Deep buttock pain when sitting
Often sharper 20 to 60 minutes into sitting and right after getting out of the car.
Piriformis syndrome usually starts as a sharp, deep spot in the buttock. It can get worse 20 to 60 minutes into sitting, or the moment you get out of the car. Some people also feel burning or buzzing down the back of the thigh that changes with hip position more than with back movement.
The piriformis is a small muscle deep in the buttock that rotates the hip. The sciatic nerve passes just beneath it on its way to the leg. When the piriformis and the other deep rotators tighten and stay guarded, they can squeeze and sensitize the nerve. Hip mechanics and the low back can keep those muscles reactive.
I use dry needling, a form of acupuncture, directly on the piriformis and its neighbors, the obturator internus and gemelli. Easing that tension is meant to give the sciatic nerve space where it leaves the pelvis. If the nerve stays reactive once the muscle relaxes, I set fine needles beside it and run a mild current through them. This is electroacupuncture, and it aims to help the nerve signal more normally.
Most people have tried piriformis stretches, foam rolling, anti inflammatory medication and often physical therapy or chiropractic adjustments. When the nerve is part of the problem, stretching the muscle also stretches the nerve, and that can flare it. Imaging of the back and hip can show findings that aren’t the current cause, or show nothing at all. The piriformis sits deep under the gluteus maximus, where dry needling can reach it. New York does not permit PTs or chiropractors to use that tool.
My first questions are how long you can sit, which hip positions change the leg pain, and whether your back hurts on its own. Then the exam:
For piriformis syndrome I work alongside orthopedists, physiatrists and physical therapists. If your exam suggests checking back in with one of them, I’ll let you know and send along what I found.
It can be, though it’s also used loosely for any deep buttock pain with leg symptoms. I treat it as a pattern to confirm on exam. The question is whether the deep hip muscles, the nerve, the low back or the hip joint is driving it.
A disc usually irritates a nerve root in the spine, and bending the back tends to change the leg pain. With piriformis pain, hip rotation and pressure on the buttock usually matter more. I test both, because they can overlap.
It depends. If the sciatic nerve is sensitive, a hard stretch can pull on it and make things worse. I’d usually calm the muscle and nerve first, then add movement once it stops provoking pain.
I do. It sits deep, under the gluteus maximus, and needling can reach it. Settling the muscle also lessens the strain on the sciatic nerve beneath it. Often both need attention, the muscle with dry needling and the nerve with electroacupuncture.
Early on, 1 or 2 visits a week usually helps bring the irritation down. Visits taper as sitting and stairs get easier.
See a doctor promptly for weakness that’s getting worse, foot drop, loss of bladder or bowel control, or numbness in the saddle area. Fever, unexplained weight loss, recent major trauma, or severe pain that doesn’t change with position also need medical assessment first.
Adults with pelvic floor, nerve and orthopedic pain, along with neurological conditions. Most of my patients come to me after other care hasn't fully settled things. If you're looking for general wellness acupuncture, I'm not the right fit.
We review your history and what you've already tried. I assess the muscles and nerves involved, and you're treated the same day.
It depends on the condition. Pelvic and orthopedic plans usually run 4 to 6 weeks. Neurological plans are usually 2 visits a week for 6 weeks or 3 a week for 4. After that, visits space out so the changes hold. These are typical timelines, not promises.
Yes. I work alongside doctors, physical therapists and specialists. If something I find needs a closer look from one of them, I'll tell you.
I'm an out-of-network provider. You pay at the time of your visit, and my office submits the claim so any reimbursement comes to you. Free benefit checks are available before your first visit through the verification form, and HSA and FSA cards work. I don't take Medicare or Medicaid, though some Medicare Advantage plans reimburse out-of-network care. Full insurance details
Yes. I treat adults, teens and children, though I don't specialize in infants or toddlers.
Yes. Book a free discovery call to ask your questions and see whether we're a good fit.
Dry needling is a form of acupuncture. Fine needles go into tight bands of muscle and trigger points to lower muscle tension and change how the area is signaling.
You may feel a brief twitch or a deep ache as the needle reaches tight muscle. It passes quickly, and any soreness afterward usually fades within a day or two.
It's generally safe with a properly trained practitioner. Needles are sterile and single-use, and I check your health history first, including blood thinners. In New York, dry needling can only be performed by licensed acupuncturists, MDs and DOs. Physical therapists and chiropractors aren't permitted to perform it.
Eat something light beforehand and wear loose clothing that lets me reach the area being treated.
Usually not. Ultrasound helps in a few specific cases, but it hasn't been shown to improve results for common trigger points. A careful hands-on exam is what guides the needle. More on ultrasound-guided dry needling
Dry needling aimed at the pelvic floor and the hip and abdominal muscles around it, for pain, tension and urinary symptoms driven by those muscles and their nerves. More on pelvic floor dry needling
Sometimes, depending on the muscles involved, and you'll be draped throughout. Treatment always follows your consent and comfort. I don't do internal exams or internal treatment.
No, though it helps if you've already seen a doctor or pelvic floor physical therapist. Bring any notes or imaging you have.
Completely. I've heard it all, and there's no judgment here, just a straightforward conversation so we can treat what's going on.
Yes, I treat adults of every gender and identity. After gender-affirming surgery involving the pelvis, bring your surgical notes and we'll decide together what fits.
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Evidence-based acupuncture and dry needling on the Upper West Side. From chronic pain and headaches to pelvic floor dysfunction, Dr. Jordan Barber pairs the highest level of training with care that actually listens.
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