Piriformis Syndrome vs Sciatica - Differences

Piriformis Syndrome (PS)

It causes pain in the hip and buttocks and is primarily associated with sciatica. In most cases, the pain is localized to the buttock area, however, sometimes, it may radiate down the leg.

Types

There are two types;

  • primary – it has an anatomic cause, like – a split sciatic nerve, split piriformis muscle, or an anomalous sciatic nerve path;
  • secondary – it can result from microtrauma, macrotrauma, local ischemia, and ischemic mass effect.

Note – since its symptoms may be similar to that of primary sacral dysfunction, lumbar radiculopathy (refers to a disease which involves the lumbar spinal nerve root), or innominate dysfunction, PS is frequently overlooked in clinical settings.

Symptoms

Common symptoms include:

  • walking with the foot turned out due to shortening of the piriformis muscle;
  • sitting lopsided with your sore buttock tilted up, to avoid pressure and pain in the area;
  • pain aggravated by walking, hip activity, or prolonged sitting.

Note – pain is typically felt in one buttock, however, you may experience a radiation of pain down the back of the leg.

Causesrun

Causes of piriformis syndrome may include:

  • foot problems, including Morton’s neuroma;
  • injury;
  • unusually vigorous exercise;
  • prior hip surgery;
  • prolonged sitting;
  • leg-length discrepancy;
  • abnormal spine alignment (like – scoliosis);
  • abnormal location or development of the sciatic nerve or piriformis muscle.

Risk Factors

Sedentary Lifestyle

Individuals who sit most of the day have a higher risk of developing PS.

Gender

Due to anatomical differences, women develop PS 6 times more often than men.

Diagnosis

PS is commonly diagnosed through a process of ruling out other possible conditions which may be causing the sufferer’s symptoms, like – a sacroiliac joint dysfunction (pain in the sacroiliac joint region) or a lumbar disc herniation.

Treatmentacupuncture

It usually doesn’t require any medical treatment since avoiding activities that trigger your symptoms and rest are the first approaches to take. If symptoms persist, treatment options include:

  • physical therapy – it is done to prevent wasting related to dysfunction and disuse in surrounding muscles as well as to regain use of the piriformis;
  • alternative treatments – these may include chiropractic manipulation, acupuncture, and trigger point therapy;
  • a corticosteroid injection – it may provide temporary relief and it is done near where the sciatic nerve and the piriformis muscle meet;
  • prescription pain medications (note – these medications can be addictive);
  • botox injections – they can relieve pain and reduce muscle spasms.

Prevention

Common prevention methods include:

  • get up and move around so you are not lying down or sitting too long without some physical activity;
  • maintain proper balance, form, and posture when exercising;
  • avoid running over uneven surfaces, or down and up hills;
  • to prevent further injury, cease the physical activity if you experience discomfort or pain in the gluteal area;
  • avoid sitting on your wallet;
  • slowly build up the intensity of whatever physical exercise you are doing;
  • during work or sporting activities, wear proper protective gear;
  • warm up and stretch before you engage in strenuous physical activities;
  • avoid physical activities which can potentially exacerbate or cause PS.

Sciatica

Image credit – https://commons.wikimedia.org/wiki/File:Sciatic_nerve2.jpg

It represents a nerve pain caused by the irritation of the sciatic nerve. The sciatic nerve is the widest and longest nerve in the body.

The pain might be worse when you sneeze, sit, or cough.

Symptoms

Symptoms include:

  • pain which radiates down the leg and possibly into the toes and foot;
  • a sharp pain which may make it difficult to walk or stand up;
  • numbness, weakness, or difficulty moving the foot, leg, or toes;
  • leg pain which is commonly described as tingling, burning, or searing;
  • pain which is worse when sitting;
  • constant pain in only one side of the leg or buttock.

When to Call the Doctor

Seek your doctor immediately if you have:

  • loss of bladder or bowel function;
  • weakness in the affected leg;
  • loss of feeling in the affected leg.

Causes

It may be the result of sleeping on a mattress which is too soft, muscle strain or spasm, bad posture, pregnancy, wearing high heels, or being overweight.

Medical conditions which cause sciatica may include:

  • spondylolisthesis – it causes one of the lower vertebrae to slip forward onto the bone directly beneath it;
  • spinal stenosis – it results from narrowing of the spinal canal with pressure on the nerves;
  • piriformis syndrome;
  • a herniated disc – it causes pressure on a nerve root.

Risk Factors

Risk factors which may put you at risk of experiencing sciatica include:

  • occupational causes, like – prolonged sitting, strenuous activity, or driving;
  • emotional stress;
  • having diabetes;
  • smoking cigarettes and second=hand smoking;
  • being heavy or tall;
  • being between age 45 and 64.

Diagnosis

Image credit – https://commons.wikimedia.org/wiki/File:Sciatica.png

In order to make an accurate diagnosis, your healthcare professional will take a detailed medical history, including:

  • what event or action led to the onset of the pain;
  • the duration and nature of the symptoms.

Treatment

Sciatica which doesn’t resolve itself after several days requires medical attention. Treatments include:

  • complementary therapies, such as – acupuncture;
  • medication, including anti-inflammatory and pain-relieving medication;
  • surgery;
  • traction;
  • physiotherapy;
  • chemonucleolysis – it is a non-surgical treatment during which an injection with an enzyme is inserted into the disk;
  • epidural injections;
  • manipulative therapies, like – osteopathy or chiropractic.

Bottom Line – Piriformis Syndrome vs Sciatica

Piriformis syndrome is a painful condition which occurs due to compression or irritation of the sciatic nerve near the piriformis muscle. The most common symptoms of PS are:

  • nerve pain radiating from the buttocks down the leg;
  • pain which radiates down the back of the leg to the hamstrings;
  • pain or tenderness in the buttocks, typically on one side only.

Sciatica is the name given to pain that is caused by irritation of the sciatic nerve. While the pain most commonly starts in the back, it typically travels down one lower extremity. Therefore, sciatica is different from other forms of low back pain.

In conclusion, piriformis syndrome is mainly associated with sciatica since the muscle swelling associated with PS may affect the sciatic nerve and results in tingling, pain, or numbness in the calf, thigh, or foot.

However, other symptoms of piriformis syndrome may include pain when climbing stairs, sitting for a long period of time, running or walking as well as aching, tenderness, numbness, and tingling of the buttock.

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2997212/
https://www.ncbi.nlm.nih.gov/books/NBK410173/
https://www.researchgate.net/publication/273219799_PIRIFORMIS_SYNDROME_A_REVIEW