Is It Sciatica or Something Else? Understanding the Differences Between Sciatica and Piriformis Syndrome.

Aaron S. Weinberg MD, MPhil
March 16, 2022
6 mins

If you find yourself sitting all day, or more than usual, you may start to notice some lower back pain, and then even pain that radiates down the leg. The term “sciatica,” which describes a pinched sciatic nerve, is often used by people when describing this type of pain.

And although sciatica may be the cause of your discomfort, there is another, less commonly talked about, condition — piriformis syndrome — that can cause almost identical symptoms. In this post, we’re breaking down both, so you can find the cause of your pain and feel better faster. 

Signs and Symptoms of a Pinched Sciatic Nerve

As you begin to determine whether you’re dealing with sciatica or piriformis syndrome, the first step is identifying whether you have signs of a pinched sciatic nerve. 

Common symptoms of an impinged sciatic nerve include:

     • Lower back pain that radiates through the buttocks and sometimes down the back of the leg

     • Pain in the rear or leg that is worse when sitting

     • Burning or tingling down the leg

     • Weakness, numbness, or a hard time moving the leg or foot

     • A constant pain on one side of the rear

     • A shooting pain in the leg that makes it hard to stand up

     • Pain, numbness, or tingling that radiates down the back of the leg

     • Discomfort anywhere along the nerve path of the leg

Contact your doctor immediately if you experience any of the following:

     • Sudden, severe low back pain and weakness in the leg

     • Pain that follows an injury, such as a a traffic accident

     • Difficulty controlling your bowels or bladder

     • Numbness or inability to move the leg

Although both conditions may present similarly and have similar symptoms, each has a different root cause, which is crucial in finding your solution. 

Both conditions interfere with or irritate the sciatic nerve, but sciatica results from spinal dysfunction such as a herniated disc, bone spur, or spinal stenosis. Piriformis syndrome, on the other hand, occurs when the piriformis muscle, located deep in the buttock, compresses the sciatic nerve.

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What Is Sciatica?

The sciatic nerve originates as a group of nerves near the vertebrae at the base of the spine and exits through the openings formed by the pelvis. There, those nerves join to become a single nerve that runs down through the leg. When a person has true sciatica, the nerve is pinched somewhere along the vertebral column, usually by a bulging disc or bone spur. 

What Causes Sciatica?

The most common cause of sciatica is a problem with a disc — discs are the small areas of cartilage that act as cushions between the vertebrae.

The two most common disc conditions are:

Bulging or herniated disc — A bulging disc occurs when the outer layer of cartilage protrudes out and presses onto a nerve. A herniated disc is typically due to a crack in the outer layer of cartilage and allows for the inner cartilage to protrude out of the disc. 

Bone spur — A bone spur occurs when fragments of the vertebral bone extend into the nerve. 

Sciatica can also be caused by:

     • Lumbar spinal stenosis

     • Spondylolisthesis

     • Trauma that can result in spinal cord injuries

     • Spinal tumor

What Is Piriformis Syndrome?

The piriformis muscle is a long, thin muscle that runs across the gluteal region and attaches to the femur on the outside of the hip. The piriformis muscle helps the hip rotate and bend and offers additional stability when you are standing and walking. 

Piriformis syndrome occurs when the piriformis muscle is too tight (or, very rarely, too loose) and irritates the nearby sciatic nerve. 

What Causes Piriformis Syndrome? 

There are two main types of piriformis syndrome, both with unique causes. 

Primary piriformis syndrome — Primary piriformis syndrome occurs when your anatomy is the root cause. This can be because you have a split piriformis muscle or split sciatic nerve, making it easier to become impinged. 

Secondary piriformis syndrome — Secondary piriformis syndrome is more common and occurs from a muscle spasm of the piriformis muscle, tightening or swelling of the muscle (from injury), or bleeding near the muscle. 

How Can I Tell the Difference?

You should always consult your healthcare provider for a diagnosis. However, there are simple ways to determine what might be causing your symptoms, if you are looking to try home remedies before seeing a specialist. 

In general, true sciatica will cause pain in the lower back that may radiate into the legs. Stretching, or changing positions is unlikely to change the pain. 

Piriformis syndrome will usually cause pain that begins in the buttocks. Piriformis syndrome can typically be relieved by stretching the gluteal and hip muscles. 

Both conditions can typically be managed at home by:

     • Staying active

     • Stretching and exercising

     • Using heat and cold packs

     • Using NSAIDs (Non-steroidal anti-inflammatory drugs) 

At the end of the day, you know yourself — and your own pain tolerance — best. And remember, you don't need to wait until you’re in severe pain to speak to our compassionate healthcare providers. 

At Carbon Health, we’re here to help relieve your painful symptoms, and can refer you to a specialist if needed. Book an appointment for an in-person or virtual visit today. 

 

Carbon Health’s medical content is reviewed and approved by healthcare professionals before it is published, but it is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Talk to your healthcare provider about questions you may have regarding your health or a medical condition, and before making changes to your healthcare routine.


Aaron S. Weinberg MD, MPhil

Aaron S. Weinberg, MD, MPhil, is Director of Program Development at Carbon Health and triple board-certified in Pulmonary, Critical Care, and Internal Medicine.


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