told me there are a lot of people who has scolio and lived. MRI shows normal. please advice on what should I do. He prescribed me with a muscle relaxant but it did nothing to relieve the pain.

  36. Daisy S says:


    I’ve been on and off injured for the last 2 years with various problems in my left leg. I used to love running and also playing tennis and I’ve always been very sporty and is a big part of who I am so I’ve found the whole experience pretty devastating to be honest.

    It started after a long tennis match when I was very stiff and tired afterwards which was understandable as had been a very long match. Ever since this match a few years ago I have had an uncomfortable sensation in my knee almost like a light pinching or something moving around, which is markedly worse when covered by a material. I can’t wear jeans anymore and find even light tights uncomfortable. Taping does slightly help I’m not sure if it’s because it hides the sensation of my knee or because it’s supportive. Whenever I’ve seen a consultant they’ve done MRIs but told me nothing is wrong with my knee and it’s just muscle imbalance. I have rested and done lots of strengthening but can’t get rid of this discomfort and feel it must be more than maltracking patella. To me the material thing feels more nerve like.

    I took a few months of sport and tennis but it’s never really gone. I’ve just managed it with tape and learnt not to wear material over my legs that aggravates it. Since returning to sport I got a stress fracture of the navicular – which I know in unusual. I was actually playing tennis, but hadn’t gone back to running. I then was in a cast and boot for a period and then came back very lightly to sport after six months recovery for 5 months and got a stress reaction in my talus. I haven’t been put in a boot or anything but am still not doing any running or tennis still 3 months on. Sometimes walking I get a shooting pain on the inside of my foot – not sure this is normal!! I’ve reduced the extreme orthotics I had after the navicular stress fracture as I think it may have moved the problem but really don’t know what to do anymore. Do you think there is any possibility this could be a nerve thing that’s weakening my foot. I’m terrified of hurting myself again and can’t even imagine ever getting back to sport I love. I’d really appreciate any help you have. Feel like I’m trying everything – Pilates 2 x a week, Massage, Physio and seen a rheumatologist too- who said I was osteopenic in my spine slightly but normal in my hip, but my fracture risk was low.

    I’d really appreciate any help or advice you have,

    Thanks Daisy!

  37. Bobby says:

    Hello Everyone,

    I just have a quick question. I have had very bad knees for 15 years now. Some of my friends have told me that from me favoring them when I walk that is causing my sciatic nerve to act up and crate a very sharp pain up my lower back.

    Is that possible? I have never been to a doctor for my back only for my knees.

    Should I make a appointment for my back? The pain does not seem like it wants to go away anytime soon.

    Thank you all have a great night,


  38. Kelli epps says:

    Hi for about 7 months I haven’t been able to sit without increasing nerve pain in my glutes and feet. My feet will turn bright red when too Hot and blue when too cold. Or even when I try sitting they will turn black and blue and red. Have any ideas.

  39. Painnneehelp says:

    Hi, i have been feeling pain around the upper hmstrings and glute pain for bout 5 months now. I stopped running and doing any leg exercises and been concentrating on my physio now, but nothing seems to be working, the pain feels the same as when i first feel the pain 5 months ago, also my mri shows nothing, no fracture, no inflammation, no inregularities in my pelvic region. I wonder if a cortisone shot might work? But since the mri shows nothing, i doubt the doctor would give it. Help?

  40. Evonne says:

    I have been having a burning sensation in my right leg and right butt. I went to a neurologist and had an EMG and NCS. He determined it is not the nerve on that side. The only thing relieves the burning is to what I’m doing and sit. I can neither stand too long nor walk any distance without feeling that sensation. I have been taking Gabapentin sine 3/30, which hasn’t made a difference yet. What do you think?

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