Sciatica vs. Piriformis Syndrome

Sciatica vs. piriformis can often be mistaken for one another. There are some differences, however, so read on to learn more.

Do you ever feel a nagging pain down one side of your body? Do you frequently find yourself sitting or walking awkwardly because of a numb feeling in one buttock or leg? Do you come home from work some days with a little less strength or feeling in one foot? Then you may be affected by spinal nerve compression, or what doctors sometimes call radiculopathy.

Numbness, weakness, pain, or loss of feeling down one leg or side is often caused by a compressed or pinched nerve near the lower back, called the sciatic nerve. This type of lumbar radiculopathy is sometimes also called sciatica. But the lower back isn’t the only spot in the body where the sciatic nerve can be pinched.

What is Piriformis Syndrome? What is Sciatica? 

The piriformis muscle is a deep muscle in the buttock region that looks a little bit like a long ribbon stretching from the top of your thigh bone (the femur) to the inner hip.

This muscle is part of a complex of muscles responsible for spreading your legs or leg abduction. It is conveniently located just about right where we happen to put a lot of our weight when sitting. This is further exacerbated by sitting on something hard or compact. This can include a wallet, a phone, a keychain, a pocketbook, and so on.

Piriformis syndrome occurs when pressure or compression causes the piriformis muscle to spasm, which can cause pain and discomfort. Additionally, cramping in the piriformis muscle can also pinch the sciatic nerve underneath, simulating many sciatica symptoms caused by nerve compression in the lower back.  

These conditions aren’t exclusive to the elderly or the sedentary. They can occur quite frequently during pregnancy and can also occur due to long work hours and harsh labor. Sciatica is most often caused by a herniated disc, a swollen or ruptured spinal disc, one of the jelly-like structures found between each vertebra. Meanwhile, piriformis syndrome is simply a cramped muscle, which can occur for any number of reasons.

Spotting the Difference Between Sciatica vs. Piriformis

If sciatica describes a pinched nerve in the lower back, and piriformis syndrome describes a muscle spasm that can cause pinching of the same nerve lower down, how can the average patient tell the two apart?

Well, there are a few distinctions that can help you spot the difference between sciatica and piriformis syndrome. While you should always visit a doctor to get a professional diagnosis and confirm any suspicions you might have, there are a few self-test tips you can use to differentiate between sciatica and piriformis syndrome. These will help determine whether your leg pain and numbness originate around the buttock or spine. Here’s how you do it:

• First, assume a seated position. Is the pain worse? Do you have numbness or pain specifically in your buttocks or hamstrings while sitting? If the answer is yes, it could be piriformis syndrome. If no, it may be sciatica.
• If yes, begin probing these muscles carefully. Suppose you feel more significant discomfort when probing the middle of your buttock, roughly where the piriformis muscle might be (just about on top of where you might usually be sitting). In that case, this could further indicate piriformis syndrome.

Another test you can do is the straight leg test, alone or with an assistant. Begin lying face-up on a hard surface, and slowly raise one leg (while keeping your knees locked out and legs straight) until it becomes perpendicular to the floor. If you feel more pain at 30 and 90 degrees from the floor, your condition may be caused by an irritated or cramped piriformis muscle.

Ultimately, your best move is to confirm your suspicions with a doctor. Piriformis syndrome can occur without sciatica symptoms, but when the muscle does compress the sciatic nerve, it can also hide potential disc herniation higher up on the nerve’s roots. A doctor can perform the necessary imaging tests to confirm whether your spine or muscles may be the culprit behind your numbness and pain – or whether it’s a bit of both. So how do you treat sciatica vs. piriformis? Let’s find out.

Treating Sciatic Pain 

The sciatic nerve is the longest and largest in the body, innervating your muscles all the way down from the lower back and sacrum to the feet. As such, pain and numbness in one leg or buttock are some of the most common complaints in older patients or patients with a history of spinal conditions.

Thankfully, the vast majority of sciatica cases and piriformis syndrome cases respond incredibly well to conservative treatments. This means you don’t have to do much to get better – you can start by helping your body sort the issue out itself.

If you are experiencing sciatica, your doctor may recommend rest, heat or cold therapy, specific stretches, over-the-counter pain medication, limited bed rest, and prescribed physical activity.

Of course, not all cases of sciatica or piriformis syndrome resolve themselves quickly or easily. There are times when more invasive treatment options are necessary, such as when the pain is lasting multiple weeks on end or when it’s becoming severe, to the point that you have difficulty moving.

Extreme pain, weakness, loss of bowel and bladder control, and loss of mobility constitute medical emergencies. Any of these symptoms necessitate a visit to the emergency room. 

Long-term Pain Management

If over-the-counter pain meds and ice packs aren’t doing the trick, and the pain isn’t going away, then a doctor may refer you to a pain specialist to continue treating the condition.

Chronic back pain, including sciatica and frequent disc issues, may be treated via long-term pain management and targeted physical therapy. Rather than providing you with a few stretches to do at home, you may be asked to go to physical rehab at least once or twice a week for massages, stretching, and strengthening exercises.

Pain management options may expand to include antidepressants and opioid or non-opioid painkillers, as well as temporary nerve blocks or nerve stimulation in cases of sharp pain and discomfort.

Treating the underlying condition is just the first step, whether you’re struggling with piriformis syndrome or sciatica. These conditions can be prevented through continued physical therapy and strengthening, and a few key lifestyle changes. Lower body fat, a healthy diet, quitting smoking, and moderate exercise can significantly reduce the risk of sciatic pain in the future and delay other similar conditions. If you have more questions about sciatica vs. piriformis, get in contact with our pain specialists.