Sciatica or piriformis syndrome.... Which one is it? Hey guys my name is Dr. Grant Elliott with RehabFix here to talk to you about how to determine if you have piriformis syndrome or sciatica.
What is Piriformis Syndrome?
Well first, what is piriformis syndrome? Piriformis syndrome is when the sciatic nerve pierces through the piriformis muscle, and that piriformis muscle causes irritation on that nerve, thus causing the piriformis pain and the symptoms down the leg.
What is Sciatica?
Sciatica is most commonly associated with a disc herniation that is going to push out on that nerve root, which is going to send signals of nerve pain down the leg.
Piriformis Syndrome is RARE
Piriformis syndrome is actually extremely rare even though it is thrown under the bus all of the time. As low as 0.3% of all low back pain and sciatica pain cases are actually true piriformis syndrome. Most people that go into a clinic with sciatic nerve pain or pain in the glute region are told, "Oh, it's just piriformis syndrome. You need to strengthen your glutes."But how many people come to me on a daily basis and say that they've tried this and it isn't working is astounding. The point here is, it's basically never piriformis syndrome! That's just the way it is.
Common Mistake #1
So many people are told, "Oh, your piriformis hurts? You have pain down the leg? You have piriformis syndrome because that's where your pain is." And that is mistake number one. That is assuming the location of the pain is the location of the problem.
3 Quick Tests!
Here are a few key ways that you can determine if this is piriformis syndrome or sciatica.
1. Push directly on the piriformis! Does pushing directly on the piriformis create symptoms that shoot down the leg? Then maybe there is a little bit of an issue in that area. Other common symptoms are increased discomfort with sitting for long periods or sitting directly on the glute since this puts pressure on the piriformis. However, these are also common things that will cause this sciatica as well because the back is in a rounded position and that will irritate discs, which irritates nerves, which causes sciatica.
2. Another quick test that you can use to determine if this is a piriformis syndrome or sciatica is to stand up and bend forward to touch the toes!
When you bend forward, if you feel some extra tightness or pain shoot down one of the legs it's most likely sciatica. It's most likely from a disc or a nerve in the low back, because when you're bending forward you're not compressing the piriformis muscle. You're not sitting on it. You're not applying direct pressure to it. So what is most likely happening is that disc is either irritating that nerve root more or that nerve stretching and that nerve is irritated and it doesn't want to stretch so it's creating the symptoms down the leg.
3. Finally, the last quick test you can try is to sit in a chair, round your low back, bring the chin to the chest, and now whichever leg that you have the symptoms going down kick that leg out. If you feel like it's putting a zinger down your leg, then while you hold this position, look up towards the ceiling....Did it go away? Might not be piriformis syndrome! Or while holding that same position now point the foot away from you. Did it go away or lessen? That's probably not piriformis syndrome!
Most likely piriformis syndrome is just not your issue! It's super rare yet it's thrown under the bus all the time. Everyone's told they have it and that's just simply not the case.
Are Piriformis Stretches Useless?
So I'm not saying that glute or piriformis strengthening/stretching movements or exercises won't help. It certainly will. Anyone with low back issues or nerve related issues down the leg can certainly benefit by addressing the hips and addressing the strength of the glutes and things of that nature. But it ultimately will not be resolved completely and long term if you do not get an accurate assessment on your low back. You need get the low back moving the way it's meant to, and the right interventions needed to resolve that issue.
How to Properly Resolve These Issues!
This accurate and specific approach will truly resolve that pain down the leg. That way you can stop having this confusion about whether it's piriformis syndrome or if it's not piriformis syndrome or what the heck's going on. I understand that confusion I've been there. I talk with people every day that are there and it's just frustrating. You just need to find the low back movements that are right for you that will calm the disc down, calm the nerve down and ultimately make you move better and feel better!
What is the Next Step?
This can vary from person to person but in my experience with online clients around the world there is a similar pattern among many individuals with disc herniations or sciatica that is commonly missed. The majority of my clients in the RehabFix Online Low Back Program have had low back issues for years and have tried Chiro, PT, medication, injections, orthopedists - you name it! It seems like they all were missing some key components..... First I would recommend my free low back guide that discusses multiple factors that contribute to lower back pain!
Then if you still feel like you are
missing out on your life at 100%
wasting thousands $$$ on interventions that aren't producing results
working with someone you feel does NOT care about YOUR GOALS
worried about this leading to drugs or surgery
Then it's time to take action! No time to waste!
✅ Ready to ATTACK Low Back Pain?
✅ Are you sick of guessing your way through this low back pain?
✅ Want to prevent drugs or surgery?
Thanks for reading! -Dr. Grant Elliott