Ischiofemoral syndrome (IFS) is an extra-articular cause of posterior hip pain from compression between the ischial tuberosity and the lesser trochanter, often involving the quadratus femoris and occasionally the sciatic nerve (“pseudosciatica”). A narrowed ischiofemoral space usually reflects anatomical factors, but does not define IFS without compatible symptoms. Pain typically worsens with adduction–extension–external rotation or long-stride walking; scoliosis, pelvic tilt changes, or limb-length discrepancy may coexist. Anteroposterior (AP) pelvic radiographs detect deformities and prior surgery; lumbosacral and long-leg films assess spinopelvic balance and discrepancy. Ultrasound is useful to guide injections; torsional studies determines femoral version. Magnetic resonance imaging (MRI) confirms quadratus femoris edema/atrophy and quantifies relevant spaces. Management is conservative first (lifts, spinopelvic care, nonsteroidal anti-inflammatory drugs [NSAIDs], physiotherapy, image-guided injections). Refractory cases may need surgery to enlarge the space—typically endoscopic lesser trochanter osteoplasty, ischioplasty, or femoral osteotomy—with selective sciatic release. Outcomes are generally favorable; main risks are transient hip-flexor weakness and rare stress fracture or nerve injury.