Pain in the A** That Travels Down the Leg: Let’s Talk About It

By: Kelsie Mazur, DPT

If you've ever had pain running down your leg or deep in your butt, chances are someone told you, "that's sciatica." While they might be right, there's another common culprit that often flies under the radar: Piriformis Syndrome. The two can feel very similar but come from completely different sources and require very different treatments. I’m breaking this down for the masses because I see patients almost weekly that have been told they have sciatica, and it is more complicated than that!

Let’s break it down… 

Sciatica: A Nerve Problem Starting in the Back

Sciatica happens when something irritates or pinches the sciatic nerve near your spine, usually from a bulging disc, arthritis, or narrowing in the lower back. This causes sharp, electric-like pain that travels from your low back, through your butt, and often all the way down your leg. You might also feel tingling, numbness, or weakness in the leg or foot. Movements like bending, sitting, or lifting can make it worse.

Piriformis Syndrome: A Muscle Causing Nerve Trouble

Now let’s talk about piriformis syndrome. This isn’t a back problem, it starts in a small muscle deep in your butt called the piriformis. This muscle sits right over the sciatic nerve, and in some people, the nerve actually runs through the muscle. If the piriformis becomes irritated, it can press on the nerve and mimic the symptoms of sciatica minus the back pain.

Here’s the key: piriformis syndrome isn’t just caused by a “tight” muscle. It can also be caused by a weak or overstretched one. And this completely changes how we treat it.

Tight vs. Overstretched Piriformis — Why It Matters

Most people (and unfortunately, even some providers) assume piriformis syndrome is always caused by a muscle that’s too tight or in spasm. In those cases, treatments like stretching, massage, and foam rolling can help relieve the pressure on the nerve.

But here’s the catch: in some people, the piriformis is already overstretched and overworked, often because the surrounding muscles (like the glutes) aren’t doing their job. In that case, more stretching can actually make the problem worse. What the muscle really needs is stability, support, and strength.

A good physical therapist will know how to tell the difference. They'll assess your posture, movement patterns, and muscle strength to figure out whether your piriformis is locking down because it’s tight, or because it’s overcompensating for weak hips or poor movement mechanics.

So Which One Do You Have?

Here’s a quick summary:

  • Sciatica usually starts in the lower back and sends pain all the way down the leg, often with numbness or weakness.

  • Piriformis syndrome usually starts in the butt and might send pain partway down the leg, but rarely involves the foot or causes true weakness.

  • Tight piriformis? You’ll likely benefit from stretching, mobility work, and soft tissue release.

  • Overstretched piriformis? You need glute strengthening, movement retraining, and probably less stretching.

Why a Smart DPT Makes All the Difference

Because these issues feel so similar, it’s really easy to get misdiagnosed or to self-diagnose, both resulting in treating the wrong thing. That’s where a smart, well-trained Doctor of Physical Therapy (DPT) comes in.

A good DPT doesn’t just hand you generic stretches or exercises. They look at the big picture: your posture, movement habits, muscle balance, and daily routine. They ask the right questions, run the right tests, and most importantly, they listen to your story. That’s how they figure out whether your pain is coming from your spine, your piriformis, or somewhere else entirely, and create a plan that actually works.

If you’ve been dealing with stubborn butt or leg pain and just can’t seem to shake it, don’t play the guessing game. A skilled DPT can help you finally get clear answers, and start feeling like yourself again.




Let’s chat. Book an assessment and let’s get you back to feeling good in your body.
No referrals, no waiting, just answers. Did you know that we offer free 1-on-1 injury screens? Wattage Physical Therapy will take an in depth look at your ergonomics, posture, muscle tone, muscle weaknesses, and movement patterns to create a plan for YOU. If this article intrigues you, you can directly email me, Kelsie at Kelsie@wattagept.com. I would be happy to help you start the process of living a life free from pain. 

Wattage Team