Is It Sciatica or Piriformis Syndrome? Why a Precise Diagnosis Matters

One of the most common and frustrating conditions we see at our Weston clinic is that sharp, radiating pain that travels from the lower back or glute down the leg. While most people call this "sciatica," the term is often used as a catch-all for two fundamentally different problems: true sciatica and piriformis syndrome.

Choosing the wrong treatment protocol for your specific condition will, at best, provide no relief and, at worst, could make the problem worse. A thorough, professional assessment is non-negotiable.

True Sciatica: A Problem at the Source

• The Cause: True sciatica originates in the spine. It occurs when a herniated or bulging disc in your lower back (the lumbar spine) directly compresses the sciatic nerve root as it exits the spinal column. This is also called lumbar radiculopathy.
• Common Symptoms: Pain that follows a specific nerve pathway down the leg, numbness or tingling in the foot, weakness in specific muscle groups.
• The Treatment: The goal is to decompress the spinal nerve. This is achieved through targeted chiropractic adjustments, spinal decompression therapy (traction), and specific core stabilization exercises to protect the disc.

Piriformis Syndrome: The Impostor

• The Cause: This condition mimics sciatica but starts in the glute. The piriformis is a small, pear-shaped muscle deep in your buttocks. In some individuals, the sciatic nerve runs directly through this muscle. If the piriformis becomes tight, inflamed, or spasms, it can physically entrap and irritate the sciatic nerve, causing the same radiating pain.
• Common Symptoms: Pain that worsens with prolonged sitting, tenderness deep in the buttock, pain that improves with walking but returns with sitting.
• The Treatment: The goal here is to release the tight piriformis muscle. This is achieved with targeted soft-tissue therapies like Class IV Laser or Shockwave Therapy, combined with specific gluteal stretching and strengthening exercises.

Why the Right Diagnosis is Everything

As you can see, the treatments are completely different. Applying spinal decompression for piriformis syndrome will do nothing, just as stretching the glute will not fix a true disc herniation.

Our comprehensive clinical evaluation uses orthopedic and neurological testing to pinpoint the exact source of your nerve irritation. By distinguishing between these two conditions, we ensure you receive the precise, effective treatment that will end your leg pain once and for all.

How We Differentiate

| Test | True Sciatica | Piriformis Syndrome | |------|---------------|---------------------| | Straight Leg Raise | Positive (reproduces leg pain) | Usually negative | | FAIR Test | Negative | Positive (pain with hip flexion/internal rotation) | | Tenderness Location | Lower back, along spine | Deep in buttock | | MRI Findings | Disc herniation visible | Normal spine |

Learn more about our full range of solutions on our main Sciatica Treatment page.