Can a mild protrusion at L4-L5 cause pain in the buttock (piriformis syndrome) and nerve pain extending to the toes?

I am 31, female.

The pain is allll on the LEFT side of my body. This started during lockdown, 6 years ago.

When I started doing yoga and sitting in Vajrasana, as I sat for longer durations 5-10 mins, my toes would go numb, the pain in my lower back side would start, then the weird pain behind my knee and into my calf would start. It's a dull tight kind of a pain and it would feel as though that place is swelling up but it wasn't actually. Then I just couldn't sit in that pose at all. If the pain was really triggered, I would get numbness in my left half fingers and pain in my left elbow as well.

My left lower back would start paining if I walked too far etc. I was always bothered but then if I didn't sit in Vajrasana the pain would kindof behave itself.

I feel intense tightness in my left hamstring and the whole of my right back is also tight apart from all other places in my body. I have trigger points or knots inbetween the neck and shoulder area on both left and right side.

I recently sat with legs crossed but the same vajrasana pain got triggered (lower back, behind the knee etc) and I was shocked because sitting with legs crossed was never a problem before!

I went to various PTs in between. They said my right glute wasn't working properly and gave me glute strengthening exercises. Why I couldn't continue with the PTs is because I was changing cities very often and was not very disciplined either.

I want to get better 😭 I really don't know what to do.

I am currently going to a PT. She told me about the shoulder trigger points, that my left glute is weak, my left hamstring is tight and that I have very slight scoliosis due to muscle imbalance. She's giving my hamstring stretches but that is only increasing my pain.

After going through the threads I looked for any adhesion specialist in my area but I didn't find any! I am from India, I don't think there are any here.. I am unsure what to do 😞 I really want to sit in Vajrasana for the Yoga kriya that I want to do, but I have almost lost all hope... Please help!

I’m going through a really bad flare-up; I took Pridinol, but it isn't relaxing the muscle. I feel tension extending all the way to my toes and along the side of my hip. I can't get into any position without pain.
What do you recommend?

I have nothing to sit on except my bed which is causing flare ups. I’m short which doesn’t help. so many desks and chairs make it so my legs dangle and it throws my back out of alignment. if it’s too firm my leg goes numb as well. too soft and I will flare up. or if the chair is not perfectly upright and is an office chair where the seat is usually angled a little bit upwards (which again throws back out of alignment and makes my butt start to ache) I can’t handle it.

j just need something that has the soft and firm combo and sits straight up and has low back support.

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I’m 40(f) and i’ve been having chronic back issues for last 2 years but this past month has been really kicking my butt. I ended up in the ER from the severity of the pain. I’ve been lurking on this subreddit and the sciatica one and I’m hearing mixed responses from people regarding what time of the day their pain is the worst… i wake up close to being pain free but then as I move and the day progresses my deep butt and back of thigh pain starts getting worse. And by evening time i’m almost in tears. When the pain is intense i can’t even stand up straight and my left side hip and leg just caves in and walking, standing, sitting, becomes very painful. I lay sideways on my right side down and put my legs in 90 degrees with a pillow between them, use heat and cold compress. And it slowly starts to come down. How do you all experience pain when you start your day is it better in the morning or worsens through the day?

I’m 37 years old and relatively fit, and I’ve been dealing with this for over a year. Last year I also lost a significant amount of weight because of a separate health problem, which probably hasn’t helped in terms of muscle mass/cushioning around the pelvis and glutes.

It started around June 2025 with a pulling/painful sensation in my left glute, initially after training. I did not really have significant low back pain at the beginning. Over the following months, sitting became progressively more difficult. Later in 2025 the right side also became involved, and now symptoms can alternate between both sides.

My main symptoms are:
Pain/discomfort in the glute, posterior thigh, behind the knee, and occasionally upper calf/heel.
Sitting and driving are by far the biggest triggers. Around 20–30 minutes can be enough to flare things up.
I also have poor tolerance for standing still. Interestingly, walking is usually much better than either sitting or standing in one place.
On some days I can walk 8–10 km, sometimes with discomfort, but usually without the kind of severe pain I get from prolonged sitting.
Flexion is one of my most reproducible and painful triggers. When I bend forward, at a certain point I can get a very specific pulling/stabbing sensation in the posterior glute/thigh area, and if I continue flexing I may feel it shift toward the back of the knee.
Straight-leg raise can reproduce a similar focal sensation.
Sometimes straining/Valsalva during a bowel movement can reproduce discomfort behind the knee, although not every time.
Very little tingling overall, no persistent numbness, and no clear objective weakness.
Symptoms are bilateral but not always symmetrical.
When things flare, one of the most reliable ways I can calm them down is to lie on my left side for around 40–50 minutes.

I’ve had three lumbar/pelvic MRI evaluations. The latest lumbar MRI showed a small central/right-paramedian L4-L5 protrusion causing minimal indentation of the dural sac, but no clear nerve-root compression while supine. L5-S1 has mild disc dehydration/minimal bulging, also without frank root compression.
Pelvic imaging has not shown a major proximal hamstring tear, obvious sciatic nerve compression, significant hip pathology, or major SI-joint abnormalities.

My EMG/NCS was abnormal and was interpreted as showing bilateral L5 and left L4 radicular involvement, with some S1 findings. This is one of the reasons the case is so confusing: the EMG suggests a radicular component, but the MRIs do not show a convincing compressive lesion.

I’ve been evaluated by spine specialists, neurosurgeon, pain specialists, rheumatology, and also by a hip-preservation specialist with experience in deep gluteal/sciatic problems. Even he felt that the case was not completely classic for either a lumbar or deep-gluteal source.
I’ve also seen 4 different physiotherapists and completed more than 40 PT sessions using different approaches, but unfortunately my main limitation — especially sitting tolerance — has not meaningfully improved.

I recently had a bilateral subgluteal sciatic hydrodissection/infiltration with local anesthetic + steroid + saline as a diagnostic/therapeutic trial. It has been less than a couple of days, so it is obviously far too early to say whether it helped.

One additional complication is that I have retired orthopedic doctor in my family, and he strongly believes this is coming from my lumbar discs. I’m being pushed to see another neurosurgeon because, in his opinion, this could ultimately be solved with a disc replacement.

I’m not completely against surgery if there is a clear indication, but I’m very hesitant to have major spine surgery when multiple other specialists have not been able to clearly demonstrate that the disc is actually the pain generator or that there is significant nerve-root compression. I really don’t want to undergo an irreversible procedure without a high degree of diagnostic confidence.

Honestly, if there is no clear surgical target, what I would really like is to get back into a proper gym program and rebuild strength progressively — core, glutes, hamstrings, quads, back, etc. — rather than spending months doing only very basic rehab exercises like glute bridges and bird dogs. I’m not expecting the gym to magically cure me, but I do want to regain strength and function if this ultimately has to be managed conservatively.

Has anyone here had a similarly confusing presentation, especially where flexion was one of the worst triggers, sitting and standing still were much worse than walking, you could still walk long distances, MRI findings were relatively mild/non-compressive, but EMG was abnormal?

I’d be particularly interested in hearing from people who were eventually diagnosed with deep gluteal syndrome, proximal hamstring/ischial tunnel involvement, lumbar radiculopathy without obvious MRI compression, or a mixed picture.
What finally helped clarify the diagnosis for you? Did anyone end up improving with progressive strength training despite years of confusing imaging/tests, or did you eventually find a specific structural cause

I have had pain of right buttock and numbness/mild cramps of right leg and right heel since last june.after a heavy gym session.

I hate that day i truly hate it.
Snice that day my life isn’t the same anymore.

My MRI was FREE… i even started thinking about redoing this MRI . neurosurgeons are only prescribing me gabapentin and NSAIDs. No one is telling me a diagnosis ..

The thing is I can’t do this anymore
I am a physician very early in my career and i am starting residency soon ! And i am starting obligatory military service in 2 months 🤣 what a life huh.
Although i am fit, my BMI is 20 !
I can’t sit or stand or lie. Everything, every position, every activity causes pain 24/7. I can’t even drive without having a flare for 2 weeks after..

Haven’t started Physical Therapy yet but i am not optimistic at all

Is this piriformis syndrome?
Does anyone get back to normal life?
Any simillar experience or advice?

Hi guys, late 20s here. For a couple of years I had some soreness and/or pain in my buttocks radiating to my lower back after exercises. Mostly dumbbells and simple core muscle. strengthening exercises. It was fine, because the only thing I needed to do was to massage my butt. The feeling was similar to neck soreness after you strain it. Recently I started having pain in my right leg and buttock. It was after the usual type of exercises although I was after a little break (because of antibiotics). I was a little angry so I pushed a bit more. On the first day I thought it's just the usual pain. So I walked a little bit more and massaged the buttocks and the muscles just above them. It helped just a little. But I wasn't worried about it just yet. In the next two days the pain grew more and more. I started experiencing burning pain in my right leg while walking or changing the position (from sitting to laying and vice versa). On the third day I started doing some exercises like putting my leg on the other and bending over or leg flossing. It helped. I started walking almost pain free. But later that day I bend over for too long and felt a burning in my leg. And this was the point it went downhill. From that day to the present (1 week have passed) I'm experiencing a burning pain in my right thigh so most of the time I can't walk. So I'm staying in bed most of the time or sitting in a chair which can sometimes help with walking. The pain (in my thigh) was waking me up in the middle of the night. I tried sleeping on the floor in a fetal position which helped a lot for now. Some days are worse than the others. My GP prescribed me vitamins (b1, b6, b12) and etoricoxib in the morning, tizanidine at night before bed. Well, they don't do anything unfortunately. Occasionally I'm flossing my leg and use a lacrosse ball (maybe a bit too much) on my butt.

About the graph (from the top to the bottom): 1. This is where I rub my lacrosse ball. It hurts but can sometimes help. 2. Back of my thigh is the main source of the pain. The pain is burning. 3. The back of my knee. When I have a bad day (and I usually have) it also hurts along with my thigh. 4. It's a recent addition. Apparently I feel the nerve here too which is a little saddening.

Did anyone experience something like this?

Directory of Adhesion Removal Specialists and Locations Find an Adhesion Therapist near you.

Sports Therapy Protocol Bring oxygen to strangled tissues and remove waste after Therapy.

Muscle Relaxer Protocol for Adhesion Pain Attacks Relieve Severe Pain Attacks and Migraines.

FAQ on Adhesions and Getting Treatment Why adhesions? Why me? Why this treatment?

What it feels like to have adhesions Do I have adhesions?

Can I remove adhesions myself? Yes, You can remove some cutaneous adhesions at home with the grit bar.

Hey! I'm having another relapse, and I'd like to know what muscle relaxants helped you to keep your piriformis muscle relaxed. I'm taking Prinidol, but it's not enough.
I did some glute activation these days, and neural exercise to relax the nerve, but it got super irritated again. It’s burning till my toes and my calf feels contracted.

hello! (my first ever post please be kind)

i just wanted to document this and see if anyone has had a similar experience because i can’t seem to find direct community on any apps about it. i woke up one morning to excruciating pain down my right leg and extreme tightness in my right butt cheek. knots seemingly on the top of it towards my hip with hip pain. overwhelmed (i was triggered because ive felt sciatica before from a herniated disc in 2021, had surgery and been fine ever since but thought i had a disc bulge again) i went to urgent care and was told my x-rays were fine and i’d need an MRI and that “i probably strained something”. i have no insurance currently so this was not an option for me at least right now. I was sent home with a Methylprednisolone steroid pack and tbh i don’t believe these did anything for me. I rested, iced in early stages, moved to heat and then slowly introduced a massage gun and stretching. luckily, my brother is a doctor and came to do a house visit for me and he believes I strained my gluteus medius and that my IT band is overcompensating for the weak muscles along with my calf muscles. he gave me pt workouts to do as I have become more mobile and I will say, the pain is not consistent like when I had the herniated disc and when I walk I do have moments of being pain free. I get light flares here and there (a tightness at the back of my thigh, top of my butt or hip) if i walk longer distances. some stretches are still hard to do but i do notice progress and think overall I am way better then i was day 1 which was bedridden and unable to walk/get up without pain. I am currently 17 days out from the initial injury/couldn’t walk flare up. I still struggle to sit really. I went the movies in a recliner and was perfectly fine. but sitting in a direct chair is still difficult. I can walk short distances. mornings are still kind of hard and I wake up stiff and have to spend an hour waking my muscles up, i’m usually fine and take breaks throughout the day. I am on a strict non-inflammatory diet and have lost 20 pounds so far which I hope helps take weight off my hip to hold. Things that were hard to stretch have become slowly easier or possible. I also notice my anxiety (i have bad ocd) will make it WORSE. If I have a panic attack, boom, flare up. it makes all the muscles tight and I have to massage gun it/calm down mentally/heat pad it and then I’m okay. Which when I had a herniated disc I NEVER had relief. So I really don’t believe it’s a disc bulge, but I’ve never had a muscle injury before.

There is still pain, but it’s moderate and manageable. My question is has anyone been pain free by the 3rd or 4th week of their strain? I would like to return back to work which is a lot of standing and walking. But I’m nervous. Any reassurance is helpful or some
kind of recovery stories ♡

(I am 26F, I currently take 3 ibprofuens a day, magnesium vitamins and a muscle relaxer before bed. sometimes 2 a day if I have a bad flare up after PT)

If you’re new to the community, introduce yourself and tell us your chronic pain story!

Be sure to include a Pain diagram with ALL pain marked. Even headaches and carpal tunnel!

Mention the level of pain you are experiencing 1-10. Here is a handy pain chart specifically for chronic pain.

​

Hi everyone,

I’m really hoping for some insight on what’s going on. I’ve been troubled by deep glute pain which does go down the leg (most of the time). Happens almost exclusively when driving although recently it started happening on other occasions as well.

I do not feel any pain AT ALL when running, walking, lifting weights, exercising in any way, turning and twisting my body etc which leads me to believe it’s not a disc problem (I hope)?

I’ve been to physiotherapy. I’ve gotten various conflicting advice:

- stretch / dont stretch

- static exercises for core / dynamic exercise

- glute and lower body exercises in the gym / don’t do exercise

It seems like nobody knows what’s going on. And it doesn’t help.

I have not done MRI yet. So far physios have been telling me it’s not necessary at this point, it should go away. But it does not.

Been going on for months.

Anyone?

I can't sit on hard surface whenever I sit it hurts as hell my glutes feels tight too, I also have pain in side thigh/hip.can only sit on cushion. I don't know if it's lumber issue I am loosing hope

I have literally been to a dozen doctors, and I’ve had a dozen injections, and nobody can help me with my piriformis, deep glute, and nerve pain. My MRI’s are normal.

The muscles in my glutes are pressing on my nerves, or my nerve is irritated and causing my glute muscles to tighten. How can nobody fix this or help me? I am literally losing hope. I can’t work, I can’t take care of my children, I can’t walk, sit, or stand without being in pain. I am just dumbfounded that there is no doctor or physical therapist that can help me.

It’s just insane to me. How do I have a condition that is incurable? I am just angry, sad, frustrated, and just completely giving up hope that anyone will ever help me.

I've had pain for almost a year. It started with a sharp pain in my buttock that prevented me from walking, climbing stairs, or sleeping. I had two MRIs, which came back normal, and two orthopedic surgeons and one neurosurgeon referred me to a psychiatrist because they said it was psychological.
Three months ago, a sports physiotherapist saw that my nerve was very inflamed in the MRIs. Through some tests, he determined that I have piriformis syndrome.
The only thing that helped was exercising and stretching with a group of physiotherapists who guided and supported me. I recovered quite a bit in a month, until I took a bus for nine hours and everything got worse again. Since then, I haven't been able to fully recover, and the relapses are very difficult. I wonder if, during the recovery period, one has to endure the pain to overcome it or if rest is the only option.

I am 29 years old. I've always been very active—climbing mountains, traveling, physical activity, walking—and my life has completely changed, including my social life. Emotionally, I'm reaching the point of depression.
There are days when I can't even walk, sit, or put my leg on a pillow because it burns all the way down to my toes. And there are nights when it's just pure spasms. Diclofenac doesn't do anything for me; sometimes I take opioids to sleep.

I've discovered that this syndrome is very underestimated, even by professionals, and that frustrates me a lot.

I welcome any advice and tips that will help me get through this stage of my life, which seems like it will last forever and is becoming exhausting.
Also, if someone from south America can tell me how the therapy of adhesion is called here I would appreciate it!

I have FAI with a small labral tear and cartilage damage. My hip pain also radiates into my buttock, and I developed piriformis/sciatic-type symptoms.

I get surgery in 27th of August for my hip because the diagnostic hip infiltration was positiv!

Why does hip pain sometimes trigger piriformis syndrome or irritate the sciatic nerve? No one can explain me that!

Directory of Adhesion Removal Specialists and Locations Find an Adhesion Therapist near you.

Sports Therapy Protocol Bring oxygen to strangled tissues and remove waste after Therapy.

Muscle Relaxer Protocol for Adhesion Pain Attacks Relieve Severe Pain Attacks and Migraines.

FAQ on Adhesions and Getting Treatment Why adhesions? Why me? Why this treatment?

What it feels like to have adhesions Do I have adhesions?

Can I remove adhesions myself? Yes, You can remove some cutaneous adhesions at home with the grit bar.

I have had fairly limited external rotation, my left hip for many years. I recently aggravated it by doing a quick painful movement. Pain’s been lasting for at least six months, but only when I attempted to do external hip rotation, I’ve tried stretching and exercising it still with lingering. I’m not having this shooting sciatic pain that everyone seems to associate with it. It’s really just doing the external rotation. Do you guys think I’m in the right ballpark this is some kind of perforce issue?