Pain in the buttock that radiates down the leg is often referred to as “sciatica.” But in some cases, the pain may be caused by something else – namely piriformis syndrome.
Although the symptoms may be similar, the cause is not necessarily the same. Therefore, it is important to know the difference between sciatica and piriformis syndrome so that treatment can be targeted correctly.
Sciatica and piriformis syndrome can cause similar symptoms, but the cause is different. Sciatica typically originates in the lower back, while piriformis syndrome is caused by a tight muscle in the buttock that irritates the sciatic nerve.
The right treatment depends on the correct assessment. That's why it's important to investigate where the pain actually originates - so that the efforts can be targeted precisely.
What is sciatica?
Sciatica is not a diagnosis in itself, but a term for pain that follows the course of the sciatic nerve. The sciatic nerve is the body's largest nerve and runs from the lower back, through the buttock and down the back of the leg.
When talking about sciatica, the pain is often caused by irritation or pressure on a nerve root in the lower back. This can happen, for example, through:
- Disc herniation
- Wear and tear changes in the back
- Changes in the joints of the vertebrae
Typical symptoms of sciatica are:
- Pain from the lower back down the leg
- Radiating or stabbing pain
- Tingling or sensory disturbances
- Possible decreased strength in the leg
The pain may worsen by coughing, sneezing, or sitting for a long time.
What is piriformis syndrome?
Piriformis syndrome (often incorrectly spelled piriformis syndrome) is a condition in which the small piriformis muscle in the buttock irritates or presses on the sciatic nerve.
The piriformis muscle is located deep in the buttock and helps rotate the hip. In some people, the sciatic nerve runs very close to – or in rare cases, through – the muscle. If the muscle becomes tight or overworked, it can irritate the nerve.
Symptoms of piriformis syndrome may include:
- Deep pain in the buttock
- Pain when sitting for long periods of time
- Radiating pain in the back of the thigh
- Tenderness when pressed in the buttock
Unlike classic sciatica, the problem does not originate from the lower back, but from the muscles in the buttock area.
How do you differentiate between sciatica and piriformis syndrome?
It can be difficult to tell the difference yourself, as both conditions can cause pain down the leg.
However, there are some typical differences:
| Sciatica | Piriformis syndrome |
|---|---|
| Often starts in the lower back | Typically starts in the buttock |
| Can cause sensory disturbances and loss of strength | Rarely, power loss |
| Often related to disc or spinal changes | Related to muscle tension |
| Worsens when straining the back | Worsens when sitting and putting pressure on the buttock |
A thorough examination can help determine whether the pain is originating from the back or from the piriformis muscle.
Why does piriformis syndrome occur?
Piriformis syndrome is often seen in:
- Very sedentary work
- Unilateral training
- Run
- Poor hip or pelvic stability
- Compensation after injury
Sitting for long periods of time can directly strain the muscle, especially if you sit crookedly or with your legs crossed.
Treatment of sciatica
Treatment depends on the cause. If sciatica is caused by pressure from a herniated disc or other spinal changes, the focus is typically on:
- Pain relief
- Gradual movement
- Stabilizing exercises
- Load guidance
- Massage
In the vast majority of cases, the condition improves over time without surgery.
Treatment of piriformis syndrome
With piriformis syndrome, the focus is often on loosening and relaxing the tense muscle and improving movement patterns.
Treatment may include:
- Manual treatment and massage
- Stretching the piriformis
- Exercises for the hip and pelvis
- Adjusting seating positions
- Gradual building of stability
Here, targeted treatment can often provide relatively quick relief if the cause is primarily muscular.
When should you seek an assessment?
If the pain:
- Radiates down the leg
- Is persistent
- Causes sensory disturbances
- Affects your daily life
...it might be a good idea to get a professional assessment.
It is especially important to react if there is a decrease in strength in the leg or problems with bladder or bowel function - in such cases, you should seek medical attention.
