Sciatica vs. Piriformis Syndrome: How Are They Different?

Your sciatic nerve is the largest nerve you have. It starts in your low back and branches out to your hips and buttocks before running down your legs.

When something compresses this nerve, you can develop pain in your low back, buttocks, and legs. Several conditions can trigger this pain, including sciatica and piriformis syndrome. 

At Anthony Echo, MD, with multiple offices in Houston, Texas, our nerve specialist understands how easy it is to confuse these two conditions. But although they cause similar symptoms, sciatica and piriformis syndrome require different treatments. 

Keep reading to learn what you need to know to make sure you get the right care for your pain.

What is sciatica?

You develop sciatic neuritis, which most people call sciatica, when your sciatic nerve gets compressed by your spine. Sciatica usually starts in the lower back or buttocks and travels down the back of one leg. 

This pain may feel like a shooting, electric pain, a stabbing sensation, or it can be dull or achy. Sciatica usually worsens after sitting or standing for extended periods, when you walk, and after you cough or sneeze. While any person can get sciatica, your risk increases if you:

• Are over 30
• Are mostly sedentary
• Are overweight or obese
• Have diabetes
• Have a job that requires lots of sitting or standing
• Have a job that necessitates heavy lifting or twisting

Most often, a problem in your back triggers the condition. Some common causes of sciatica include herniated discs, spinal stenosis, spondylolisthesis, infection, and inflammation. Pregnancy may also trigger symptoms of sciatica, as can the wear and tear associated with aging. 

Treating sciatica

Treatments for sciatica vary. Mild cases of sciatica often resolve on their own and with lifestyle changes that address the underlying causes (e.g., losing weight, exercises, controlling blood sugar). Sometimes, therapeutic stretching, ice or heat therapy, and spinal adjustments or decompression help. 

What is piriformis syndrome?

You develop piriformis syndrome when the piriformis muscle in your buttocks compresses your sciatic nerve. If you hurt or irritate the piriformis muscle, which rests over the sciatic nerve, it can swell, tighten, or spasm.

The result? The muscle compresses the sciatic nerve and creates painful sciatica-like symptoms, including:

• Acute tenderness in the buttocks
• Dull achiness in the buttock
• Sciatica-like pain down the leg 
• Pain that worsens going uphill or up stairs
• Pain that worsens with sitting or standing for long periods
• Reduced range of motion in your hip joint

Although anyone can develop piriformis syndrome, some factors increase your risk, including: 

• Over-exercising/overuse (e.g., running)
• Injury or trauma to the muscle
• Previous surgery in the area
• Sitting for extended periods
• Lifting heavy objects

There’s no single test to tell you which condition you have, so it’s important to schedule an appointment with a provider who specializes in nerve disorders like Dr Echo if you have symptoms of either sciatica or piriformis syndrome.

Treating piriformis syndrome

Your treatment begins with an accurate diagnosis. Unfortunately, there’s no single test to tell you which condition you have. 

As an expert in peripheral nerve surgery and microsurgery, Dr. Echo has the training and knowledge needed to diagnose the root cause of your pain. With an accurate diagnosis in hand, Dr. Echo creates your customized piriformis treatment plan. 

It’s important to know that Dr. Echo begins with the least invasive treatment possible. For example, he may recommend trying heat or ice therapy, pain medicines, physical therapy or massage before moving on to more aggressive modalities. 

If your piriformis syndrome doesn’t respond to these conservative approaches, Dr. Echo may recommend trying Botox® injections, corticosteroid injections, or transcutaneous electrical nerve stimulation to ease your discomfort. 

When piriformis syndrome symptoms don’t respond to these treatments, Dr. Echo may suggest surgery to decompress the sciatic nerve. During this procedure, he strategically cuts your piriformis muscle, releasing the tendon that’s causing your nerve compression. 

Can other conditions look like sciatica or piriformis syndrome?

Yes. Sometimes a rare condition called ischiofemoral impingement (IFI) can also cause pain similar to sciatica and piriformis syndrome. 

IFI gets its name from the ischiofemoral space, between the upper part of your femur and the lower part of your pelvic bone. Your quadratus femoris muscle sits between these bones and works to move your hip out. 

When the ischiofemoral space is too narrow, it can pinch this muscle and trigger symptoms. As with the other conditions, we typically first recommend conservative therapies, like stretching and physical therapy.

IFI usually resolves with less invasive treatments, but surgery may be required if you don’t find relief. 

For an accurate diagnosis of your buttocks or back pain, schedule an appointment at the Anthony Echo, MD, office in Houston, Texas, nearest you.