The Difference Between Piriformis Syndrome and Sciatica

Syndrome  and Sciatica

Lower back manifests in a variety of ways. Back pain that’s characterized by numbness or by a burning or tingling sensation is frequently diagnosed as Sciatica. However, Piriformis Syndrome might be the cause instead. These are some of the symptoms the two conditions share:

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

Piriformis or Sciatica
What’s the Difference?

For both of these conditions, pain is caused by sciatic nerve compression, and lower back pain is often the most pervasive symptom. Invisible piriformis muscle issues, such as overuse, can cause Piriformis Syndrome.

When compression is directly related to specific, identifiable physical issues, including disc herniation and lower lumbar spinal degeneration, the correct diagnosis may be Sciatica.

Piriformis syndrome vs sciatica
What Causes It?

If a medical professional suspects that Sciatica or Piriformis Syndrome is causing lower back pain, they may order diagnostic tests, which include a standard physical exam and imaging tests. When imaging tests are necessary, they may include an MRI, CT scan or spinal x-ray. The physical causes of Sciatica may appear on these imaging tests.

Piriformis Syndrome won’t be evident on these imaging tests, and no definitive tests for the condition exist. Instead, Piriformis Syndrome is usually diagnosed by reported symptoms, including significant pain or extended numbness when straightening the legs.

These two conditions aren’t mutually exclusive. Some patients suffer from both Sciatica and Piriformis Syndrome.

Approximately one person in seven has a sciatic nerve that passes straight through the muscle instead of underneath it, which makes nerve compression more likely. In these individuals, Piriformis Syndrome is much more likely to be the correct diagnosis.

The Difference Between Piriformis Syndrome and Sciatica

Recent experience and research with high resolution ultrasonography proves that piriformis syndrome is a very rare occurrence. Pain in that region more commonly comes from sciatic nerve compression elsewhere in the hip. Our treatment is based on the integration of diagnostic ultrasonography and motion analysis, combined with thorough clinical assessment. We combine physical therapeutic techniques with ultrasound guided dry needling or guided steroid injection and ultrasound guided neuromodulation. For disc-related sciatica we add flexion distraction method to those therapies. This method was recently updated and transformed by a new technology.

Treatment for Sciatica
What Type of Doctor to See

Sciatic nerve compression causes both conditions, but the exact nature of that compression determines the most effective course of treatment. When faced with a diagnosis of Piriformis Syndrome or Sciatica what helps?

Sciatica treatments often depend on how severe the physical damage is, 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.

Treatment for Piriformis Syndrome is generally simpler. Physical therapy is sufficient in most cases to manage the symptoms, and chiropractic care can also lessen the pain experienced by sufferers. Anti-inflammatory medication may also help, but it’s often not necessary.

Stretching can also relieve symptoms in cases that are caused by overuse of the muscle. In most cases, it provides at least some relief.

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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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