Piriformis Syndrome vs. Sciatica

Pain in the Butt: Piriformis Syndrome vs. Sciatica

You may have heard the assertion that “sitting is the new smoking.” While the long-term impact of extended sitting is most certainly negative, sitting for too long can also cause frequent or constant pain in the hips, back, or backside. To further complicate matters, this same pain may be caused by standing for long periods as well.    

The two most common underlying causes of that pain are sciatica and piriformis syndrome. While they have similar symptoms, they have very different underlying causes. Here’s how you can tell them apart:  

What is sciatica?

Sciatica, technically known as sciatic neuritis, occurs when your sciatic nerve is compressed by your spine. It usually starts in the lower back or buttocks and travels down the back of one leg, and typically feels like a shooting, electric pain, a stabbing sensation, or it can be dull or achy. Sciatica usually worsens after sitting or standing for extended periods, when you walk, and after you cough or sneeze. While any person can get sciatica, it’s most common among people who:

• Are over age 30
• Are mostly sedentary
• Are overweight or obese
• Have diabetes
• Have a job that requires lots of sitting or standing
• Have a job that necessitates heavy lifting or twisting

Most often, the condition is triggered by a problem in your back such as a herniated disc, spinal stenosis, spondylolisthesis, infection, or inflammation. Pregnancy may also trigger symptoms of sciatica, as can the wear and tear associated with aging. 

How is sciatica treated?

Mild cases of sciatica can often resolve on their own or with lifestyle changes that address the underlying causes (e.g., losing weight, exercises, controlling blood sugar). Sometimes, therapeutic stretching, ice or heat therapy, and spinal adjustments or decompression can also help. 

What is piriformis syndrome?

Piriformis syndrome is caused by the piriformis muscle in your buttocks compressing your sciatic nerve. Because the piriformis muscle rests over the sciatic nerve, anytime the muscle swells or tightens as a result of strain or injury. As a result, the muscle compresses the sciatic nerve and creates painful sciatica-like symptoms, including:

• Acute tenderness in the buttocks
• Dull achiness in the buttock
• Sciatica-like pain down the leg 
• Pain that worsens going uphill or up stairs
• Pain that worsens with sitting or standing for long periods
• Reduced range of motion in your hip joint

Although anyone can develop piriformis syndrome, some factors increase your risk, including: 

• Over-exercising/overuse (e.g., running)
• Injury or trauma to the muscle
• Previous surgery in the area
• Sitting for extended periods
• Lifting heavy objects

Treating piriformis syndrome

Your treatment begins with an accurate diagnosis. Unfortunately, there’s no single test to tell you which condition you have. Most physicians who specialize in orthopaedic and nerve issues will opt for the least invasive treatment first. For example, they may recommend heat or ice therapy, pain medicines, physical therapy, or massage before moving to more aggressive treatment options. Additional treatment possibilities include Botox® or corticosteroid injections, transcutaneous electrical nerve stimulation to ease discomfort, or even potential surgery.  

See a specialist at DOC Orthopaedics

There’s no easy way to tell whether the pain in your back or hips is from sciatica or from piriformis syndrome, so it’s important to schedule an appointment with a physician who can make an accurate diagnosis and begin treatment quickly to ease your discomfort. The specialists at DOC Orthopaedics and Sports Medicine are ready to discuss your options. 

Since 1972, these specialists have been committed to providing exceptional orthopaedic care through innovative techniques, quality services, patient communication and education. With specialties ranging from general orthopaedics and physical therapy to sports medicine and more, the doctors at DOC Orthopaedics and Sports Medicine can provide local expert guidance on back and hip pain and determine what may be the appropriate next step to managing your pain. Click here to schedule an appointment today.