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Piriformis Syndrome and Buttock Pain: Integrative Treatment Without Surgery

Medically reviewed by Dr Krushal Pabari, MD, PGCP - Rheumatic & Musculoskeletal Diseases · Last reviewed: 4 November 2026

Key facts

Piriformis syndrome is pain deep in the buttock, often worse when sitting, that can run down the back of the leg like sciatica, when the piriformis muscle irritates the sciatic nerve [1][2]. It is part of deep gluteal syndrome, which a British Journal of General Practice editorial calls an overlooked cause of sciatica: the spine and the MRI can look normal [3]. Cure4Pain is an integrative and functional medicine clinic in Mumbai, India, with online consultations worldwide. Dr Krushal Pabari and AT. Chintan Dalal treat the weakened lower back and buttock muscles often found alongside it with twitch-response dry needling and electroacupuncture, with basic nutritional support, in coordination with your existing consulting physician.

Watch our explainer videos
AT. Chintan Dalal, N.D.

Scientific explainer videos in our Resources section

In our Resources section, our clinical team discusses piriformis syndrome and buttock pain and their management in detail: the lower back and gluteal muscles, dry needling and electroacupuncture.

Watch our scientific explainer videos

Sciatica with a normal MRI? The cause may be in your buttock, not your spine

Sciatica does not always come from the spine: a 2018 systematic review in the European Journal of Orthopaedic Surgery and Traumatology found that the piriformis muscle can cause sciatica [1]. Piriformis syndrome is defined by four features: buttock pain, pain made worse by sitting, tenderness deep in the buttock near the sciatic notch, and pain when the piriformis muscle is put under tension [1].

  • Overlooked: a 2019 editorial in the British Journal of General Practice calls deep gluteal syndrome “an overlooked cause of sciatica” [3].
  • How often: in a 2013 Pain Practice study of 93 people with long-term low back pain, about 17% met a clinical test for piriformis syndrome [4], and in a 2024 British Journal of Pain study of 110 people with sciatica, 27 had at least half their pain relieved by an injection into the piriformis muscle [5]. These are estimates from single clinics; there is no gold-standard test yet [1].
  • Anatomy: in more than 10% of people the sciatic nerve runs through or above the piriformis muscle instead of below it, according to a 2020 meta-analysis of 44 anatomy studies [6]; whether this makes symptoms more likely is not proven.
  • Lower back and buttock muscles: in a 2023 study of 91 people in Malaysia, a thicker piriformis went with a weaker gluteus maximus in those with low back pain and piriformis syndrome [7].
  • A quick self-check: if sitting for a while, especially on a hard seat, brings on deep buttock pain that eases when you stand and walk, piriformis syndrome is one possible cause; an examination is needed to check it, as no single test confirms it [1].
  • What this means for you: if your sciatica scan was normal or does not explain your pain, the buttock muscles are worth checking, which is why we examine the lower back and buttock together.

What is piriformis syndrome?

Piriformis syndrome is a cause of buttock pain and sciatica-like leg pain in which the piriformis muscle, deep in the buttock, irritates or compresses the sciatic nerve, according to a 2020 review in The Bone and Joint Journal [2].

  • The piriformis muscle: a small muscle running from the base of the spine (sacrum) to the top of the thigh bone, which turns the hip outwards.
  • The sciatic nerve: the large nerve that runs under (or sometimes through) the piriformis on its way down the back of the leg [6].
  • Deep gluteal syndrome: the wider name for nerve irritation in the buttock, which includes piriformis syndrome and other small hip muscles and the hamstring attachment [2].

What are the symptoms of piriformis syndrome?

The most common symptoms are buttock pain and pain made worse by sitting, according to systematic reviews of the clinical features [8][1].

  • Where it hurts: deep in the buttock, sometimes spreading down the back of the thigh and leg like sciatica [2].
  • What makes it worse: sitting, especially for long periods, and movements that stretch or tighten the piriformis [1].
  • Other signs: tenderness deep in the buttock near the sciatic notch [1]; some people also have worse balance and uneven leg strength [9].

Why do I have piriformis syndrome? Causes and risk factors

The exact cause is often unclear, and a 2020 review notes that research on deep gluteal syndrome is still limited [2], and one small study linked it with a weaker gluteus maximus [7].

  • Long sitting: in a survey of university students, sitting position, sitting time and low activity were linked with symptoms [10]; this is an association only.
  • Nerve anatomy: a sciatic nerve running through the muscle in more than 10% of people [6].
  • A wallet in the back pocket: sitting on a thick wallet can cause similar buttock and leg pain (“fat wallet syndrome”), so take it out before sitting [11].

Piriformis syndrome vs sciatica, slipped disc or deep gluteal syndrome: what is the difference?

Sciatica from the spine is usually caused by a slipped (herniated) disc, narrowing of the spinal canal or a slipped vertebra, according to the NHS [12], while piriformis syndrome starts in the buttock and is defined by buttock pain and pain on sitting [1].

  • Slipped disc or pinched nerve: see Sciatica, Slipped Disc and Pinched Nerve & Radiculopathy; an examination tells them apart, and a normal MRI does not rule out piriformis syndrome [3].
  • The straight-leg raise test: lifting your straight leg while lying on your back does not rule out piriformis syndrome, according to a systematic review [1].
  • The FAIR test: one clinical check bends, crosses and turns the hip inward (flexion, adduction, internal rotation) to see whether it brings on the buttock pain [4][13].
  • The hip joint: pain mostly in the groin points to the hip joint (see below).

Hip pain when sitting or lying down: is it piriformis, the hip joint or the back?

Where you feel the pain helps to tell them apart: hip joint arthritis usually causes pain in the groin or thigh that can spread to the buttock or knee, according to the American Academy of Orthopaedic Surgeons [14], while piriformis syndrome causes pain deep in the buttock that is worse on sitting [1].

  • Over 45, pain worse when walking and stiffness after moving: may be hip osteoarthritis, according to the NHS [15]; see Osteoarthritis & Joint Pain.
  • Pain at the point of the hip spreading down the outside of the thigh, worse lying on that side: may be trochanteric bursitis, according to the American Academy of Orthopaedic Surgeons [16].
  • Deep buttock pain worse on sitting, sometimes running down the leg: may be piriformis syndrome [1].
  • Back pain with leg pain: may come from the spine; see Lower Back Pain and Sciatica.
  • Self-care for hip pain: the NHS advises not sitting in low chairs, which can put extra pressure on your hips [15].
  • Hip and buttock pain at Cure4Pain: if your hip or buttock pain comes from piriformis syndrome or the buttock muscles, it is treated as described on this page, in Mumbai or online; hip joint arthritis is covered on Osteoarthritis & Joint Pain. The consultation fee is shown when you book.

How does Cure4Pain treat piriformis syndrome without surgery?

At Cure4Pain, piriformis syndrome is treated as a problem of weakened lower back and buttock muscles, with a simple, focused plan after examining those muscles:

  1. Twitch-response dry needling: fine needles into tight knots (trigger points) in the piriformis, buttock and lower back muscles, producing a brief twitch.
  2. Electroacupuncture: fine needles with a gentle electrical current to the same muscle groups.
  3. Basic nutritional support: a bare minimum of nutritional supplementation, correcting what your tests show is low.

Clinic observation: in our clinic, piriformis syndrome most often goes with weakened lower back and buttock muscles, and many people report relief within 6 to 8 weeks of this treatment. This is a clinic observation, not a trial result: people also improve with other simple care, so we cannot say which part made the difference, and further studies are needed.

What published studies show: dry needling reduced pain in a randomised trial [17] and in a review of hip pain trials [18]; we found no trial that has tested electroacupuncture or supplements for piriformis syndrome.

If you take painkillers or other medicines, any change is made under clinical guidance from Team Cure4Pain, in coordination with your existing consulting physician.

Does dry needling or acupuncture help piriformis syndrome? What the research shows

Dry needling may help: in a randomised trial of 32 people with piriformis syndrome in the journal Muscle & Nerve, three sessions of ultrasound-guided dry needling lowered pain by about 2 points on a 10-point scale at 1 week compared with waiting; this was a short-term result in a small trial [17].

  • Review of hip pain trials: a 2024 systematic review of 7 trials (273 people, including piriformis syndrome) found dry needling reduced pain and improved movement and strength compared with sham needling, no treatment, steroid injection or laser, with no serious side effects; strong evidence is still lacking [18].
  • Compared with shockwave therapy: in a 2026 trial of 48 people with piriformis syndrome, dry needling and shockwave therapy, each with stretching, gave similar improvements at 1 and 3 months [19].
  • Acupuncture: in a single 2024 trial of 60 people with piriformis syndrome in China, trigger-point acupuncture worked as well as a steroid injection at 1 month and better at 2 and 3 months [20].
  • Electroacupuncture: we found no human trial of electroacupuncture for piriformis syndrome; it is part of our clinic practice, and further studies are needed.

Which stretches and exercises help piriformis syndrome?

Stretching is the best-studied exercise: in a controlled trial of 45 people with deep gluteal syndrome, all groups improved, and stretching improved disability more than compression exercises [13].

  • Piriformis stretch (often called the figure-4 stretch): lying on your back, cross the ankle of the painful leg over the opposite knee and gently pull that thigh towards your chest until you feel a stretch deep in the buttock.
  • A second trial: in 40 people with piriformis syndrome, a contract-then-stretch method (post-facilitation stretching) reduced pain more than another stretching technique [21].
  • Strengthening: simple buttock exercises such as bridges and side-lying clams improved balance in a small study of people with piriformis syndrome, but not pain after one session [22]; we found no trial that tested strengthening as a treatment.
  • Avoid for now: long periods of sitting and the activities that bring on the pain [2].

How should I sit with piriformis syndrome?

Pain made worse by sitting is one of the defining features of piriformis syndrome [1], so the aim is to sit for shorter periods and take the pressure off the painful buttock.

  • Break up sitting: stand up and move regularly instead of sitting for long periods.
  • Take the wallet out: of your back pocket before sitting [11].
  • Avoid very low chairs: the NHS advises this for hip pain because low chairs put extra pressure on the hips [15].

What can I do at home for piriformis syndrome?

Rest, avoiding the activities that provoke the pain, and physiotherapy-style exercises are the usual first steps, according to a 2020 review in The Bone and Joint Journal [2], and a 2023 systematic review advises that first-line care should follow back pain and sciatica guidance, namely physiotherapy [23].

  • Gentle stretches of the buttock, as above [13].
  • Keep moving: short walks rather than long sitting.
  • Painkillers: take any medicine under clinical guidance from Team Cure4Pain, in coordination with your existing consulting physician.

Which vitamin deficiency causes piriformis syndrome?

No vitamin or mineral deficiency has been shown to cause piriformis syndrome, and the one study we found that gave B vitamins also gave another drug, so their effect could not be separated [24]. In our clinic, nutrition is kept basic: correcting what your tests show is low, as part of overall health.

How long does piriformis syndrome last?

In a 10-year study of 918 people treated with injections and physical therapy (Archives of Physical Medicine and Rehabilitation, 2002), 79% had improved by at least half at an average of about 10 months [25]. We found no study that followed piriformis syndrome without treatment.

  • Sciatica in general: the NHS says sciatica usually gets better in a few weeks to a few months [12].
  • In our clinic: many people report relief within 6 to 8 weeks; this is a clinic observation, and further studies are needed.

When are injections or surgery considered for piriformis syndrome?

A 2022 meta-analysis of 16 studies found that injections into the piriformis with local anaesthetic, steroid or botulinum toxin reduced pain, with a local anaesthetic plus steroid working best, but many studies were small and not randomised [26].

  • Steroid adds little: in a double-blind trial of 47 people, adding a steroid to a local anaesthetic gave no extra benefit [27], so the benefit seen with steroid mixtures may come mainly from the local anaesthetic.
  • Botulinum toxin: a systematic review of 7 studies found only mild side effects but not enough data to measure pain relief [28].
  • Overall: a 2023 systematic review found that no single conservative treatment can be recommended over another, and that surgery may have a place for long-lasting cases [23].
  • Surgery: in a 2025 review of 17 studies (386 people), complications occurred in about 13%, most often lack of relief (about 5%) or recurrence (about 3%), with similar results for open and keyhole surgery [29].

We do not give injections at Cure4Pain. If, after a detailed investigation and consultation, Dr Krushal Pabari and AT. Chintan Dalal find that an injection or surgery is the right next step, we refer you to the right specialist. You stay under our primary care: we continue your treatment, home plan and nutrition care, and we send systematic feedback on your progress to the specialist.

When is buttock, hip or leg pain urgent?

Go to an emergency department or call emergency services if you have sciatica on both sides, weakness or numbness in both legs that is severe or getting worse, numbness around or under your genitals or around your bottom, or new problems controlling your bladder or bowels, according to the NHS [12]. For hip pain, the NHS advises emergency care for severe hip pain after a fall or injury, being unable to walk or put weight on the leg, or tingling or loss of feeling after an injury, and urgent help if the hip is hot and swollen or you have a high temperature [15].

Does Cure4Pain work with my own doctor for piriformis syndrome?

Yes. We share our findings with your existing consulting physician, orthopaedic surgeon, neurologist or physiotherapist, and any change to medicines is made under clinical guidance from Team Cure4Pain, in coordination with your existing consulting physician.

What happens at a piriformis syndrome consultation?

Your first consultation (in Mumbai or online) covers your history, an examination of your lower back, hips and buttocks, a review of any MRI or X-ray and blood tests, and a written plan. Dry needling and electroacupuncture are given in the clinic in Mumbai; assessment review, basic nutrition and home exercises can be done online. We plan in blocks of a few weeks with regular reviews. Individual results vary.

Evidence: key studies

StudyWhat it found
Hopayian and Danielyan, Eur J Orthop Surg Traumatol 2018 [1]Four defining features; the piriformis can cause sciatica; no gold-standard test.
Tabatabaiee et al., Muscle Nerve 2019 [17]Dry needling lowered pain about 2 points at 1 week vs waiting.
Fishman et al., Arch Phys Med Rehabil 2002 [25]918 people treated with injections and physical therapy: 79% improved by at least half at about 10 months.
Hilal et al., Pain Physician 2022 [26]Injections reduced pain; many studies small and non-randomised.
Hopayian et al., J Bodyw Mov Ther 2023 [23]No single conservative treatment better than another; physiotherapy first.
Garden et al., J Am Acad Orthop Surg 2025 [29]Surgery complications about 13%, mostly lack of relief or recurrence.

Piriformis syndrome FAQs

Is piriformis syndrome the same as sciatica?

No. Sciatica is pain along the sciatic nerve, most often from a slipped disc or narrowing in the spine, according to the NHS [12]. Piriformis syndrome is one non-spinal cause of sciatica, in which a muscle deep in the buttock irritates the nerve; it is defined by buttock pain, pain on sitting, deep buttock tenderness and pain when the muscle is tensed [1].

How do I know if it is piriformis syndrome or a slipped disc?

Piriformis syndrome starts in the buttock and is worse on sitting [1], while sciatica from the spine is most often caused by a slipped disc, according to the NHS [12]. An MRI can show a disc problem, but a normal scan does not rule out piriformis syndrome, so an examination is needed [3].

Why does piriformis syndrome hurt more when I sit?

Pain made worse by sitting is one of the four defining features of piriformis syndrome in a 2018 systematic review [1], together with buttock pain, deep buttock tenderness and pain when the piriformis muscle is tensed. Shorter sitting, breaks to walk and taking the wallet out of the back pocket can help [11].

Can weak glutes cause piriformis syndrome?

In a 2023 study, a thicker piriformis went with a weaker gluteus maximus in people with low back pain and piriformis syndrome [7]; this shows a link, not cause, and further studies are needed. In our clinic, piriformis syndrome most often goes with weakened lower back and buttock muscles; this is a clinic observation.

How long does piriformis syndrome take to heal?

In a 10-year study of 918 people treated with injections and physical therapy, 79% had improved by at least half at an average of about 10 months [25]; we found no study of piriformis syndrome without treatment. In our clinic, many people report relief within 6 to 8 weeks; this is a clinic observation, and further studies are needed.

Can piriformis syndrome cause hip, groin, knee or foot pain, or numbness?

Piriformis syndrome mainly causes deep buttock pain that can spread down the back of the thigh and leg [2]. Pain mostly in the groin, or spreading to the knee, more often points to the hip joint, according to the American Academy of Orthopaedic Surgeons [14], and numbness or weakness in both legs, or around the genitals or bottom, needs emergency care [12].

Is my hip pain from piriformis syndrome or the hip joint?

Hip joint arthritis usually hurts in the groin or thigh, according to the American Academy of Orthopaedic Surgeons [14], while piriformis syndrome hurts deep in the buttock and is worse on sitting [1]. Pain at the point of the hip that spreads down the outer thigh may be bursitis [16].

Can piriformis syndrome affect both sides?

Pain in both buttocks and legs should not be assumed to be piriformis syndrome: sciatica on both sides is an emergency warning sign, according to the NHS, and needs urgent medical care [12].

What exercises help piriformis syndrome, and which should I avoid?

Stretching is the best-studied exercise for piriformis syndrome: in a controlled trial of 45 people, stretching improved disability more than compression exercises [13]. Avoid long periods of sitting and the activities that bring on the pain [2].

Does dry needling help piriformis syndrome?

Dry needling may help piriformis syndrome: in a randomised trial of 32 people in Muscle & Nerve, three sessions lowered pain by about 2 points on a 10-point scale at 1 week compared with waiting, a short-term result [17]. The evidence is still limited, and longer studies are needed [18].

Does acupuncture help piriformis syndrome?

Trigger-point acupuncture may help piriformis syndrome: in a single 2024 trial of 60 people, it worked as well as a steroid injection at 1 month and better at 2 and 3 months [20]. The evidence is still limited, and further studies are needed.

Do I need an injection for piriformis syndrome?

Not always. A 2022 meta-analysis found piriformis injections reduced pain, but many studies were small and not randomised [26], and adding a steroid to a local anaesthetic gave no extra benefit in a double-blind trial [27]. We do not give injections; if one is right for you, we refer you and continue your care.

Is piriformis syndrome serious?

Piriformis syndrome can be painful and long-lasting, but in a 10-year study of 918 people treated with injections and physical therapy, 79% had improved by at least half [25], and a 2026 systematic review in Advances in Orthopedics notes that most patients improve with non-surgical treatment [30]. Sciatica on both sides, numbness around the genitals or bottom, or problems controlling your bladder or bowels need emergency care, according to the NHS [12].

How much does piriformis syndrome treatment cost at Cure4Pain?

The consultation fee for piriformis syndrome at Cure4Pain, in Mumbai or online, is shown when you book. We do not give injections, so any injection cost is set by the specialist we refer you to.

Can I consult online for piriformis syndrome?

Yes, for assessment, a review of your scans and tests, basic nutrition and home exercises. Dry needling and electroacupuncture need an in-person visit in Mumbai.

Who treats you

  • Dr Krushal PabariMD, PGCP - Rheumatic & Musculoskeletal Diseases. Assistant Professor, Cooper Hospital; Guest Professor, CMP Homoeopathic Medical College.
  • AT. Chintan Dalal, N.D.BNYS, R.AP. Functional nutrition and Coimbra Protocol practitioner.

Consultations look at the whole person: alongside the medical and nutritional plan, we bring a strong interest in behavioural science to counselling on stress, sleep and lasting lifestyle change.

How consultations work: Mumbai or online worldwide

Book through our patient portal. You can see us in person at our clinic in Malad West, Mumbai, or online from anywhere. Your first consultation reviews your history and tests; we then agree a plan together and set the monitoring schedule.

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Related conditions and articles

This page is for education and does not replace medical advice. Do not start, stop or change any medicine or supplement without medical guidance.

References

1. Hopayian K, Danielyan A. Four symptoms define the piriformis syndrome: an updated systematic review of its clinical features. Eur J Orthop Surg Traumatol 2018;28(2):155-164. doi:10.1007/s00590-017-2031-8

2. Park JW, et al. Deep gluteal syndrome as a cause of posterior hip pain and sciatica-like pain. Bone Joint J 2020;102-B(5):556-567. doi:10.1302/0301-620X.102B5.BJJ-2019-1212.R1

3. Hopayian K, Heathcote J. Deep gluteal syndrome: an overlooked cause of sciatica. Br J Gen Pract 2019;69(687):485-486. doi:10.3399/bjgp19X705653

4. Kean Chen C, Nizar AJ. Prevalence of piriformis syndrome in chronic low back pain patients. A clinical diagnosis with modified FAIR test. Pain Pract 2013;13(4):276-81. doi:10.1111/j.1533-2500.2012.00585.x

5. Yürük D, et al. Prevalence of priformis syndrome in sciatica patients: Predictability of specific tests and radiological findings for diagnosis. Br J Pain 2024;18(5):418-424. doi:10.1177/20494637241254349

6. Poutoglidou F, et al. Sciatic Nerve Variants and the Piriformis Muscle: A Systematic Review and Meta-Analysis. Cureus 2020;12(11):e11531. doi:10.7759/cureus.11531

7. Othman IK, et al. Association of Piriformis Thickness, Hip Muscle Strength, and Low Back Pain Patients with and without Piriformis Syndrome in Malaysia. Life (Basel) 2023;13(5). doi:10.3390/life13051208

8. Hopayian K, et al. The clinical features of the piriformis syndrome: a systematic review. Eur Spine J 2010;19(12):2095-109. doi:10.1007/s00586-010-1504-9

9. Jardak M, et al. Does piriformis muscle syndrome impair postural balance? A case control study. Somatosens Mot Res 2021;38(4):315-321. doi:10.1080/08990220.2021.1973404

10. Batool N, et al. Prevalence of piriformis syndrome and its associated risk factors among university students in Pakistan: a cross-sectional study. BMJ Open 2025;15(1):e092383. doi:10.1136/bmjopen-2024-092383

11. Johnson A, Kenchaiah R. Fat Wallet Syndrome: A Rare Piriformis Syndrome Mimic Evaluated with Magnetic Resonance Imaging. Ann Indian Acad Neurol 2026. doi:10.4103/aian.aian_545_26

12. NHS. Sciatica. nhs.uk/conditions/sciatica

13. Shamsi M, et al. A controlled clinical trial investigating the effects of stretching and compression exercises on electromyography of calf muscles in chronic LBP patients with a deep gluteal syndrome. BMC Sports Sci Med Rehabil 2024;16(1):12. doi:10.1186/s13102-023-00802-4

14. American Academy of Orthopaedic Surgeons (OrthoInfo). Osteoarthritis of the hip. orthoinfo.org/diseases–conditions/osteoarthritis-of-the-hip

15. NHS. Hip pain in adults. nhs.uk/symptoms/hip-pain

16. American Academy of Orthopaedic Surgeons (OrthoInfo). Hip bursitis. orthoinfo.org/diseases–conditions/hip-bursitis

17. Tabatabaiee A, et al. Ultrasound-guided dry needling decreases pain in patients with piriformis syndrome. Muscle Nerve 2019;60(5):558-565. doi:10.1002/mus.26671

18. Forogh B, et al. Efficacy of trigger point dry needling on pain and function of the hip joint: a systematic review of randomized clinical trials. Acupunct Med 2024;42(2):63-75. doi:10.1177/09645284231207870

19. Dede BT, et al. Extracorporeal shock wave therapy versus dry needling for piriformis syndrome: A randomized clinical trial. Turk J Phys Med Rehabil 2026;72(1):39-47. doi:10.5606/tftrd.2026.16718

20. Liu LX, et al. [Clinical study of piriformis syndrome treated with trigger-point acupuncture]. Zhen Ci Yan Jiu 2024;49(9):957-963. doi:10.13702/j.1000-0607.20230336

21. Shahzad M, et al. Effects of ELDOA and post-facilitation stretching technique on pain and functional performance in patients with piriformis syndrome: A randomized controlled trial. J Back Musculoskelet Rehabil 2020;33(6):983-988. doi:10.3233/BMR-181290

22. Chaari F, et al. Immediate effect of hip exercises-inducing motor unit recruitment on static and dynamic postural balance in patients with piriformis muscle syndrome. J Bodyw Mov Ther 2024;40:1738-1743. doi:10.1016/j.jbmt.2024.10.027

23. Hopayian K, et al. A systematic review of conservative and surgical treatments for deep gluteal syndrome. J Bodyw Mov Ther 2023;36:244-250. doi:10.1016/j.jbmt.2022.12.003

24. Huang ZF, et al. Effect of Mannitol plus Vitamins B in the management of patients with piriformis syndrome. J Back Musculoskelet Rehabil 2019;32(2):329-337. doi:10.3233/BMR-170983

25. Fishman LM, et al. Piriformis syndrome: diagnosis, treatment, and outcome–a 10-year study. Arch Phys Med Rehabil 2002;83(3):295-301. doi:10.1053/apmr.2002.30622

26. Hilal FM, et al. Efficacy of Botulinum Toxin, Local Anesthetics, and Corticosteroids in Patients With Piriformis Syndrome: A Systematic Review and Meta-analysis. Pain Physician 2022;25(5):325-337. pubmed.ncbi.nlm.nih.gov/35901473

27. Misirlioglu TO, et al. Piriformis syndrome: comparison of the effectiveness of local anesthetic and corticosteroid injections: a double-blinded, randomized controlled study. Pain Physician 2015;18(2):163-71. pubmed.ncbi.nlm.nih.gov/25794202

28. Koh MM, Tan YL. Use of botulinum neurotoxin in the treatment of piriformis syndrome: A systematic review. J Clin Orthop Trauma 2022;31:101951. doi:10.1016/j.jcot.2022.101951

29. Garden AR, et al. Evaluation of the Complications and Outcomes of Endoscopic and Open Surgical Treatment of Piriformis Syndrome: A Systematic Review. J Am Acad Orthop Surg 2025;33(15):e878-e887. doi:10.5435/JAAOS-D-24-01223

30. Warman FI, et al. Endoscopic vs Open Surgeries for Piriformis Syndrome: A Systematic Review and Meta-Analysis. Adv Orthop 2026;2026:5126019. doi:10.1155/aort/5126019

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