Sciatica Relief: Why the Piriformis Isn't the Whole Story

If you've been dealing with sciatica, you've probably heard about the piriformis muscle. It's true — a tight piriformis can compress the sciatic nerve and send pain shooting down your leg. But in my experience working with sciatica clients over 27 years, the piriformis is rarely the only problem. It's usually the loudest symptom of something bigger going on in the hip.

Here's what I actually find, and what I do about it.

The Real Culprit: Your Lateral Rotators

The hip is surrounded by a group of six small muscles called the lateral rotators. Their job is to rotate the femur outward — and they work constantly, whether you're walking, sitting, or standing. When these muscles get chronically tight (which they do in most adults, especially those who sit for long hours), they compress the entire hip joint and put pressure on the structures running through it — including the sciatic nerve.

The piriformis is one of these six muscles. But so are the obturator internus, gemellus superior and inferior, obturator externus, and quadratus femoris. When I'm working with a sciatica client, I'm not just targeting one muscle. I'm systematically working through all of them.

What My Approach Looks Like

Every session I do for sciatica is different because every body is different. But there's a consistent logic to how I work.

I start by assessing where the tension is — not just in the hip, but in the glutes, the low back, and the hamstrings. This matters because tight hamstrings pull on the pelvis and increase compression at the hip. A tight low back does the same. If I only work the hip and ignore everything feeding into it, you'll feel better for a day and be right back where you started.

From there I use a combination of deep tissue work, movement, and assisted stretching woven throughout the session. I'm not pressing on one spot for five minutes and moving on. The work is fluid — softening a muscle, moving the joint, returning to the tissue, stretching, moving again. This approach works with your body's natural mechanics rather than against them.

The stretching and movement component is deliberately progressive. When a muscle is in spasm or in protective mode — which is common with chronic sciatica — you can't force it open. Pushing too hard too fast causes the muscle to guard further, which is the opposite of what you want. Instead, I work incrementally, introducing movement and range of motion gradually as the tissue responds and trust develops. Each step informs the next. This is where I can truly tailor the session to where you are that day — your specific pattern of tension, your current level of discomfort, how your body is responding in real time.

One thing I make clear to every sciatica client from the start: tell me if anything is uncomfortable. Not uncomfortable in a productive, releasing way — but uncomfortable in a way that doesn't feel right. This matters more with sciatica than almost any other condition, because the sciatic nerve is already aggravated. Pressing too hard in the wrong place or moving too aggressively can inflame the nerve further and set you back. Pain is not a sign that the work is working. The slow, progressive approach exists precisely to avoid that — to create release without reaction. Your feedback during the session is part of the treatment.

The goal is to lengthen and release the lateral rotators, glutes, and the smaller surrounding hip muscles so they stop compressing the nerve. When those muscles soften and the hip opens up, most people feel the sciatica ease significantly — sometimes within the session itself.

A Note on Lumbar Sciatica

Not all sciatica originates in the hip. In some cases the sciatic nerve is being compressed at the lumbar spine itself — a herniated disc, bone spur, or spinal stenosis putting pressure on the nerve roots before they even exit the spine. That's a structural issue that requires a chiropractor, orthopedist, or spine specialist to properly diagnose.

I'm not a chiropractor. I don't take X-rays or perform spinal adjustments. What I can tell you is that even in cases of lumbar sciatica, softening the surrounding musculature — the lumbar erectors, quadratus lumborum, and deep spinal muscles — can meaningfully reduce the compressive load on those structures and provide real relief. Less muscular tension around an irritated nerve means less pain, even if the underlying structural issue remains.

I don't rely on a diagnosis to tell me where to work. I listen to what you tell me about your pain pattern, and I use my hands to find where the tension lives. That conversation — between what you feel and what I feel — guides everything. It's not a protocol. It's responsive work based on what's actually happening in your body on that day.

Why the Low Back and Hamstrings Matter

This is where a lot of massage therapists stop short. They work the hip and call it done. But if your hamstrings are chronically tight — which they are for most people who sit regularly — they're constantly pulling the pelvis into a posterior tilt, which loads the hip differently and keeps those lateral rotators under tension.

Same with the low back. Tight lumbar muscles compress the spine and can directly irritate the nerve roots that form the sciatic nerve before it even reaches the hip. Working the low back as part of a sciatica session isn't optional — it's essential.

I treat the whole chain. By the time a session is over, we've addressed the hip, the glutes, the low back, and the hamstrings as a system — not as isolated parts.

What You Can Do Daily

Massage gets you there. Daily movement keeps you there. I always give my sciatica clients a few simple hip openers to do on their own — not because they replace the work, but because they maintain and build on it.

These don't need to be complicated. A few minutes of targeted stretching each morning can make a significant difference in how quickly you progress and how long the results last. Some of my favorites to recommend:

Figure-four stretch — lying on your back, cross one ankle over the opposite knee and gently pull both legs toward your chest. This targets the piriformis and lateral rotators directly.

90/90 hip stretch — sitting on the floor with both knees bent at 90 degrees, one in front and one to the side. Hold and breathe. Rotates the hip in both directions and opens the entire lateral rotator group.

Standing hip circles — standing on one foot, draw slow deliberate circles with the lifted knee. Warms up the joint and keeps the lateral rotators mobile throughout the day.

Supine knee-to-chest with rotation — lying on your back, bring one knee to your chest and gently rotate it across the body. Hold 30 seconds each side. Targets the glutes and lateral hip simultaneously.

Done consistently — even 5 minutes a day — these compound over time and make each massage session more effective.

What to Expect

Most of my sciatica clients notice a significant reduction in symptoms after the first session. That said, if you've been dealing with this for months or years, one session isn't a cure. The pattern of tension took time to develop and it takes a few sessions to fully unwind.

What I can tell you is that the approach works — not because I'm pressing harder than anyone else, but because I'm working the whole system instead of just the symptom.

If you're dealing with sciatica in Westchester and want to get out of pain, I come directly to your home with everything needed. No commute, no spa, no wasted time. Just focused therapeutic work where you're most comfortable.

📞 Call or text: (914) 523-0116 🌐 dougoconnelllmt.com

Serving Bronxville, Eastchester, Scarsdale, White Plains, Harrison, Chappaqua, Tarrytown, Irvington, Dobbs Ferry, Hastings-on-Hudson, Ardsley, and throughout Westchester County, NY.