Piriformis syndrome is a clinical condition that arises as a result of compression of the sciatic nerve near the piriformis muscle. It is defined as one of the causes of non-discogenic sciatica, that is, subordinate to extraspinal problems. The piriformis muscle is one of the six short external rotators in the gluteal region of the proximal thigh and the sciatic nerve, after originating from L4-S3 roots, exits the pelvis through the great sciatic foramen, passing beneath the piriformis muscle and just above the superior gemellus. The two structures have a very intimate relationship; hence, inflammation or irritation of the piriformis muscle can tease the sciatic nerve causing classic sciatica-like pain. Since there are numerous causes that can lead to this sciatica-like/low-back pain scenario, diagnosis is not easy at all. Recent literature favors a diagnosis of exclusion through medical history combined with specific physical tests. Conservative treatment is the preferred choice, with many different possible techniques. Surgical treatment is usually reserved to specific cases refractory to healing.