A patient comes in certain they have sciatica: deep pain in the buttock that shoots down the back of the leg. Often they are right. But a meaningful number of them do not have a spinal problem at all. Their symptoms are coming from a small muscle deep in the hip called the piriformis, and the distinction matters, because the treatment is different.
At Bromberg Chiropractic in Cambridge, telling these two apart is a routine and important part of what we do. Here is how to understand the difference.
The Two Problems That Feel Alike
True sciatica is irritation of the sciatic nerve, usually where its roots exit the lower spine, most often from a disc issue or narrowing. The pain originates in the back and travels down the leg along the nerve.
Piriformis syndrome is different. The piriformis is a small muscle deep in the buttock that runs right next to (and in some people, right through) the sciatic nerve. When the piriformis becomes tight, irritated, or spasms, it can compress the sciatic nerve at the hip, producing pain that travels down the leg and feels almost identical to spinal sciatica. The difference is the source: a muscle in the buttock, not a nerve root in the spine.
How to Tell Them Apart
No self-test is definitive, but there are useful clues:
- Where it starts. Piriformis pain is usually centered in the deep buttock and is tender to press there. Spinal sciatica often involves the low back as well.
- What aggravates it. Piriformis pain frequently worsens with prolonged sitting (especially on a hard surface or a wallet), climbing stairs, or activities like running. Spinal sciatica often worsens with bending forward, coughing, or sneezing.
- Back symptoms. Significant low back pain points more toward a spinal source; pain that is almost entirely in the buttock and leg points more toward the piriformis.
These overlap, which is exactly why a proper examination beats guessing. Getting the source right is the difference between treatment that works and treatment that frustrates.
Who Gets Piriformis Syndrome
It is common in runners and cyclists, in people who sit for long hours, and in those with weak glutes and poor hip mechanics that force the piriformis to overwork. It also shows up after a fall onto the buttock. If you are active, our post on chiropractic for runners and athletes covers related issues.
How We Treat Piriformis Syndrome
Because the problem is muscular, the treatment centers on the soft tissue and the mechanics behind it.
Release the Muscle
Soft tissue therapy, including Active Release, directly addresses the tight, irritated piriformis and the surrounding hip muscles, relieving the pressure on the nerve. (Learn how Active Release Technique works.)
Restore Hip and Pelvic Mechanics
A piriformis rarely acts up in isolation. Restoring proper motion to the hip, pelvis, and lower back removes the mechanical stress that made the muscle overwork in the first place.
Strengthen and Correct the Cause
Weak glutes and poor mechanics are the usual root cause. Our posture and gait analysis identifies the imbalances, and targeted strengthening keeps the piriformis from being overloaded again.
What You Can Do at Home
- Do not sit on your wallet. It is a classic aggravator of the piriformis.
- Break up long sitting. Stand and move regularly.
- Stretch and strengthen the hips gently. We will show you the specific moves for your situation, since aggressive stretching can sometimes worsen an irritated nerve.
Get the Diagnosis Right
If you have been treating "sciatica" with no lasting relief, the real culprit may be your piriformis, and it needs a different approach. Contact Bromberg Chiropractic in Cambridge and we will pinpoint the true source of your buttock and leg pain and treat it directly.
