Sciatica or Piriformis Syndrome? How you can tell the difference

Are you suffering from a “True Sciatica Condition” or from what’s called a Piriformis Syndrome? A true sciatica condition can be due to a disc bulge or some degenerative changes to the lower lumbar spine usually in the L5/S1 vertebral levels. Where as a Piriformis syndrome occurs when you have irritation to the sciatic nerve as it passes the Piriformis muscle. Now both can and will give you pain into the “butt” with pain, burning or shooting sensations radiating into the leg, some time but not always going all the way to the foot. Usually a “Piriformis” problem will only be to 1 leg where as a disc can be to both or alternating between the two sides in some cases, depending on the location of the disc bulge. Now you may say if they both cause similar pain and “feel” the same what difference does it make. The treatment approach for the two conditions can vary greatly. First how do we tell which is which?

Sciatica from a disc or injury to the lowback can be determined by performing a few different orthopedic maneuvers. If you are in a seated position and raise the leg straight out and you get shooting pain think lowback/disc. If you are sitting or lying on your back and you bring the knee up straight to the same shoulder there should be no pain, but if you cross the knee to the opposite shoulder and get pain in the “butt” think Piriformis syndrome. The piriformis muscle assists in rotating the femur. Another way we check in the office is I have the patient in a standing position and put pressure at the lower lumbar joint. If that gives them pain – think sciatica. However, if I do that and they don’t get any or very little pain but when I apply digital pressure (take my finger and push) on the Piriformis muscle (which is located in the dimple of the butt) they have the pain shoot into the butt, leg etc. – think Piriformis. In my office more people come in with Piriformis injuries then actual disc/Sciatica injuries. You can try these simple checks at home but if you can’t figure it out you need to get it checked by a Chiropractor to see which one it is so you know what treatments and exercises to do to get it better.

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