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Published on 10/01/2025
That searing, shooting pain down your leg can be debilitating. It’s the kind of pain that makes you wince with every step, every shift in position. For many, the immediate assumption is sciatica. However, what if the true culprit, or at least a significant contributing factor, lies elsewhere? What if muscle knots in your hips and buttocks are playing a bigger role in your pain than you think?
Sciatica refers to pain that radiates along the path of the sciatic nerve, which is the longest nerve in your body. This nerve originates in your lower back, runs through your buttocks, and extends down the back of each leg to your toes.
True sciatica typically occurs when this nerve becomes compressed or irritated, often due to issues like a herniated disc, narrowing of the spinal canal, or bone spurs in the lumbar spine. The resulting pain can range from a mild ache to a sharp, burning sensation or even electric shock-like pain. It’s often accompanied by numbness, tingling, or weakness in the affected leg and foot.
This is where muscle knots come into play. Imagine your muscles as being made up of thousands of tiny fibers. When these fibers become tight, irritated, or overstressed, they can develop into hyperirritable spots known as trigger points, or muscle knots. These knots can be locally tender, but more importantly, they can also cause “referred pain” – pain that is felt in a different part of the body.
Several muscles in the hip and gluteal region are notorious for developing muscle knots that can send pain radiating down the leg, mimicking sciatica. Two key players here are the piriformis muscle and the other gluteal muscles (gluteus maximus, medius, and minimus).
The illustrations below show the location of the muscle knot (black dot) and the area of pain (red). Sometimes the pain is in a different area than the muscle knot; this is called referred pain. For a head-to-toe guide on muscle knots and referred pain patterns, check out our Happy Muscles- Self-Help Guide to Un-Knot Your Pain.
The piriformis is a small, deep muscle located in the buttocks, behind the gluteus maximus. Interestingly, the sciatic nerve passes directly underneath, or in some cases, through the piriformis muscle. When a piriformis muscle knot develops, the muscle can become tight and compress the sciatic nerve, leading to a condition often referred to as piriformis syndrome.
The symptoms of piriformis syndrome are similar to those of true sciatica: pain in the buttock that radiates down the back of the thigh, sometimes extending into the calf and foot. You might also experience tenderness in the buttock area and pain that worsens with prolonged sitting, hip rotation, or walking uphill. This is why understanding the difference between true sciatica and piriformis syndrome is crucial for effective treatment.
While the piriformis often gets the spotlight, trigger points in the other gluteal muscles can also contribute to radiating leg pain. Trigger points in the gluteus medius, for example, can cause pain along the side of the buttock and down the outer thigh, sometimes even reaching the ankle. Knots in the gluteus maximus can lead to pain in the buttocks and down the back of the thigh.
These gluteal muscle knots that are causing leg pain might not directly compress the sciatic nerve in the same way the piriformis can. However, the referred pain patterns can still feel similar to sciatica, leading to confusion in diagnosis and treatment.
Differentiating between sciatica and pain from piriformis muscle knots or other gluteal muscle knots can be tricky, even for healthcare professionals. Muscle knots, or myofascial trigger points, can mimic or aggravate sciatica by irritating nearby nerves or referring pain along the sciatic pathway. While true sciatica often originates from spinal issues, such as disc herniation, muscular sources of pain should also be considered in the differential diagnosis (Fairag et al., 2022).
Keep in mind these guidelines are general, and a thorough evaluation by a healthcare professional, including a detailed medical history and physical examination, is necessary for an accurate diagnosis. Imaging tests like MRI might be necessary to rule out spinal issues as the primary cause of your pain.
If your leg nerve pain is linked to muscle knots—particularly in the piriformis or other gluteal muscles—targeting these areas can be an effective way to relieve sciatica. Here are some strategies to consider:
Radiating leg pain is often assumed to be sciatica, but muscle knots in the hips and buttocks can produce similar symptoms. These knots can mimic nerve pain by referring discomfort down the leg.
Muscle Knots Can Refer Pain
Trigger points in the piriformis and gluteal muscles can cause pain in areas far from the actual knot. This referred pain often follows the sciatic nerve path.
Piriformis Syndrome Mimics Sciatica
When the piriformis muscle compresses the sciatic nerve, it can cause pain that radiates from the buttock down the leg. This condition, known as piriformis syndrome, shares many symptoms.
Clues to Differentiate the Pain Sources
Muscle-related pain often starts in the buttock or hip and worsens with sitting or hip rotation, while true sciatica may begin in the lower back.
Self-Treatment Can Be Effective
Foam rolling, massage tools, and stretching can help release muscle knots and relieve sciatic-like pain. Improving posture and movement habits also plays a key role in long-term relief.
If you’re struggling with persistent radiating leg pain that feels like sciatica but hasn’t responded well to traditional sciatica treatments, it’s time to consider the possibility of muscle knots. Piriformis muscle knots and other gluteal muscle knots are often overlooked culprits that can significantly contribute to this type of discomfort.
By understanding the potential role of these muscular issues and exploring targeted therapies, you can take a more proactive approach to finding lasting relief.
Faussett, S. & Zuleger, J.A. (2017). Happy Muscles. Self-Help Guide to Un-Knot Your Pain. ISBN: 978-0-692-30150-0.
Fairag, M., Kurdi, R., Alkathiry, A., Alghamdi, N., Alshehri, R., Alturkistany, F. O., Almutairi, A., Mansory, M., Alhamed, M., Alzahrani, A., & Alhazmi, A. (2022). Risk Factors, Prevention, and Primary and Secondary Management of Sciatica: An Updated Overview. Cureus, 14(11), e31405. https://doi.org/10.7759/cureus.31405
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Disclaimer: This information is for general knowledge and informational purposes only and does not constitute medical advice. Consult a healthcare professional before starting any new exercise program.
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Dr. Julie Zuleger has over 20 years of experience as a Licensed Massage Therapist, Certified Strength and Conditioning Specialist (CSCS), Corrective Exercise Specialist, CYT-500 Yoga Instructor, and Human Movement Specialist. Julie promotes self-care using massage tools and stretching-based programs and teaches continuing education courses for yoga teachers, massage therapists, athletic trainers, strength and conditioning, fitness, and wellness professionals. Julie holds a PhD in Education and is the Director of Kinesiology and Education at Tiger Tail USA.
