Is Your Butt Pain "Piriformis Syndrome" or a "Herniated Disc"?

In our "Piriformis Syndrome Treatment" video (bit.ly/piriform...) that has over 250k views and over 300 comments, one of the biggest problems people face is: "I have butt pain and I'm not sure if it's piriformis syndrome or a disc problem".
In this video, Dr. Chris of Barefoot Rehab in Denville, NJ, discusses HOW TO THINK to see if your problem is more likely at the piriformis or coming from the low back.
DOES YOUR MRI SHOW A HORRIBLE HERNIATED DISC?
- YES -- more likely a herniated disc
- NO -- more likely piriformis syndrome
IF YOU HAVE BUTT PAIN WHEN YOU WAKE UP IN THE MORNING?
- YES -- more likely a herniated disc
- NO -- more likely piriformis syndrome
IF YOU DO A HAMSTRING STRETCH TEST (barefootrehab.com/hamstring-stretch-test/) AND HAVE HORRIBLE PAIN AT YOUR BUTT CHEEK:
- ON BOTH SIDES - more likely a herniated disc
- ON ONE SIDE - more likely piriformis syndrome
- IN HAMSTRING or CALF -- more likely a herniated disc
IF YOU HAVE BUTT PAIN WHEN YOU SIT:
- PAIN IS RIGHT WHERE YOU'RE SITTING, PUTTING PRESSURE - more likely piriformis syndrome
- PAIN IS IN ANOTHER LOCATION THAT ISN'T YOUR BUTT PAIN - more likely a herniated disc
IF YOU HAVE PAIN WALKING:
- LONG STRIDES - more likely piriformis syndrome
- SHORT STRIDES - more likely a herniated disc
Once all of the data and puzzle pieces are put together, we can look at the image on the puzzle to determine what your best option for treatment will be. And guess what, your problem can be a little bit of both problems!
Tally each of these data points into buckets and which bucket, piriformis syndrome or a herniated disc, then pursue adhesion removal treatment for that problem primarily.
If you want PERMANENT pain relief for your butt pain, call us, your local expert chiropractor at Barefoot Rehab in Denville, NJ! 862-205-4847
▬ MORE on Piriformis Syndrome ▬▬▬▬▬▬▬▬▬▬
► Success story: • When Piriformis Stretc...
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[@007emv]

Hi Dr, is it possible to have both problems at same time?

[@TheBingoP]

It’s super clear explanation that I’Ve never heard from any doctors before. Thank you so much super cool doctor . Cheers from Thailand

[@drchrisstepien]

Happy to help! Let us know if there's anything else we can answer for you.

[@TheBingoP]

Barefoot Rehab My mom has a right hip pain in the morning for 3 months. Every morning, it took her 30 min more or less to deal with the pain before she could walk. She’s been visiting several doctors but the pain is still there. Could you please give more explanation on this subject? Thank you in advance.

[@drchrisstepien]

@@TheBingoP Where exactly in her "right hip"? Morning pain that gets better after moving is almost always a kind of arthritis. The only question is, "disc" or "hip". If she's had low back episodes that are severe and spasmy for 2-10 days or has a horrible MRI of low back or hip, put it higher up on your diagnostic list.

[@TheBingoP]

Barefoot Rehab Thank you so much for your speedy reply. It’s very helpful. I’ll seek more details and get back to you next week when I meet my mom. Cheers 🤓

[@MrKillahippo]

Mr Barefoot, I was miss diagnosed. the Ultra/S showed I had Pirfomis Syndrome and for 2 weeks we were treating piriformis syndrome, I was not getting any better. in fact it was worse, now with calf tightness and numbness under my left foot. Sitting, bending,laying down to long all hurt. I insisted on an MRI and that showed L5s1 disc budge. What you explained proved my instinct right. after sleep ,getting out of bed was a nightmare. ( and I know that when I start walking like a duck it's always disc) I've had I injection of cortisone and it gave me 20% left hip moment again, (still suffer P/S all the way down the L/leg.) but I'm needing another injection as the Dr seems to suggest that the next needle has to be curved so it can get in between two bones and then under to exact spot. Have you ever had a subject with both? as I feel I have and did you have to treat the disc first? Your in put would be appreciated. I can't visit 'cause I'm in Australia.

[@Vic72075]

Hi Doc.. 25 days ago I had excruciating right side butt pain, and back of right thigh, now I have a numb foot on top and toes. After taking Medrol steroid the pain subsided on the right butt, I still have numb foot, but it moves around. The new problem that started today is I’m getting an ache in the lower butt cheek on the left side now! Where the butt meets the thigh in the crease. How can I get this on both sides?.. I’m tired of taking Antiinflammatories.. can this be happening on the left side now?.. I went through so much agony. Thank you if you can answer ❤️

[@anjyel777]

Same goes to me. Really suffer cause of this pain

[@gbdjski231]

My saga started around 6 months ago with clasic mild low back pain which got really bad in two months. I could barely bend down and straight was even harder. Pain was the worst in the muscles some 5 cm paralel to the spine on both sides. When pain got so bad i visited manual therapist who found ou i had huge lumps on my muscles in the lumbar region. Did few masages and tecar teraphy sessions and the pain in the low back went away and I could normally bend down again. But just a few days later pain in my buttocks occured and somewhere on top of the buttocks, over si joint. Went to that teraphist again, did masage my butt and find out I had a very very tight and painful periformis muscle. Did a few sesions with massage and tecar, I massaged it with ball, did stretching but cannot get that piriformis to release. When I sit on the massage ball, there are many very painful trigger points , lumps on my butt that are very stubborn. And now sciatic pain occured in my right leg, shooting down to the calf at evening. My hamstrings are also very tight. Im desperate, seems like my status is getting worse despite therapy, stretching, etc. Also to mention - I have a sitting job, I sit for about 10 hours per day, sometimes more.. and I reduced sports activity in the last 3 months to minimum since my low back was killing me. Now I dont know what to do, what is this? I will go to a chiro, I just found one who is supposedly very good and I hope he will know what to do...

[@drchrisstepien]

I wouldn't see a chiro. I'd see an adhesion specialist. Even though piriformis has lumps, it sounds like you have a lumbar disc problem. Where do u live?

[@janetbradbury5021]

I am more confused now. There is high hamstring tendonopathy for sit bone pain to consider also. Hip problems can drive you nuts !

[@drchrisstepien]

Ha, there's even more, posterior femoral cutaneous nerve entrapments or pudendal nerve entrapments. THe history really matters!

[@Jacob-hl3gt]

What if when I lay down for an hour or so I get up and bottom of my foot left side is numb. Sciatica?

[@MaxBadstibner]

Pain is really awful in the morning. Feels like there is a vice clamped down on my entire right glute. Tylenol and movement tend to help though.

[@Mat_Scott]

Great explanation. My pain is more in the hip region and hurts in the morning after waking up but gets better after stretching and moving around a bit. Doesn't sound like either of these.

[@drchrisstepien]

Agreed, you could have labrum degeneration, hip osteoarthriitis, disc referral, or some other muscle pathology.

[@chuckliddell4562]

Kool 👍

[@rigobertodelamora421]

Can you recommend any doctors to have my left hip pain checked in California? Fresno.

[@drchrisstepien]

Veronica Jacquez www.findanadhesionprovider.com

[@Sword._Saint]

Hi, so I have this insane pain in the butt when I lie down. It usually doesnt affect me at all when walking or sitting but when I lie down its worse than a kick in the balls. I've tried all exercises and streches on the internet and nothing seems to work. What could it be? I'm 24 years old. Also, I've been walking unevenly for a couple of weeks, thats probably related too (I've tried hip muscle exercise for this but it just made the pain worse)

[@Sword._Saint]

@LuceLiLi Damn, that sucks. I'm doing clamshells with a hip band and it seems to be working so far, pain is less and hip feels aligned. Hopefully, your pain gets better too 👍

[@flatfishmickey]

Thanks so much for the information. I’ve been dealing with accurate pain on the left side of my butt for about 5 months now. Seen a chiropractor and currently seeing a physical therapist. One said sciatica (chiropractor). Physical therapist says piriformis syndrome. After seeing your video I am wondering what type of Dr I should see to get an official diagnosis. I’ve been considering a spinal orthopedic Dr. any suggestions? Thanks in advance for your time.

[@free-spirits2011]

Morn' Doc...Namaste from India🙏 G8rt explanation...really makes senses...thanks. Past 1 month I have pain in the middle of my left buttocks...with no pain downwards or any surrounding areas. Trying to figure the core cause of it....but in vain...coz of confusion not really able to concentrate on any strengthening & stretching routines...it's become a Herculean task. Done Xray...Past 1 week seeing a PT...using Tens/IFT.....also visited Orthopedic...given few anti inflammatory doses. Would appreciate ur best guidance in this situation...Pls assist !!!

[@danielleivang4247]

Tens/IFT wont help you out, see a orthopedic doctor or licensed chiropractor

[@drchrisstepien]

Tell me exactly which motions or movements make it worse or better? And describe the quality of it? How old are you?

[@EskimoLady870]

If pain coming from buttock down leg,an stiffness

[@drchrisstepien]

What are you asking?

[@moonlighth8643]

Now you just help me confirmed that I may have both, using your questions above. Is there anyone you know in Virginia Beach/Richmond area who does what you do? I need help more than ever before. I have been to manual therapist, D.O, chiropractors and even sports medicine doctor. None of them helps to neither diagnose the root, nor cure the pain. Help me please. What can I do

[@BGCDOG]

Hi Chris..I have been dealing with butt pain myself for about 7 months now & really hasn’t got much better…I’ve gotten a couple different cortisone shots for Gluteals tendinitis & trochanter bursitis really to know avail….D one know someone in Massachusetts or Boston that might be able to help me? Thank You & loved the video..

[@drchrisstepien]

Hey BC - sorry to hear this. Are you 100% sure gluteal tendonitis and troch bursitis are the right diagnoses? Dr. Keith Puri at the VA hospital is the only doc who does this work in Mass. We have a lot fo patients drive down from Mass too. Hope this is helpful.

[@catoob8372]

I love you too ! now , where in south Louisiana is a doctor that knows the kind of stuff you are talkin about here? I know he's not in my city, for sure. I've been crippled for 9 mo. the physical therapist and my internist have no clue what is going on. but I guarantee I have been studying this more intensely than they have. you just assured me that my pain is sciatic and/or piriformis. not the discs. the symptoms you talk about are exactly what I have. I wish there was someone that understands this.

[@drchrisstepien]

There aren't any adhesion specialists in Louisana. I recommend you fly to St Louis. Precision Health Group is the best in this country.

[@PurpleLightWarriorc]

You are so far away . I wish I would have seen this video. Do you know of anyone in Phoenix Arizona that that helps people figure out if it's TRUE piraformis ? I would like to find someone like you who really explains it well .

[@GearJamminHank]

Can you recommend a doctor in the metro Atlanta area? I can't come to Jersey for multiple visits.

[@drchrisstepien]

There aren’t any yet. Closest is FL or NC?

[@GearJamminHank]

@@drchrisstepien Florida? That might work, I go there alot.

[@drchrisstepien]

@@GearJamminHank Veracity Soft Tissue Dr andy Wengert

[@gholamhosseinsadeghi7609]

Hi Dr.If lift a heavy thing about 40 pounds with bad position and get pain in the butt and shooting to leg, is it regards to disc or priformis syndrome? Thanks

[@drchrisstepien]

Not enough info to guess a diagnosis. It's more common to be disc though given your data. But that's a generalization.

[@TheEnnisfan]

Hey Doc, any chance you can recommend a place such as yours or maybe a colleague out here in Los Angeles? If I was in Jersey, I'd come out to your clinic. Your videos are awesome. Thanks for all the info.

[@drchrisstepien]

TY for kind words. The ONLY doc who does this in CA is --> mydrcohen.com/

[@Vickie2417]

Barefoot reh is Brandon Cohen in La or in MA, I click ur sites n it is not in LA

[@Vickie2417]

Mr effinisfan, did u find doctor in LA ? I have same pain not cure? B Cohen is not in LA but in MA

[@1982kinger]

I'm pretty sure mine's a little bit of both.... I don't have pain shooting down the back of my legs but I have lots of piriformis pain in my ass and pain in my l4 l5 area

[@drchrisstepien]

Yup, it almost always is both, just a matter of degree.

[@Tesseramous]

Not one of my doctors has ever said anything about 'an adhesion at the hip rotators'. The medical system sucks.

[@drchrisstepien]

So sorry friend

[@joshuas4joryemopido48]

Hello Doctor, i have this problem, i feel pain on my butt especially the lower region and also some pain on the groin please help me out. Thank you

[@drchrisstepien]

Sounds like you need treatment. Can you make it to NJ?

[@Vickie2417]

I have back pain mri shown compress fracture , try back exercise Still no help. so what exercise do u suggest

[@drchrisstepien]

You don't have a weakness problem. You have a compression fracture. The fracture is what needs to be addressed. You can get checked for adhesion and then if only the muscles are clean, then slowly strengthen with planks, side planks, farmers carries, etc.

[@carmenbugeja8722]

The pa in is in the morning with the disc, is there anyway to ease the psin?

[@drchrisstepien]

An evaluation would be needed to say! Have you seen any doctor or therapist for it’?

[@govindindian1126]

Sir I'm having pain on my butts, in left side and thts goes down all over the foot since 1 last one month.., is it periformis, I'm taking anti Inflamatory tabs, and having tens therapy ,.. Will it be okk, how longer this pain will take to heal.? Please help

[@drchrisstepien]

It can take up to a couple years if you do all the right things. If you don't do the right things, it could also never heal. So take care of it!

[@marahmillicentbalarny8447]

One year ago I fell on my butt, I had deep purple bruise covering the whole left buttock . Bruised healed, but now I can feel sitting on a hard surface an uncomfortable feeling, almost like a small tennis ball on that area...what do you think?

[@drchrisstepien]

Sounds like you have ADHESION where the injury was! This is very good cuz it's 100% fixable!

[@edwardsullivan5829]

Thank you so much for posting this information!

[@drchrisstepien]

Anytime my friend! If there's any other type of content we can create for you, feel free to let us know!

[@Alibaba.Logic.Builders]

L5 S1 shows disc shows small left paracentral protrusion indenting thecal sac I can walk the sensation is less But buttocks gets heated What it could be

[@drchrisstepien]

Sounds like it's that disc, but hard to say without aan exam.

[@lindacomer6417]

Last October I fell hard and fractured my left femoral hip. Had surgery now I have butt pain and hear clicking noise in my hip when I lay down on my back and bring my bend leg to my chest. Could it be possible that I had refractured my hip??? Also, I can bend over to pick something off the floor and I have no pain.

[@drchrisstepien]

I doubt you re-fractured it without a force into it but it's possible, especially if your diet and metabolic health isn't good. It's more likely that you have degeneration in the hip or have adhesion that you need to get checked.

[@lindacomer6417]

@@drchrisstepien Thank you for responding back to me. I already have an appt next week to have it checked out. Thanks again. ❤️

[@drchrisstepien]

@@lindacomer6417 Very welcome!

[@cathyleposa-petraud8054]

Great Video..... Thank You❤❤❤

[@drchrisstepien]

Thank you!

[@abotrump5186]

Can back curve do any of these symptom

[@WSILAB072]

Hi do you know anyone in Cape Town South Africa that can help me with this treatment

[@drchrisstepien]

Hi there, we don't have any adhesion specialists outside of US and Australia.

[@charldutoit6184]

@@drchrisstepien thanks for letting me know

[@christophersony7975]

Just wondering if piriformis syndrome can be caused by lifting something heavy. About six weeks ago I did exactly that and the next morning I had the most horrendous pain in my butt and all the way down the back of my leg to my foot which is numb from the tip of my little toe to the heel. It’s bearable until I try to walk . If I do try within minutes the pain becomes excruciating. I’m so confused because my own symptoms do seem to contradict some parts of the explanation to it being piriformis. But then it doesn’t entirely match up to the symptoms of a herniated disc either. Oh my god someone help please.

[@drchrisstepien]

This sounds more like a herniated disc, but it can be a combo of both. Remember, your body is your body. Symptoms do not have to present exactly is what you might read. Most PS or Disc issues can present as just hamstring tightness even.

[@christophersony7975]

@@drchrisstepien thank you for the reply. I’m seeing a therapist this week. 👍

[@drchrisstepien]

@@christophersony7975 awesome! Let us know how it goes

[@felipesamano8060]

MRI shows l5s1 disc herniation. No back pain but on buttock and lump can be felt. Could it be that I also have piriformis syndrome?

[@drchrisstepien]

Yes, it's possible. But by far, it's more common to be coming from the disc. It's called Sclerotegenous referral if you want to look it up.

[@felipesamano8060]

@@drchrisstepien thank you ! Il be sure to talk about it more with the pain institute 🙏🏼

[@tomtomlinson4826]

Love you back!

[@drchrisstepien]

Haha : )

[@sumner8642]

I have a disc problem but i have pain on one side only. :/

[@drchrisstepien]

How long have you had pain?

[@sumner8642]

@drchrisstepien almost 8 months ;/ thanks for your reply

[@drchrisstepien]

It’s been long! Where are you located?

[@coolcanoechic]

This is excellent! Still trying to figure out exactly where my problem lies.

[@drchrisstepien]

Let us know deets and we can see if wee can help u

[@donniestevens1559]

Mine never goes away

[@drchrisstepien]

So sorry friend!

[@jesbuddy7]

When you say mri, is it the at the lumbar?

[@drchrisstepien]

In this case, 100% correct. There's no need to check a hip MRI for this constellation of symptoms.

[@MightyMagnuss]

Hi Doc. Trying to figure out if I have piriformis as I am scheduled for decompression. Have had 2 mri's, one in 2017 and one 2021. Both show degeneration in l2/l3 and l4-s1 and asymmetrical disc bulge l4/l5 and left sided foraminal disc herniation with HIZ, possible l4 nerve compression. Asymmetrical disc bulge l5/s1 and osteophytes with facet joint hypertrophy and lateral recess stenosis with s1 nerve compression. I have sciatica...or some nerve pain down my left leg, outer calf and outer part of my left foot incl outer toes. Only a sore spot/area in left buttock if I massage. Is a decompression the right thing to do?

[@drchrisstepien]

So your imaging isn't great and your symptom locations sound like they're sciatic nerve related. But you don't have any information on your functional testing (ranges) or presence of adhesion. If it were me, I would get this stuff looked at before getting cut open for obvious reasons (you're missing data). Where do you live?

[@MightyMagnuss]

@@drchrisstepien Thank you for replying. I appreciate it. Well, I live in Denmark (Scandinavia), so far from the US. Function wise, I have no loss in strenght and can do heel-toe raise/walk. Slr test is approx 70 degrees last time I was checked. I did try slump test by myself and that gave symptoms down my leg and improved when I lifted my head. Agreed, am a bit nervous getting cut open

[@drchrisstepien]

@@MightyMagnuss Yeah sounds like a spinal issue. I wish you luck finding an answewr.

[@MightyMagnuss]

@@drchrisstepien Thank you and thank you very much for your time

[@drchrisstepien]

@@MightyMagnuss happy to help

[@KhunThuRaAung-c8b]

❤

[@drchrisstepien]

❤️❤️

[@MV-zp2uy]

C’est intéressant. On pourrait avoir la même chose en français????’🤷🏼‍♀️🤷🏼‍♀️

[@drchrisstepien]

No hablo frances?

[@MV-zp2uy]

@@drchrisstepien In english and spanish i understand but for tecnical information is difficulté for me sorry

[@drchrisstepien]

@@MV-zp2uy It's ok try to translate to ENglish?

[@MV-zp2uy]

@@drchrisstepien piriformes Syndromes Piriformes Syndromes

[@drchrisstepien]

@@MV-zp2uy kzbin.info/www/bejne/rnuxY6V4ac1pisk

[@lc2489]

Can you have both at the same time ?

[@drchrisstepien]

Both at same time is most probably above each individually.

[@jerseyjoe1677]

Well said.

[@Irish_all_day]

I think I have a little bit of both

[@drchrisstepien]

Yup, both is most common presentation.

[@akilcyrus6289]

Very useful information

[@drchrisstepien]

happy to help!

[@collettaueara344]

please come to Fiji.

[@drchrisstepien]

Ha, maybe some day.

[@allieb7757]

I think I have both.

[@drchrisstepien]

Yes this is very common

[@allieb7757]

@@drchrisstepien apparently, it's from a facet joint - can't remember if it was L4 or L5.

[@dragansimonovski4045]

Soooo... I have both. Great!

[@drchrisstepien]

Work each piece individually - that's how you get fixed!

[@dragansimonovski4045]

@@drchrisstepien Since I don't have many options for treatment in my country, do you advise using an inversion table? I tried it and it seems to relieve my pain a bit...

[@drchrisstepien]

@@dragansimonovski4045 It definitely helps a small percentage of people. Just keep an eye on how you feel in the 24 hour window over weeks to months. B/c some people feel better during inversion, they think it's good for them but fail to notice that pain has been increasing over weeks/months. If that happens, you're getting worse, which you should obviously notice is bringing you in the wrong direction.

[@dragansimonovski4045]

@@drchrisstepien Thank you for the advice!

[@robertgriffith1992]

know anybody in billings montana? for this diagnosis? ive been to two doctors , a physical therapist, and i have been trying to figure this out for YEARS. from what ive been seeing it seems like it could be a little bit of both. everytime i work out on my legs, when i get sore, I feel super tender where my lower back and upper buttcheek is. and sometimes its so bad , ill get this like singing pain that literally freezes me and gives me horrible tightness and muscle spasms for a week or more...

[@drchrisstepien]

Hey my friend. I don't. You can see the closest provider on integrativediagnosis.com and click "find a provider". Here for you otherwise.

[@tuxedomask90250]

Hello I have an issue with my sciatic nerve on the left posterior pirformis. I am a veteran and go through VA, my MRI showed that I had no issues with my discs other than narrowing and no compressed nerves according to my doctor. Despite that it does hurt when I sit down for long periods of time on the left side. I have numbness, tingling down the left side as well as issues stretching my hamstring, and although with PT I have gotten better in the last few months, it has not improved since then. I was wondering what kind of doctor I should be asking for that is an equivalent to what you do or what your specialty is and is there anything i can do in the meantime to get some relief? Thank you for your time.

[@drchrisstepien]

Hi Jeffrey! First, I'm sorry for your struggling. It's NOT OK that someone hasn't been able to diagnose you correctly yet. That's why we exist. You should ask for an "Integrative Diagnosis" doctor. There are about 30-50 of us across the world. None of us work in VA hospitals, we all work privately. So you'd have to look outside the VA. If you can't find an ID doctor, find a good musculoskeletal doctor and myofascial therapist who can 1) diagnose you correct 2) remove the adhesion like we are. This will BE VERY HARD to find, but it's your only shot if you can't get to us or one of our colleagues. Hope this helps!

[@tuxedomask90250]

@@drchrisstepien thank you for your help. I'll ask my PCP about this and finding out if va can cover this. Im supposed to be going for rehab soon and I'll ask then about it as well. I'm going for nursing school and it is a struggle to have to sit down and learn when my butt is bothering me 😅

[@drchrisstepien]

@@tuxedomask90250 Fully understand. If you have any doubt yourself, ask for lumbar MRI. If there's any way you can have someone help you with this Pencil Test, that could help a lot too. www.barefootrehab.com/pencil-test-low-back-pain/