When it comes to piriformis vs sciatica, while these two terms are sometimes used interchangeably, the conditions are not the same and differ in terms of causes, symptoms, and treatments. Understanding the differences between piriformis vs sciatica can give you a greater awareness of how your back pain and leg pain can intersect, how specific postures and movements can result in more significant discomfort or relief, and how spinal conditions can affect not just your back but your feet, your fingers, and your ability to balance.
Piriformis vs Sciatica Key Differences
Because the sciatic nerve also runs underneath the piriformis muscle, both conditions result in similar symptoms. Here’s how they differ:
Piriformis is named after the piriformis muscle, one of the deeper muscles in the hips responsible for hip rotation. If you were to picture your pelvis and leg bones, piriformis would run from the sacrum (bottom of the spine) over the pelvic bone, attaching at the top of the femur (thigh bone). When contracted alongside other muscles, the piriformis plays a role in externally rotating the thigh (i.e., turning your knee outward).
Sciatica, on the other hand, is a form of lumbar radiculopathy, or the impingement of nerve roots along the lower portions of the spine (the lumbar region). It is called sciatica because the nerve roots most often affected by problems in the lumbar region conjoin to form the sciatic nerve, the longest nerve in the human body. This nerve runs along the lower back and hips into the calves, splitting into smaller nerves through the feet.
What Is Piriformis Syndrome?
Piriformis syndrome is a type of nerve impingement. While it does have its name, it is not formally recognized as a separate condition – medically. Piriformis syndrome is simply a form of sciatic nerve impingement. This is why it’s a syndrome (i.e., a collection of symptoms) rather than a formal diagnosis. The main difference between a case of piriformis syndrome and a case of sciatica is that one involves an impinged nerve, while the other involves a compressed or affected nerve root.
While symptoms are similar across both conditions, there are a few significant differences and wildly different causes. Piriformis syndrome occurs when an inflammation, injury, or prolonged/unwanted contraction of the piriformis muscle results in damage or compression to the sciatic nerve. Symptoms will usually include pain in the hips and buttocks, especially around the inner portion of the muscle where the piriformis is found – as well as secondary pain symptoms running down a single thigh and leg.
While piriformis syndrome can sometimes be identified through damage or inflammation in the soft tissue of the buttock, it can still be challenging to spot in most imaging technology. It may be best determined through physical tests. For example, cases of piriformis syndrome may differentiate themselves from instances of sciatica through how pain responds to specific postures and physical activities, including:
- Effects of sitting;
- Certain hip movements;
- Walking up or down stairs;
- Moving up or down an incline;
- Raising and lowering legs while lying down.
Suppose your doctor suspects that your hip or leg pain results from a piriformis-related impingement. In that case, they may ask you to perform specific movements to determine whether your piriformis is injured, inflamed, or otherwise hurt and whether that could be causing your leg pain. Most cases of piriformis syndrome are resolved through rest and recovery, which may include rehabilitative exercises and anti-inflammatory medication.
What Is Sciatica?
Sciatica is a pain symptom with many different causes, all of which relate to the lower portion of the spine. Unlike piriformis syndrome, where the nerve itself impinges, sciatica occurs when the nerve roots of the sciatic nerve are damaged or compressed along their origin points in the lumbar spine. The spine itself is a bony column of individual spinal joints or vertebrae. Each vertebra has its foramina, or gaps, where the spinal cord branches off into the rest of the peripheral nervous system. The nerve roots that run through these foramina can be compressed by multiple different things, including:
- Herniated disc;
- Compressed fracture;
- Unstable or slipping disc (spondylolisthesis);
- Narrowing in the gap caused by bony growth (spinal stenosis).
Some of these conditions go away independently and are the most common causes of sciatica. But some of these causes are much more severe and can worsen progressively. This is why most unprompted back and leg pain go away on their own after a few days. This can lead to rapidly recurring cases of sciatic pain or sciatica that worsen and eventually result in loss of feeling or paralysis as the nerve roots are damaged. Diagnosing sciatic pain is not very difficult, but diagnosing the exact cause can take time and multiple tests. A doctor may need to utilize special imaging techniques to determine whether your:
- Foramen is closing;
- Spine has been fractured;
- Discs have become enlarged.
Among other potential causes. Because many cases of sciatica go away on their own, a doctor might only resort to imaging tests if the pain becomes chronic, recurring, or severe.
Is Sciatic Pain Permanent?
Sciatic pain does not always go away on its own. Conditions like degenerative disc disease can make herniated or inflamed discs – the spongy tissue between your spinal joints – more common. Age and wear and tear on the cartilage between your bones (osteoarthritis) can accelerate episodes of sciatic pain.
Over time, more care is needed to manage growing pain symptoms and loss of mobility. But some cases of sciatica are more severe than others and require immediate medical intervention. In these cases, sciatic pain could be a precursor to worse symptoms, including loss of feeling. Symptoms to watch out for include:
- Loss of feeling in one limb;
- Sudden spike in pain severity;
- Loss of bladder or bowel control;
- Back and leg pain coupled with a fever;
- Spreading numbness and loss of strength.
Suppose your sciatic pain is chronically recurring, yet your spine is stable. In that case, your doctor may recommend a comprehensive pain management plan to reduce pain symptoms while going through a treatment plan to address underlying causes.
Can Exercise Help Ease Sciatic Nerve Pain?
Physical rehabilitation and therapy are core treatment modalities for nerve impingement. A supervised and specialized exercise plan can reduce pain symptoms and help improve mobility and reduce the likelihood of recurring symptoms and future spinal problems. Not all cases of sciatica are appropriately addressed through exercise, though.
Some require other medical interventions before an exercise plan can be considered safe, including – in some instances – surgery. For example, an unstable spine, benign tumor, or progressively narrowing gap in the spine may require different surgical interventions to address instability, remove the compressing tissue, or make more space.
When comparing piriformis vs sciatica, both involve the sciatic nerve and may affect pain symptoms in the hips and legs. However, sciatica is often associated more with back pain than hip pain and vice versa for piriformis. Furthermore, each condition has multiple distinct causes, with very different treatment approaches despite similar symptoms. Do not try to self-diagnose your back pain or leg pain – always consult a spine specialist first.