Piriformis Trigger Point: 5 Mistakes Your Clinic Must Avoid

The treatment of the piriformis trigger point is a high-value therapeutic intervention for clinics and professionals seeking to optimize outcomes in patients with gluteal or non-radicular sciatic pain.

Designed for clinics looking for a results-driven and up-to-date approach, this guide not only provides effective techniques for treating the piriformis muscle, but also analyzes the main mistakes commonly made in consultations, helping you improve outcomes and position your service as a benchmark in advanced physiotherapy.

What is the Piriformis Trigger Point and How Is It Identified?

The piriformis trigger point is a common myofascial dysfunction in patients with deep gluteal pain or pain radiating down the leg. This hypersensitive spot is located in the piriformis muscle, situated in the posterior pelvic region, and can trigger symptoms similar to piriformis syndrome or even false sciatica.

In clinical settings, identifying it is key to treating pathologies that may impair mobility, cause pain when sitting or walking, and even compress the sciatic nerve.

The piriformis trigger point is a hyperactive area within the muscle that is often the direct cause of piriformis contracture. This contracture causes deep pain and can mimic false sciatica.

To identify it, the physiotherapist must perform deep palpation between the sacrum and the greater trochanter of the femur, where pressure on the trigger point reproduces referred pain and may provoke a local spasm. In addition, tests such as the FAIR test (Flexion, Adduction, and Internal Rotation of the hip) can help confirm the involvement of the piriformis muscle in the pain condition.

Benefits of Properly Treating the Piriformis Trigger Point in Your Practice

Applying effective techniques to this point can significantly change a patient’s progress. Some clinical benefits include:

  • Immediate relief of radiating gluteal pain
  • Improved pelvic and lumbar mobility
  • Reduced pressure on the sciatic nerve
  • Prevention of relapses in athletes and chronic patients
  • Increased effectiveness of functional rehabilitation programs

How to Recognize a Piriformis Contracture in a Patient

As we mentioned earlier, the trigger point in the piriformis muscle is often the direct cause of deep pain or an indirect one when the pain radiates in the form of sciatica (as it compresses the sciatic nerve, which causes this radiation). Identifying this contracture during consultation requires a combination of a detailed patient history, clinical palpation, and specific orthopedic tests. 

The patient typically presents with pain in the gluteal region, which may radiate down the back of the thigh, mimicking sciatica, although without associated neurological signs (such as loss of strength or reflexes). They often report worsening pain when sitting for prolonged periods, climbing stairs, or crossing their legs.

During physical examination, tension and pain may be detected on deep palpation between the sacrum and the greater trochanter, where the piriformis is located. Pressure on the trigger point may reproduce radiating pain. Moreover, the FAIR test (flexion, adduction, and internal rotation of the hip in side-lying position) usually tests positive, causing gluteal pain due to compression of the muscle over the sciatic nerve.

The contracture may also limit internal hip rotation and cause discomfort during movements that stretch the muscle. Accurate diagnosis relies on ruling out other causes of sciatica and confirming myofascial involvement through detailed examination.

5 Effective Techniques to Treat the Piriformis Trigger Point

Professionally, treating the piriformis trigger point should be done with precise tools and advanced techniques. The most recommended are:

1- Ultrasound-Guided Dry Needling

Ultrasound-guided dry needling allows for accurate localization of the trigger point within the piriformis muscle and its deactivation through direct mechanical stimulation. The use of ultrasound ensures anatomical precision, minimizes risks, and optimizes results in patients with persistent or recurrent pain.

  • Highly effective invasive technique
  • Allows for maximum precision in deactivating the trigger point
  • Especially useful in chronic or resistant cases

2- Piriformis Electroacupuncture

This technique combines the benefits of acupuncture with transcutaneous electrical stimulation, achieving a deep relaxing effect on the piriformis muscle. It is especially indicated in cases of severe contracture or when more intense modulation of neuropathic pain is needed.

  • Involves inserting needles into the muscle and applying low-frequency electrical current
  • Helps release deep tension and modulate pain

3- Percutaneous Neuromodulation

This method allows direct influence over nerve conduction and motor control through finely dosed electrical impulses. It is ideal for treating sciatic nerve sensitization caused by the piriformis and improving the neuromuscular activation pattern.

  • Electrical stimulation of the sciatic nerve or sacral plexus using needles
  • Advanced technique ideal for clinics integrating cutting-edge technology

4- Deep Manual Therapy

Well-applied manual therapy on the piriformis muscle helps release myofascial restrictions, reduce muscle tension, and improve local vascularization. It is often a first choice in conservative approaches and an excellent complement to invasive interventions.

  • Ischemic compressions, myofascial release techniques, or deep transverse massage
  • Can be combined with invasive treatment for longer-lasting results

5- Guided Piriformis Stretching

Active and progressive stretching of the piriformis helps maintain muscle functionality after trigger point deactivation. It also prevents new contractures and improves hip mobility, making it an essential phase in the functional recovery plan.

  • Essential complementary intervention to improve muscle elasticity
  • A key part of postural re-education protocols

Recommended Materials for Clinics

To successfully implement piriformis trigger point treatment, a clinic should have:

  • Dry needling needles (various gauges and certified brands) – Essential for precisely and effectively deactivating the piriformis trigger point in deep contractures.
  • Electroacupuncture or neuromodulation device (compatible with needle electrodes) – Ideal for treating complex piriformis contractures through electrical stimulation of the muscle and sciatic nerve.
  • Portable or desktop ultrasound device (for guided localization) – Crucial for accurately locating the piriformis trigger point and safely guiding interventions in a deep anatomical area.
  • Adjustable treatment tables with lateral access for gluteal approach – Enables comfortable and safe access to the piriformis muscle during manual and invasive treatments.
  • Ultrasound gel or contact lubricant – Enhances ultrasound image quality, making it easier to identify the piriformis muscle and its trigger point.
  • Gloves, antiseptic, and sharps disposal containers – Ensure a sterile and safe environment when performing invasive techniques in the gluteal region.
  • Anatomical posters of the piriformis muscle (for patient education) – An educational tool to help patients understand what the piriformis trigger point is and how it causes contracture.


5 Common Mistakes in Treating the Piriformis Muscle in Clinics

Treating the piriformis muscle may seem simple, but in clinical practice it’s easy to make mistakes that compromise diagnosis or treatment effectiveness. Here are some of the most common errors:

1. Confusing the Piriformis Trigger Point with True Sciatica

It’s common to attribute gluteal and leg radiating pain to a herniated disc without first ruling out piriformis contracture or piriformis syndrome. This delays appropriate treatment.

2.Incorrectly Identifying the Trigger Point

The piriformis is a small, deep muscle. Approaching it without solid anatomical knowledge or without ultrasound guidance may lead to ineffective or even risky needling.

3. Applying Only Superficial Treatment

Massage or passive stretching may bring temporary relief but do not deactivate the trigger point. It’s necessary to combine invasive or deep techniques to address the dysfunction at its root.

4. Ignoring the Relationship with the Sciatic Nerve

In many cases, the piriformis compresses the sciatic nerve. Ignoring this interaction can result in no improvement or even worsening of symptoms with certain techniques.

5. Treating the Muscle Without Reeducating Movement

Once the contracture is resolved, failing to correct the muscle activation pattern or not working on pelvic mobility can lead to relapses.

Final thoughts from Agupunt

The piriformis trigger point is a frequent but often underdiagnosed cause of gluteal pain and false sciatica. Proper treatment can make a significant difference in the patient’s functional recovery and in the quality of services your clinic offers.

Having the right material is essential, but equally important is avoiding common mistakes such as misdiagnosing the condition, applying insufficient or incorrect treatments, or failing to consider the relationship with the sciatic nerve.

Mastering piriformis trigger point treatment enables a resolutive, safe, and distinctive approach to piriformis contractures, positioning your clinic as a leader in advanced physiotherapy and supporting long-term patient loyalty.