If you’ve been feeling a deep ache in your butt, a sharp pain down your leg, or numbness that gets worse when you sit or move, you might be dealing with more than just tight muscles.

These are common signs of Deep Gluteal Syndrome (DGS)—a condition where something in your hip, like a tight muscle or scar tissue, presses on the sciatic nerve.

What’s tricky is that up to 49% of people with sciatica-like symptoms show nothing unusual on a back scan¹, because the real problem might be deeper in the glutes.

You might’ve heard of this as piriformis syndrome. That used to be the common name, but we now know other muscles and tissues can also press on the nerve, so the broader term “Deep Gluteal Syndrome” is used instead².

If these symptoms sound familiar, this guide will help you understand what’s going on—and what you can do about it.

What is Deep Gluteal Syndrome?

Deep Gluteal Syndrome (DGS) is a condition where something in the deep part of your butt—like a muscle, ligament, or scar tissue—presses on the sciatic nerve.

This pressure can cause pain, tingling, or numbness in your buttocks, hips, or down the leg. It’s often confused with sciatica or back problems, but in this case, the pain isn’t coming from the spine—it’s coming from deeper inside your hip.

This condition used to be called Piriformis Syndrome because the piriformis muscle was believed to be the main cause. Now we know that other structures in the gluteal area can also press on the nerve, so doctors now call it Deep Gluteal Syndrome².

Who Gets Deep Gluteal Syndrome?

Deep Gluteal Syndrome can affect anyone, but it’s more common in:

People who sit for long periods: like office workers, truck drivers, and students
Active individuals: like runners, weightlifters, and cyclists
People with past hip injuries or surgeries
Middle-aged adults, especially between 40 and 60 years old¹
Women may be slightly more likely to experience it due to differences in hip shape and movement patterns³

How Common is Deep Gluteal Syndrome?

It’s estimated that 6% to 17% of people who are seen for sciatica-type symptoms may actually have DGS¹. That means nearly 1 in 6 people with leg pain might not have a back problem at all—the issue is in their glutes.

Common Signs and Symptoms of Deep Gluteal Syndrome (DGS)

Deep, aching pain in the buttock: You feel a deep, dull ache in one butt cheek—often worse after sitting or standing still for a while.
Pain that shoots down your leg: You get a sharp, burning, or electric-like pain that travels from your butt down the back of your thigh, sometimes reaching your calf or foot.
Worse when sitting for too long: Sitting for more than 20–30 minutes—especially during driving or desk work—makes the pain worse, and you often need to shift around or stand up for relief.
Relief when standing or walking: The pain often eases when you get up and walk, especially after sitting for a long stretch.
Pain when crossing your legs or shifting your weight: You notice the pain flares up when crossing your legs, twisting your hips, or leaning to one side while sitting.
Tingling or numbness in the leg: You sometimes feel pins and needles or numbness that starts in your butt and travels down your leg.
Pain with pressure on the glute: Pressing a spot deep in your buttock—especially near the piriformis—feels sore or brings on your usual symptoms.
Pain when stretching or using the hip: Movements like lunges, deep squats, or high steps can trigger pain or tightness in the butt and back of the leg.
Discomfort when lying on the affected side: Sleeping on your painful side causes pressure and discomfort that may wake you up or make it hard to fall asleep.
Mild weakness in the leg: Your leg may feel slightly weak or “off,” especially during long walks or after sitting for a while.
Symptoms on one side only: Unlike some other conditions, DGS almost always affects just one side—not both.

Why Does Deep Gluteal Syndrome Happen?

If you have Deep Gluteal Syndrome (DGS), it means something deep in your butt is pressing on your sciatic nerve. This pressure causes pain, tingling, or numbness, usually in your butt and down the back of your leg.

The problem happens in a small space behind your hip joint called the deep gluteal space. That space holds muscles, tendons, and the sciatic nerve. It’s tight to begin with, so even a small change—like muscle tightness or swelling—can squeeze the nerve and set off your symptoms².

What Causes the Pressure?

Muscle tightness or overuse: Repeating the same movement, working out hard, or sitting too long can cause the deep hip muscles to tighten and press on the nerve.
Poor posture or weak glutes: Sitting with crossed legs or slouching can change how your hip moves and lead to more nerve pressure.
Too much sitting: If you don’t move your hips often, the muscles around the nerve can get stiff and lose flexibility.
Small repeated strains: Running, lifting, or twisting can create inflammation or scar tissue that slowly narrows the space.
Tight anatomy: Some people naturally have a smaller space for the nerve to pass through, which can raise the risk of irritation³.

How the Nerve Reacts

When the sciatic nerve is pressed over and over, it gets more sensitive. Even small movements can start to hurt.

That’s why the symptoms can build over time. The good news is: nerves can recover if the pressure is removed and the area starts moving well again⁴.

What Other Conditions Could It Be?

Deep Gluteal Syndrome shares symptoms with a few other conditions. Here are five possibilities your pain might be instead, listed from most to least likely:

Lumbar Radiculopathy (Sciatica from the Back)

This is when a disc or joint in your lower back presses on a nerve. It causes similar leg pain, but the pain usually starts in the back, not the butt. Movements like bending or lifting often make it worse, unlike Deep Gluteal Syndrome which flares more with sitting¹.

→ Click here to learn more about Sciatica

Piriformis Syndrome

This is a more specific type of DGS where the piriformis muscle alone presses on the sciatic nerve. Symptoms are nearly the same, but piriformis syndrome doesn’t involve other structures in the gluteal space².

Hamstring Tendinopathy

This causes pain at the top of the hamstring, especially when sitting. It doesn’t cause numbness or tingling down the leg, which is common in DGS⁴.

Ischiofemoral Impingement

This is pinching between bones deep in the hip. It causes pain in the butt or groin, especially with long steps, but usually no nerve symptoms like DGS³.

Sacroiliac Joint Dysfunction

This is pain from the joint where your spine meets your pelvis. It can feel similar but doesn’t usually send pain down the leg. Pain often worsens with standing or walking, not sitting⁵.

Common Mistakes When Treating Deep Gluteal Syndrome (DGS)

Pushing Through the Pain

Trying to ignore the pain or “tough it out” often makes things worse. What starts as a mild ache can turn into sharp pain, numbness, or long-term nerve issues if the pressure isn’t relieved⁴.

Only Stretching the Glutes

Stretching feels good short-term, but it’s not a full solution. If you don’t work on strength, posture, and movement, the problem usually comes back.

Sitting Too Much

Long hours of sitting—especially without breaks—puts pressure right where the nerve runs. If you don’t move regularly, healing slows down and symptoms can get worse.

Rushing Back to Activity

Feeling a bit better doesn’t mean you’re in the clear. Going back to hard training too soon often flares things up again. Progress needs to be steady, not rushed.

Waiting Too Long for Help

Hoping it goes away on its own is risky. The longer the nerve is irritated, the harder it is to fix. Early treatment gives you the best shot at a full recovery.

What If You Don’t Treat It?

Left alone, Deep Gluteal Syndrome can become chronic. Pain may spread, leg strength can drop, and in rare cases, surgery might be needed to free the nerve⁴.

Types of Scans For Deep Gluteal Syndrome

If your symptoms suggest Deep Gluteal Syndrome (DGS), your doctor might send you for a scan. These don’t always give a clear answer, but they can help rule out other problems or show signs of nerve irritation.

Here are the three most common scans used and what we’re looking for in each:

MRI (Magnetic Resonance Imaging)

An MRI gives a detailed picture of your muscles, joints, and nerves. With DGS, we’re looking to see if anything in the deep gluteal area—like a muscle, tendon, or scar tissue—is pressing on the sciatic nerve.

We’re also checking that the pain isn’t coming from a disc or joint in your lower back.

MR Neurography

This is a special type of MRI that focuses on the nerves. It can show swelling or irritation of the sciatic nerve itself. It’s more detailed than a regular MRI, but not always easy to access.

If your symptoms are clearly nerve-related and other tests don’t show much, this scan can help.

Ultrasound

An ultrasound is often used to guide injections, but it can also help spot tight muscles or unusual movement around the sciatic nerve. It’s not as detailed as an MRI, but it’s useful for checking how things move in real time, especially during certain positions or movements.

Is Surgery Needed?

The good news is, surgery for Deep Gluteal Syndrome (DGS) is rarely needed. Most people feel better with the right rehab plan, some lifestyle changes, and time.

Even when the pain is stubborn, surgery is usually a last resort—only after other treatments have been tried for a while⁴.

When Surgery Might Be Considered

You’ve had symptoms for more than 6 to 12 months
You’ve already tried physiotherapy, injections, rest, and other non-surgical treatments
Pain is still stopping you from sitting, walking, working, or training
Scans show that something—like scar tissue or a tight muscle—is clearly pressing on the nerve
Your symptoms match the scan results and haven’t improved with time⁶

Surgery is done to release the pressure on the sciatic nerve, either by removing scar tissue or loosening tight structures. In many cases, this can be done with a small camera (endoscopic surgery), which leads to quicker healing and fewer complications⁷.

How Physio Helps After Surgery

Physiotherapy after surgery is a key part of recovery. Even if the nerve is no longer trapped, your muscles and movement patterns still need work. We’ll help you gently rebuild strength, improve flexibility, and fix how you move so the problem doesn’t come back.

Early rehab focuses on easing pain and restoring motion, while later phases help you return to normal activity or sport with confidence.

Treatment Options for Deep Gluteal Syndrome (DGS)

As a physiotherapist, I want you to know: Deep Gluteal Syndrome can almost always be treated without surgery.

With the right mix of movement, hands-on care, and smart changes to how you move and live, most people fully recover and get back to doing what they love.

Here are the most effective tools I use in pratice:

Exercise Therapy

This is the foundation of your recovery. The goal is to take pressure off your sciatic nerve by fixing how your hips and glutes move and support your body.

We’ll focus on:

Glute strengthening (especially glute med and max)
Hip mobility exercises
Core stability
Nerve gliding (to help the sciatic nerve move freely)
Gradual return to walking, sitting, and training

Exercise helps reduce symptoms and fix the root of the problem, not just cover it up⁴.

Myofascial Release

This hands-on technique targets tight muscles and tissues deep in your hip and butt. When these tissues are stiff, they press more on the nerve. Releasing them helps reduce pain, improve blood flow, and calm the nervous system³.

Orthopedic Manual Therapy

We use specific hands-on techniques to loosen stiff joints in the hips, pelvis, and spine. If these areas aren’t moving well, they can overload the deep gluteal space. Manual therapy helps restore proper movement and reduce pressure on the nerve⁴.

Dry Needling

This technique uses fine needles to release tight knots deep in the glute muscles. It helps reduce pressure on the nerve, relieve soreness, and improve flexibility. It’s especially useful when deep muscles like piriformis are hard to reach by hand⁴.

Taping and Strapping

Taping can help support your pelvis and glutes during activity. It reduces pressure on the irritated area and can improve posture or movement during your rehab. It’s not a fix on its own, but it helps you stay active while healing.

Education and Load Management

Understanding what makes your pain better or worse is key. I’ll help you:

Change how you sit and move
Adjust your workouts or daily activity
Break up long periods of sitting
Spot warning signs early

Getting better is not just about doing more—it’s about doing the right things, at the right time.

Conclusion

As your physiotherapist, I want you to know that pain from Deep Gluteal Syndrome (DGS) doesn’t have to be something you live with. It might be stopping you from sitting comfortably, training the way you want, or just feeling like yourself—but it’s treatable.

With the right plan, some changes to how you move, and a bit of patience, you can get back to doing the things you love without that deep ache or nerve pain slowing you down.

I’ve worked with many people who felt stuck—frustrated by butt or leg pain that didn’t make sense and didn’t go away. But with consistent rehab and the right support, they didn’t just feel better—they moved better, trained smarter, and came back stronger.

If you’re ready to take that next step, I’m here to help guide you every part of the way.

Make Your Booking

Send a WhatsApp Message

About the Author

Daniel da Cruz is a licensed physiotherapist based in Sandton, South Africa. He works with patients dealing with problems such as Deep Gluteal Syndrome, hip impingement, and tendon injuries.

Using a combination of targeted exercise therapy, manual techniques, and clear education, Daniel helps people relieve pain, move better, and daily activity or return to sport with confidence.

References

Hopayian, K., & Heathcote, J. (2019). Deep gluteal syndrome: an overlooked cause of sciatica. British Journal of General Practice, 69(687), 485–486. https://doi.org/10.3399/bjgp19X705653
Kizaki, K., Uchida, S., Shanmugaraj, A., Aquino, C. C., Duong, A., Simunovic, N., Martin, H. D., & Ayeni, O. R. (2020). Deep gluteal syndrome is defined as a non-discogenic sciatic nerve disorder with entrapment in the deep gluteal space: a systematic review. Knee Surgery, Sports Traumatology, Arthroscopy, 28(10), 3354–3364. https://doi.org/10.1007/s00167-020-05966-x
Drăghici, L. M., Dumitru, R., & Popescu, D. (2023). Deep gluteal syndrome: An underestimated cause of posterior hip pain. Journal of Medicine and Life, 16(1), 8–12. https://doi.org/10.5606/tftrd.2024.14668
Kay, J., Morrison, L., Fejtek, E., Simunovic, N., Martin, H. D., & Ayeni, O. R. (2017). Surgical management of deep gluteal syndrome causing sciatic nerve entrapment: a systematic review. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 33(12), 2263–2278. https://doi.org/10.1016/j.arthro.2017.06.041
Metikala, S., & Sharma, R. (2022). Endoscopic sciatic nerve decompression for deep gluteal syndrome: A systematic review. Cureus, 14(3), e23153. https://doi.org/10.7759/cureus.23153

Deep Gluteal Syndrome: 3 Proven Fixes for Sciatic Pain

Share This: