Piriformis Syndrome vs. Sciatica Pain - Telling the Difference

What is Piriformis Syndrome?

The piriformis muscle is a muscle that runs deep to the other gluteal muscles near the hip joint and low back; because of where it is attached, it helps abduct and rotate the hip while also providing vital stabilization to the pelvis and hips with weight-bearing activities. Since the sciatic nerve runs near, or sometimes even within (depending on your body’s specific anatomy), the piriformis muscle, stiffness, weakness, or a muscle spasm can lead to nerve irritation.

Essentially, dysfunction of the piriformis can lead to sciatica.

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What is Sciatica?

The sciatic nerve is a large nerve that branches from the low back, through the glute muscles, and down the back of the leg before branching further into the lower legs and feet. When there is inflammation, stretching, or compression of the sciatic nerve particularly along the nerve root (where it exits the spine itself); it can produce debilitating symptoms in any of the areas it runs along.

Low back pain and shooting, burning, or aching sensations in the buttocks and down the back of the legs are most common.

Causes of sciatica are most often due to underlying issues related to spine degeneration, such as a herniated disc, spinal stenosis, or bone spurs in the lumbar spine (low back).

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Why the Confusion Between the Two?

With these two conditions, many symptoms overlap and lead to back pain or leg pain caused by sciatic nerve pain.

• The key to understanding the difference is knowing what is causing sciatica pain symptoms in the first place.
• It’s also important to note that while piriformis syndrome can cause sciatica, sciatica does not cause piriformis syndrome.

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How to Test for Piriformis Syndrome

The best way to determine if the piriformis is causing your sciatica symptoms is by testing the muscle itself. The orthopedic piriformis test is often used to do this and can be done in side-lying or sitting. Essentially, if putting the hip in a “figure 4” type position that stretches the piriformis reproduces the symptoms you have been experiencing, there is a very good chance that this muscle is the culprit behind your pain.

If you don’t experience a change in symptoms while stretching, or even palpating the piriformis muscle, your doctor or physical therapist can start to look at other possible causes of your symptoms that are most likely being caused by dysfunction within the low back itself. Let’s quickly review the tests:

The FAIR Test

It is also known as the flexion adduction and internal rotation test, or the side-lying piriformis test. Lie on your side with the painful hip facing up toward the ceiling. With your top hip flexed to about 60 degrees and your knee to 90 degrees, your doctor will bring your knee down toward the floor while keeping your pelvis stabilized and assess your symptoms. 

Seated Piriformis Test

Sitting in a seat while crossing the affected leg to rest the ankle on the unaffected knee can also assess piriformis involvement. While in this position, bending the trunk forward or bringing the knee closer to your chest will cause pain if the piriformis is at fault for your pain.

If these two tests do not reproduce your symptoms, it will be time to further assess the lower back to determine what is causing your sciatica symptoms. Your doctor can use tests such as a supine (lying on your back) straight leg raise or sitting slump test to further assess the root cause of your pain, such as disc herniation. Additionally, an in-depth history, physical exam, and possibly diagnostic tests like an MRI can all help you get to the bottom of your symptoms.

Getting the Right Diagnosis

Understanding what is going on in your body is vital to get started with the right treatment. While some of the basics of recovery will be similar regardless of the cause, getting a personalized recovery program that gives you long-term results all starts with a proper diagnosis. Knowing which exercises to complete and what home remedies will be most beneficial will help you quickly get the pain relief you are seeking.

To get a proper diagnosis, it is best to seek medical advice from trained healthcare professionals. Whether that’s from an orthopedic doctor or with a round of physical therapy, you can get the answers you are seeking. Get in touch with your preferred medical advisor today to start the recovery process and stop living with lower back pain and/or buttock pain.