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Navigating Pain: Distinguishing between Sciatica and Piriformis Syndrome


9.4 - How Do I Know if I Have Sciatica or Piriformis

If you have pain in your buttock and down the back of your leg, you may wonder if you have sciatica or piriformis syndrome. These two conditions can cause similar symptoms, but they have different causes and treatments. This article explains the difference between sciatica and piriformis syndrome, how to diagnose them, and how to manage them.

What Is Sciatica?

Sciatica is not a disease but a set of symptoms caused by irritation or compression of the sciatic nerve. This nerve, the longest and largest nerve in the body, runs from the lower back, through the buttocks, down the back of the legs, and to the feet. It controls the muscles and sensations in the lower limbs.

Sciatica can be caused by various conditions that affect the spine, such as:

  • Herniated disc (also known as a slipped disc or bulging disc) – A disc is a cushion between the bones (vertebrae) of the spine. When a disc bulges or ruptures, it can press on the sciatic nerve and cause pain, numbness, tingling, or weakness in the leg.
  • Spinal stenosis – This is a narrowing of the spinal canal, which is the space where the spinal cord and nerves pass through. Spinal stenosis can result from aging, arthritis, injury, or infection. It can compress the sciatic nerve and cause similar symptoms as a herniated disc.
  • Spondylolisthesis – This is a condition where one vertebra slips forward over another. It can occur due to trauma, degeneration, or congenital defects. It can also pinch the sciatic nerve and cause leg pain.
Sciatica usually affects only one side of the body. The pain can range from mild to severe, particularly in the last stages of sciatica, and may be worse when coughing, sneezing, or sitting for a long time. The pain may also radiate to the lower back, hip, or foot.

What Is Piriformis Syndrome?

Piriformis syndrome is a condition that shares symptoms with sciatica, but its root cause lies in the piriformis muscle, which is located deep within the buttocks and runs from the lower spine to the top of the thigh bone. This muscle can tighten or spasm, leading to pain that travels from the buttocks down the leg. The pain from piriformis syndrome is often described as a dull ache and might intensify after prolonged sitting or walking. 

Piriformis syndrome can be caused by various factors that affect the piriformis muscle, such as:

  • Injury – A trauma to the hip, buttock, or leg can cause swelling, inflammation, or spasm in the piriformis muscle. This can squeeze the sciatic nerve and cause pain.
  • Overuse – Repetitive activities that involve the piriformis muscle, such as running, cycling, or climbing stairs, can cause fatigue or strain in the muscle. This can also irritate the sciatic nerve and cause pain.
  • Tightness – Sitting for long periods of time or having poor posture can cause the piriformis muscle to become tight or shortened. This can reduce the space for the sciatic nerve and cause compression and pain.

Piriformis syndrome can also affect only one side of the body. The pain is usually felt in the buttock and may spread to the lower back or leg. The pain may be worse when sitting, standing, squatting, or moving the leg outward.

How Is a Diagnosis Made?

There is no definitive test to diagnose sciatica or piriformis syndrome. Your doctor will ask you about your medical history and symptoms and perform a physical examination. The physician may also order some imaging tests, such as X-rays, an MRI, or a CT scan, to rule out other causes of your pain.

Your doctor may also perform some specific tests to differentiate between sciatica and piriformis syndrome. Examples include:

  • Straight leg raise test – You lie on your back and raise one leg at a time with the help of your doctor. If you feel pain in your lower back or leg at 30 to 90 degrees of elevation, it may indicate sciatica.
  • FAIR test – FAIR stands for flexion, adduction, and internal rotation. During this test, you lie on your side with the affected leg on top and bend it at 90 degrees at the hip and knee. Your doctor then moves your leg inward and downward while applying pressure on your buttock. If you feel pain in your buttock or leg, it may indicate piriformis syndrome.

How Are These Conditions Treated?

The treatment for sciatica or piriformis syndrome depends on the severity and cause of your pain. In most cases, conservative treatments are effective at relieving the symptoms. These treatments include:

  • Rest – Avoid activities that worsen your pain and give your nerve and muscle time to heal.
    Ice or heat – Apply ice or heat packs to the affected area for 15 to 20 minutes several times a day. Ice can reduce inflammation and swelling, while heat can relax muscle spasms and increase blood flow.
  • Medication – Over-the-counter pain relievers, such as ibuprofen and naproxen, can ease pain and inflammation. Your doctor may also prescribe stronger painkillers, muscle relaxants, or anti-inflammatory drugs if needed.
  • Physical therapy – A physical therapist can teach you exercises and stretches to strengthen your core and back muscles, improve your posture and flexibility, and reduce pressure on your sciatic nerve. The physical therapist can also use modalities, such as ultrasound, electrical stimulation, or massage, to relieve your pain and inflammation.
  • Injections – If conservative treatments do not work, your doctor may recommend injections of corticosteroids or local anesthetics into your piriformis muscle or around your sciatic nerve. These injections can reduce inflammation and pain for several weeks or months.
  • Surgery – Surgery is rarely needed for sciatica or piriformis syndrome. However, if your pain is severe and does not improve with other treatments, or if you have nerve damage or loss of function in your leg, your doctor may suggest surgery. The type of surgery depends on the cause of your pain. For example, if you have a herniated disc, your doctor may perform a discectomy or less invasive microdiscectomy to remove the disc fragment that is pressing on your nerve. If you have piriformis syndrome, your doctor may perform a piriformis release to cut or loosen the piriformis muscle that is compressing your nerve.

How Can Sciatica or Piriformis Syndrome Be Prevented?

You can take proactive steps to prevent sciatica or piriformis syndrome by taking care of your spine and piriformis muscle. Some tips include:

  • Maintain a healthy weight – Being overweight can put extra stress on your spine and piriformis muscle and increase the risk of nerve compression.
  • Exercise regularly – Physical activity can keep your muscles strong and flexible and increase your blood circulation. You should aim for at least 30 minutes of moderate exercise most days of the week. Make sure to warm up before you exercise and stretch afterward.
  • Avoid prolonged sitting – Sitting for long periods of time can tighten your piriformis muscle and reduce the space for your sciatic nerve. Take breaks every hour and move around or stretch. Also use a comfortable chair with good support and adjust the height and position of your desk and computer.
  • Use proper lifting techniques – Lifting heavy objects incorrectly can injure your spine or piriformis muscle and cause nerve compression. Bend at your knees, keep your back straight, and hold the object close to your body. You should also avoid twisting or jerking while lifting.

    Distinguishing between sciatica and piriformis syndrome can be challenging due to their overlapping symptoms. By understanding the underlying causes and characteristic features of each condition, you can take proactive steps toward seeking appropriate medical advice and managing your pain effectively. If you have persistent or severe pain that interferes with your daily activities, you should see your doctor for a proper diagnosis and treatment plan.

    If you have sciatica due to a herniated disc that is not responding to conservative treatment, a discectomy or less invasive microdiscectomy may be discussed and potentially recommended. Although this is generally a very successful procedure, having a large hole in the outer ring of the disc more than doubles the risk of needing another operation. A new treatment, Barricaid, is a bone-anchored device that closes this hole, and 95 percent of Barricaid patients did not undergo a reoperation due to reherniation in a 2-year study timeframe. This treatment is done immediately following the discectomy—during the same operation—and does not require any additional incisions or time in the hospital. 

If you have any questions about the Barricaid treatment, ask your doctor or contact us at 844-288-7474.

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