Sciatica or Piriformis Syndrome

Sciatica or Piriformis Syndrome?

Sciatica and piriformis syndrome can seem quite similar, particularly in terms of symptoms, and this similarity in how they feel has caused considerable confusion for doctors and patients alike. Some individuals have stated that they are actually the same thing, but despite similarities in symptoms, the underlying causes of the two conditions are different.

Sciatica refers to irritation of the sciatic nerve, that arises from nerve roots in the lumbar spine. The most common cause of sciatic nerve irritation, or “true” sciatica is compression of one or more of its component nerve roots due to disc herniation or spinal degeneration in the lower lumbar region. Sciatica usually begins in the buttock area and, depending on the severity of the underlying nerve compression and inflammation, may extend down the entire leg to the ankle and foot.

Piriformis syndrome is sometimes called false sciatica, because, instead of actual nerve irritation, it is caused by referred pain as a result of overuse of the piriformis muscle. Piriformis attaches to the upper femur bone and then runs across the back of the pelvis to the outside edge of the sacrum, the triangular pelvic bone at the base of the spine. The symptoms of piriformis syndrome are very similar and may be indistinguishable from true sciatica.

Both conditions are caused by sciatic nerve compression and they share some common symptoms:

  • Discomfort while sitting
  • Radiating leg pain
  • Lower back pain
  • Burning pain through the back of the legs or buttocks
  • Lower back and buttocks tightness

In some cases, piriformis syndrome may cause true sciatic nerve irritation, as the sciatic nerve may run underneath or even through the middle of the piriformis, so contraction of the piriformis may produce sufficient compression of the sciatic nerve to produce actual nerve symptoms. This is one of the main sources of confusion when it comes to distinguishing true sciatica from piriformis syndrome.

As mentioned earlier, the symptoms of true sciatica are very similar to piriformis syndrome. Both cause pain, tingling, burning, “electrical shock” sensations, and/or numbness down the leg, often all the way to the foot. In addition, both sciatica and piriformis syndrome tend to be at least partially related to biomechanical functional problems in the joints of the back and pelvis and they may even be present simultaneously in the same person, so it can be difficult to tell them apart.

But since the most effective treatment for the two conditions varies significantly, it is important to determine the correct diagnosis if at all possible.

Sciatica as well as piriformis syndrome respond very well to conservative treatment.

Piriformis syndrome is caused by overuse and that happens when the tight piriformis is forced to do the work of other large muscles (like the gluteus maximus, the gluteus medius) As a treatment approach for piriformis syndrome, physiotherapy can include hands on techniques such as deep tissue massage, MET ( muscle energy techniques), dry needling and a progressive rehabilitation programme for the hip and pelvis muscles.

Sciatica treatments often depend on the severity and cause, whether it has resulted from disc herniation or degeneration in the lumbar spine. Postural advice, manual therapy, neurodynamics and cryotherapy can help managing symptoms in the acute stage and a guided strengthening programme for the core and back extensors can prevent future episodes from recurring.

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