Chronic and severe back pain affects an estimated 16 million Americans and can often be debilitating. Treatments for lower back pain differ greatly depending on where the pain is coming from and what caused it. Simply put, not all back pain is equal. Two types of back pain can cause real issues for people. They are piriformis syndrome and sciatica pain. So, let’s look at the differences: piriformis syndrome vs sciatica.
Sometimes, a slipped disc can cause nerve compression and a radiating sensation. In other cases, a pulled muscle can lead to weeks of discomfort and rehab. Understanding where your back pain comes from can bring you closer to seeking the proper care and getting a better quality of life.
However, many cases of back pain can be traced back to one tricky anatomical item, the sciatic nerve. Most instances of damage or compression to the sciatic nerve are called sciatica. The bad news? The sciatic nerve is the longest in the body, meaning it not only radiates pain throughout multiple areas of the back and legs but can also be compressed or damaged at multiple points. The two most common places for the sciatic nerve to be compressed are the lumbar vertebrae and the piriformis muscle.
What Is Piriformis Syndrome?
Sciatica refers to pain symptoms caused by a compressed sciatic nerve, while piriformis syndrome is caused by sciatic nerve compression in the buttocks. This type of pain occurs near the piriformis muscle. Knowing piriformis syndrome vs sciatica pain can help you establish your issue and find a solution faster. The piriformis muscle is one of several deep tissue muscles within the hips and buttocks, primarily responsible for abducting (a.k.a. spreading) the legs.
It originates at the lowest portion of the spine and attaches to the top of the femur. When these muscles contract, they help you pull your legs apart and rotate your hip. Furthermore, the piriformis muscle also plays a central role in turning your leg and foot outward. Its position is essential in the context of back pain because the piriformis muscle inserts itself just above the greater sciatic notch. This is a space for the sciatic nerve to run through the hips and down each of your legs.
Remember, the sciatic nerve also originates in the lower back – although it develops higher up, closer to your navel. Involuntary contractions, or spasms, can cause an abnormally long period of contraction. This long-term swelling can compress and damage the sciatic nerve as it runs underneath the muscle. The resulting nerve pain from a compressed sciatic nerve is called piriformis syndrome. When your piriformis muscle contracts, it becomes shorter but thicker.
Piriformis Syndrome vs. Sciatica
In many ways, there is very little difference between piriformis syndrome and sciatica. However, that difference significantly changes how a patient receives back and leg pain treatment. Most doctors may refer to sciatic pain as sciatica. Still, the technical term for most cases of sciatica is lumbar radiculopathy or nerve compression in the lower back’s portion of the spine. Piriformis syndrome is technically a form of sciatic pain, but not sciatica. However, where most cases of sciatica would involve treatment of the area surrounding the lower back, a matter of piriformis syndrome would require addressing the hips and buttocks instead.
Piriformis Syndrome vs Sciatica Treatment Differences
Sciatica treatments target the lower back, even though the pain can travel down to the buttocks and legs. Treatment of sciatica differs depending on the severity of the condition – in most cases of lumbar radiculopathy, the compression is caused by swelling from a herniated or damaged disc. Disc herniation can occur more often with advanced age and may pass with proper rest and recovery. If the swelling fails to die down, however, your doctor may need to recommend specialized treatment, such as local injection, corticosteroids, and nerve blocks to address the inflammation.
Painkiller injections can also help provide temporary yet lasting relief in cases of severe sciatica, especially if the pain is recurring. Other obstructions can also cause sciatica in the spine. Spinal stenosis, or a narrowing of the spine’s nerve gaps, can cause pain in the back and limbs. Sometimes, this can develop unwanted bony growths, called bone spurs. Removing these can help relieve sciatic pain. Treatment for stenosis may require more immediate interventions, including surgery. Piriformis syndrome, on the other hand, is usually caused by an irritation of the piriformis muscle.
This irritation might be anything from a sports injury after a period of inactivity to pulling a muscle or internal bleeding. Sedentary patients are more likely to develop piriformis syndrome, as the muscle is more vulnerable to tearing or other forms of injury. Differentiating between the two is essential because not only are the treatments different, but the pain relief methods differ as well. For example, stretching that might help sciatica patients at home could worsen piriformis pain. However, self-diagnosis can be very difficult because sciatica and piriformis syndrome share the most symptoms. If you are experiencing unilateral (one-sided) back and leg pain, go to a doctor.
Recognizing Piriformis Syndrome
There are several different ways to diagnose piriformis syndrome or sciatica. A physical examination is usually the first step. Your doctor may ask you to perform several stretches on the exam table to rule out one. In addition, they will figure out whether you may have any symptoms that could indicate a third option, such as sacroiliac joint dysfunction or lumbar disc disease. After a physical examination, a doctor may recommend imaging to better look at your spine and hips. This advice may help them recognize other potential causes of your pain, including tumors.
Rest, physical therapy, and over-the-counter pain medication are crucial in treating sciatica and piriformis syndrome. But when further medical interventions are needed, treatments can differ significantly. Surgery may become necessary in severe cases, especially when spinal instability, large bone spurs, or a potential tumor are identified as root causes of your pain. Seeking medical attention as early as possible is your best bet for receiving the proper care and getting rid of your pain.
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