The Difference Between Sciatica and Piriformis Syndrome

The Difference Between Sciatica and Piriformis Syndrome

Pain in the lower back and buttocks is often accompanied by a burning or tingling sensation, and is frequently diagnosed as sciatica. However, piriformis syndrome may sometimes be the cause instead.

The two conditions share some of the same symptoms in common:

  • Discomfort when sitting
  • Radiating leg pain
  • Lower back pain
  • Burning pain at the back of the legs or buttocks
  • Tightness in the lower back and buttocks
  • Pain during hip and knee movement

Knowing which condition is the root cause of your pain and discomfort is essential for effective treatment. A wrong diagnosis can delay recovery, costing extra time and money, and unnecessarily prolonging your pain.

Piriformis Syndrome vs Sciatica: What is the Difference?

Sciatic nerve compression is responsible for pain in both of these conditions, with lower back pain often being the most pervasive symptom. However, the two conditions have distinct characteristics.

Piriformis Syndrome vs Sciatica: What is the Difference?

Sciatica often arises from a herniated disc or degeneration of the lower spine that places pressure on the sciatic nerve roots in the lumbar vertebrae. Because the sciatic nerve is the longest nerve in your body, traveling from the lumbar spine, down your legs and all the way to your feet, compression at the nerve root can manifest as pain anywhere along its path.

Piroformis syndrome also compresses the sciatic nerve, but at a location farther along its path. Pressure on the nerve is caused by swelling or tightening of the piriformis muscle, a small muscle located deep in the buttock, behind the gluteus maximus. In some cases, a fibrous band forms within the piriformis, entrapping the sciatic nerve and preventing it from gliding freely during normal hip and knee movement. Entrapment can cause painful stretching of the nerve. In physically active people, piriformis syndrome is often caused by overuse during sports or exercise.

Sciatica Diagnosis

To determine whether sciatica or piriformis syndrome is causing lower back pain, your doctor will do a physical exam and review your medical history. Imaging may help to differentiate between the two conditions, although piriformis issues are not likely to appear on images due to the muscle’s location deep within the buttock.

Piriformis Syndrome is usually diagnosed by reported symptoms, including significant pain or extended numbness when straightening the legs. Some patients suffer from both sciatica and piriformis syndrome. About one in seven people have a sciatic nerve that passes straight through the piriformis muscle instead of beneath it, making nerve compression more likely.

Recent experience and research with high resolution ultrasonography indicates that piriformis syndrome is relatively rare . Pain in that region more commonly arises from sciatic nerve compression elsewhere in the lumbo-pelvic region.

At NYDNRehab, our diagnosis is based on high resolution diagnostic ultrasonography, integrative motion analysis, and thorough clinical assessment.

Physical Therapy for Sciatica

Sciatica treatment at NYDNRehab combines physical therapeutic techniques with ultrasound guided dry needling or guided steroid injections, along with ultrasound guided neuromodulation. For disc-related sciatica we add the flexion distraction method to those therapies. This method was recently updated and transformed by a new technology.


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Sciatica treatments often depend on how severe the physical damage is, and whether that damage has resulted from disc herniation or something else. Anti-inflammatory medication and regular visits to physical therapy are often effective for managing symptoms. Some cases are so severe that they require treatment with surgery or other medications, including steroid injections. However, research shows that long-term outcomes are similar for conservative care and surgery.

Treatment for Piriformis Syndrome

Piriformis Syndrome is generally simpler to treat than sciatica. Physical therapy is sufficient in most cases to manage the symptoms, and chiropractic care can also lessen pain. Anti-inflammatory medications or ultrasound guided Botox injections may also help, but they are often not necessary. Nerve flossing exercises can help release an entrapped sciatic nerve, and certain stretches may help relax the piriformis.

About the Author

Dr. Lev Kalika is clinical director of NYDNRehab, located in Manhattan. Lev Kalika is the author of multiple medical publications and research, and an international expert in the field of rehabilitative sonography, ultrasound guided dry needling and sports medicine Dr. Kalika works with athletes, runners, dancers and mainstream clients to relieve pain, rehabilitate injuries, enhance performance and minimize the risk of injuries. His clinic features some of the most technologically advanced equipment in the world, rarely found in a private clinic.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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