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Piriformis Syndrome vs. Sciatica
Can't tell the difference? This article will help you differentiate the two.
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Piriformis syndrome and sciatica both commonly cause symptoms that can affect mobility, daily activities, and quality of life. Both conditions share similarities.
However, piriformis syndrome vs sciatica are not the same thing. Understanding the difference between sciatic pain vs piriformis helps get the best treatment to ease symptoms.
What is Piriformis Syndrome?
Piriformis syndrome is inflammation or irritation of the piriformis muscle, which is located deep in the buttocks.
The muscle runs from the base of the spine to the quadriceps.
The muscle may become inflamed due to overuse from activities such as cycling and running. Sitting for too long can also cause inflammation of the piriformis muscle. Other causes include muscle tightness and anatomical variations, which can increase the risks of piriformis syndrome.
Piriformis syndrome is fairly common. Although studies vary, it affects about 2.4 million people in the United States.
When the piriformis muscles become inflamed and/or spasms, it can compress the sciatic nerve.
Symptoms of piriformis syndrome include:
- Pain in the glutes, which is described as a sharp or shooting pain
- Trouble sitting
- Numbness or tingling that may radiate to the legs
What is Sciatica?
The sciatic nerve originates in the lumbar region of the back. It runs down the buttocks and down the leg. Sciatica refers to nerve pain in the sciatic nerve caused by compression or irritation of a sciatic nerve root.
Sciatica pain is widespread. Research indicates that the lifetime incidence of developing sciatica is between 10% to 40%.
Sciatica can develop with a variety of conditions that cause compression and/or inflammation of the nerve and may include:
- Bulging disc
- Herniated disc
- Injury to the spine
- Bone spur
- Spinal stenosis
Symptoms of sciatica include:
- Pain from the lower back to the buttocks and down the hamstring
- Pain may feel sharp, burning, or electrical shock
- Numbness and tingling may occur
Similarities and Differences Between Sciatic vs Piriformis Syndrome
Some of the symptoms of piriformis syndrome vs sciatica are similar, but the origin of the pain may differ. Below is more information on how piriformis and sciatic are similar and different.
Similarities
- Pain: Pain may have similar characteristics in both sciatica and piriformis syndrome. Both conditions can cause pain in the buttocks and down the leg. The pain may be shooting, sharp, achy, or burning.
- Numbness and tingling: In both conditions, a tingling sensation and numbing that travels down the back of the leg can develop.
- Problems sitting: Pain in both conditions can make it challenging to sit for long periods, and sitting may also make the pain worse.
Differences
There are also differences between sciatica and piriformis, such as the following:
Pain Location
The location of the pain may differ between the two conditions, including where it originates.
- Piriformis syndrome: Piriformis syndrome originates in the buttocks. It typically causes pain in the glutes, upper thigh, and possibly the hips. However, lower back pain is less common.
- Sciatica: Sciatica originates around a spinal nerve root. The symptoms may vary depending on the affected nerve root. Usually, sciatica pain starts in the buttocks or lower back and travels down the back of the legs. It may travel all the way to the foot and toes. In some cases, the affected leg may also feel heavy.
Causes
There is also a difference between the causes of sciatica and piriformis syndrome.
- Piriformis syndrome: Piriformis syndrome occurs when the piriformis muscles spasm or become tight or inflamed. This can occur from injury, tightness, or overuse of the piriformis. When the piriformis muscle becomes irritated, it puts pressure on or compresses the sciatic nerve.
- Sciatica: Although piriformis syndrome can cause sciatic pain, it is not the only cause. Several conditions can compress the sciatic nerve, such as spinal stenosis, herniated discs, and bone spurs.
Movement
Both conditions affect mobility and movement. But it may affect it differently.
- Piriformis syndrome: Pain may worsen with specific hip movements, such as turning the leg outward or external rotation. Sitting for extended periods of time can also aggravate the pain.
- Sciatica: With sciatica, pain may worsen with back movements, such as bending forward and twisting. Standing and walking can also worsen the pain.
Diagnosis
It can be challenging to differentiate between piriformis syndrome and sciatica. The doctor will take a medical history and review symptoms. You may also undergo certain imaging tests, such as a CT scan or MRI, to help determine the cause.
It is also common for your medical exam to include a review of your gait, reflexes, and posture. Your doctor may also test for piriformis syndrome vs sciatica, such as manipulating your joints to determine which position causes discomfort.
Treatment
Treatment for piriformis syndrome and sciatica may also differ. For example, treatment for piriformis syndrome aims to reduce buttock and leg pain. This may include treatment such as:
- A few days of rest
- Physical therapy to stretch and strengthen the piriformis muscle
- Massage therapy
- Medications to relax the muscle
- Steroid injections
- Heat and cold may also help reduce symptoms
Sciatica treatment depends on the underlying cause. Usually, doctors will start with the least invasive treatment.
Sciatica treatment options may include:
- Pain medication
- Steroid injections
- Physical therapy
- Surgery
| Table header 0 | Piriformis Syndrome | Similarities | Sciatica |
|---|---|---|---|
| Pain Location | Buttocks, upper thigh, possibly hips | Buttocks, down the leg (shooting, sharp, achy, or burning) | Buttocks, lower back, down the leg (to foot and toes) |
| Numbness and Tingling | Tingling sensation and numbness down the back of the leg | ||
| Difficulty Sitting | Pain makes sitting challenging and uncomfortable | ||
| Cause | Piriformis muscle spasm, tightness, or inflammation | Compressed spinal nerve root | |
| Pain Aggravation | Worsened by hip movements (external rotation), sitting | Worsened by back movements (bending, twisting), standing, walking | |
| Treatment | Rest, physical therapy, massage, medication, steroid injections, heat/cold | Pain medication, steroid injections, physical therapy, surgery |
How to Test for Piriformis Syndrome vs Sciatica
Certain tests may also help a clinician distinguish and determine if the piriformis muscle is possibly tight and the cause of sciatica pain. Tests may include the following:
Straight Leg Raise Test
One possible test for piriformis syndrome vs sciatica is the straight leg raise.
A straight leg raise test helps assess for tightness in the hamstring muscles, irritation in the lumbosacral region, and irritation of the sciatic nerve. To perform a straight leg raise:
- Lie on your back with both legs extended.
- While keeping one leg fully extended flat on the ground, lift the other leg up towards the ceiling.
- Stop lifting the leg when you feel tightness or pain in the buttocks or back of the leg.
Sciatica vs Piriformis
If you have piriformis syndrome, you likely feel pain in the buttock, which may not travel down the leg.
In sciatica, you typically feel pain in the back of the leg, and it may radiate down the leg to the foot and toes as you raise the leg.
Pace Sign Test
The pace test helps assess the tightness of the piriformis muscle. It does not determine other causes of sciatica pain. However, it is easy to perform and may help rule out piriformis issues. To perform the pace test:
- Lie on your back with both knees bent, keeping your feet flat on the floor.
- Cross one ankle over your opposite thigh slightly above your knee.
- Slowly and gently pull your bent knee towards your chest until you feel a stretch in your glute.
Sciatica vs Piriformis:
If you have piriformis syndrome, you may feel pain in your glute when you do the test.
In sciatica, you likely will not feel pain during the move.
Inner Range Hip Rotation Test
An inner-range hip rotation test helps assess irritation and tightness in the piriformis muscle. To perform the test:
- Start on your back with both knees bent and your feet flat on the floor.
- Lift one leg and bring your knee to your chest while keeping the other foot flat on the floor.
- Slowly rotate the bent knee inwards towards the body's midline.
Sciatica vs Piriformis:
If you have piriformis syndrome, you may feel pain in your glute when rotating the knee inwards.
In sciatica, this test likely does not cause pain.
Sciatica vs Piriformis Syndrome: Know the Difference
It is helpful to understand the difference between sciatica and piriformis syndrome. Knowing the difference can help you start appropriate treatment to decrease symptoms.
Piriformis syndrome occurs when the piriformis muscle becomes tight or inflamed. Spasms and inflammation can entrap the sciatic nerve. The main symptoms are buttock and hip pain.
Sciatica refers to pain at any point along the sciatic nerve. The main symptoms are lower back pain radiating to the back of the leg. Causes can vary and include spinal stenosis and a herniated disc.
Treatment aims to reduce symptoms. In piriformis syndrome, treatment also involves muscle strengthening to prevent future episodes. Sciatica treatment may also include treating the underlying cause.
It is essential to see a medical professional if you are unsure if you have sciatica vs piriformis syndrome. In some instances, it is possible to make symptoms worse. For example, if you perform certain stretches for piriformis syndrome and you actually have a herniated disc, you may make symptoms worse.
If you have symptoms of either piriformis syndrome or sciatica that do not resolve with home treatment, such as rest, ice and heat, it is best to see a medical professional for further guidance.
About the Author
MaryAnn DePietro CRT is a licensed respiratory therapist with over 15 years of clinical experience in critical care, emergency medicine, and pulmonary rehabilitation. She is also an American Council on Exercise certified personal trainer and holds specialty certifications in orthopedics, senior fitness, and weight management. MaryAnn has a degree in Rehabilitation from Penn State University and a degree in respiratory therapy.
In addition to her clinical experience, she has written extensively about all things medical, as well as health, fitness, and aging for various websites, magazines, and newspapers.
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