How Piriformis Syndrome causes Sciatic Pain

As a physical therapist in Traverse City, MI, I work with a lot of people who have sciatic nerve pain or irritation and have been told they have piriformis syndrome, but they have no idea what that is. So today, I want to help you understand how piriformis syndrome causes sciatic nerve pain, how it differs from sciatica, and what to do about it.

The piriformis is a muscle that sits at the top of the buttocks.  It runs from the top of the femur on the outside of your leg and goes all the way across the top of the buttocks to the sacrum. The sacrum is the bottom of the spine. The sciatic nerve, a large nerve that exits from the spine and goes down the leg, lies underneath the piriformis muscle.

This fact of our anatomy becomes very important for people with sciatica symptoms. Sciatica can be characterized by pain, numbness and tingling, or weakness down the back of the thigh, which can go all the way to the foot and ankle.

What happens to cause sciatica is that the sciatic nerve is being irritated. It can be irritated anywhere along its path. If the nerve is being irritated from something happening in the spine itself, above the sacrum, we call this Sciatica. If the nerve is being irritate from the piriformis muscle (if this muscle is tight and squeezes the nerve), we call it piriformis syndrome.

Here are a few unique pointers to help you understand where your pain may be originating from:

• Areas affected by pain:
  • In piriformis syndrome, buttock and hip pain is typically more common than lower back pain.
  • In sciatica, the leg pain is usually greater than lower back pain and the pain may radiate into your toes. The affected leg may also feel heavy.
• The effect of movement:
  • In piriformis syndrome, the pain typically increases while sitting for long periods of time and/or during hip movements.
  • In sciatica, raising the affected leg while lying down (while keeping the other leg straight) may induce pain.

To really test for piriformis syndrome, move your hip in such a way as to stretch the piriformis muscle. For example, cross your affected leg over the other leg. Does this intensify the pain? Then you most likely have piriformis syndrome.

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See what Mayo Clinic has to say about Back Pain: Back pain - Symptoms and causes - Mayo Clinic