Piriformis (FAIR) Test

The Piriformis Test is an orthopedic assessment to evaluate for piriformis syndrome. Specifically, compression or irritation of the sciatic nerve by the piriformis muscle or piriformis tightness in the deep buttock. It is indicated for clients with buttock pain, radiating pain down the leg, or suspicion of sciatic nerve entrapment at the hip, and is sometimes referred to as the FAIR (Flexion, Adduction, Internal Rotation) test.

How the Test is Performed

Classic Piriformis Test

  • Client position: Side-lying at the edge of the table, with the unaffected leg down (support) and the affected leg on top.

  • The hip on the tested side is flexed to about 60°, with the knee also flexed, while the lower leg stays straight.

  • The therapist stabilizes the pelvis, then applies downward pressure to the upper knee (attempting to adduct and internally rotate the hip).

  • Positive test: Pain or reproduction of symptoms in the deep buttock or radiating down the back of the thigh/leg, especially along the sciatic nerve distribution.

  • Sometimes, direct palpation over the piriformis muscle is used to increase sensitivity.

FAIR (Flexion, Adduction, Internal Rotation) Variant

  • Client position: Side-lying; affected hip flexed, adducted, and internally rotated.

  • Downward pressure is applied to the knee, increasing the stretch on the piriformis.

  • Positive: Pain at the buttock or along the sciatic nerve.

Other Variants

  • Supine version: Patient lies on back, flexes hip/knee to 90°, then examiner externally rotates hip while pushing the knee toward the table.

  • Active versions and resisted maneuvers are sometimes used for confirmation.

Clinical Significance

  • A positive Piriformis Test suggests piriformis syndrome or piriformis muscle tightness, with sciatic nerve entrapment possible in about 15% of individuals whose nerve passes through the muscle.

  • Reproduces classic buttock and radiating pain, distinguishing it from lumbar root or SIJ pathology.

  • Should be part of a comprehensive assessment including lumbar and hip evaluation, as lumbar or SIJ disorders can cause similar symptoms.

Assessment

  • Use the test for clients with deep buttock pain, radiating posterior thigh pain, sitting intolerance, or piriformis syndrome suspicion.

  • Document sidedness, symptom reproduction, and any aggravation during direct palpation for clinical records.

Treatment

  • If positive:

    • Avoid aggressive deep tissue or friction directly over the piriformis if acute pain or nerve symptoms are severe.

    • Focus on gentle myofascial release, trigger point therapy, neuromuscular re-education, and stretching of the piriformis and lateral hip.

    • Educate clients about neural flossing/mobility exercises, posture, and activity modification to avoid nerve aggravation (prolonged sitting, crossing legs, heavy squats).

    • Address sacroiliac, lumbar, and hip flexibility/mobility to relieve compensatory strain.

Safety and Referral

  • Refer clients for further assessment if pain is severe, persistent, or if there are neurological deficits (weakness, persistent numbness, bowel/bladder symptoms).

  • Collaborate with a physical therapist or medical professionals for multidimensional management in stubborn or complex presentations.