Sciatica Or Piriformis Syndrome?

Sciatica Or Piriformis Syndrome?
There is considerable confusion regarding the conditions
sciatica and piriformis syndrome. Some think that they are
the same thing, but although they have very similar
symptoms in many cases and can be present simultaneously,
the underlying causes of sciatica and piriformis syndrome
can be quite different.

Sciatica refers to irritation of the sciatic (often
mis-spelled as syatic or psyatic) nerve, that arises from
nerve roots in the lumbar spine. The most common cause of
sciatic nerve irritation, or "true" sciatica is compression
of one or more of its component nerve roots due to disc
herniation or spinal degeneration in the lower lumbar
region. Depending on the severity of the compression
and/or inflammation of the sciatic nerve components,
sciatica may extend into the buttock area, into the thigh,
or sometimes all the way down the leg to the foot.

Piriformis syndrome, also known as "pseudo-sciatica"
(meaning "false sciatica"), is actually referral pain and
other symptoms (tingling, numbness, etc.) caused by
tightness and knots of contraction in the piriformis
muscle, which runs from the upper femur bone to the edge of
the sacrum, the triangular pelvic bone that is below the
lumbar spine. The symptoms of piriformis syndrome are very
similar and may be indistinguishable from true sciatica.

In some cases, piriformis syndrome may cause true sciatic
nerve irritation, as the sciatic nerve may run underneath
or even through the middle of the piriformis, so
contraction of the piriformis may produce sufficient
compression of the sciatic nerve to produce actual nerve
symptoms. This is one of the main sources of confusion
when it comes to distinguishing true sciatica from
piriformis syndrome.

As mentioned earlier, the symptoms of true sciatica are
very similar to piriformis syndrome. Both cause pain,
tingling, burning, "electrical shock" sensations, and/or
numbness down the leg, often all the way to the foot. Add
to this that the underlying causes of both sciatica and
piriformis syndrome can be related to biomechanical
problems in the spine and pelvic joints, and the fact that
the two conditions can be present at the same time, even
doctors may have a difficult time distinguishing between
the two.

But since the most effective treatment for the two
conditions varies signficantly, it is important to
determine the correct diagnosis if at all possible.
Fortunately, there is a simple way to tell the difference
between sciatica and piriformis syndrome in most cases.

Two simple maneuvers will distinguish sciatica from
piriformis syndrome in the majority of cases (when the
problem is one versus the other and not both conditions at
the same time). First, in a seated position, if one
straightens the leg on the painful side (so that the leg is
parallel to the floor), and the sciatica symptoms increase,
this is usually a sign of true sciatic nerve irritation.

The second maneuver is done in two parts. First, from the
sitting position one bends the leg and pulls the knee on
the painful side towards the same-side shoulder. There
usually is no major increase in pain except in severe cases
of true sciatica in this position. The second part of the
maneuver is to pull the knee toward the opposite side
shoulder. An increase in the sciatica-like symptoms is a
strong indication of piriformis syndrome.

Once it has been determined if symptoms are due to true
sciatica or piriformis syndrome, or some combination of the
two, the most effective treatment can be employed.

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Dr. George Best is in private practice in San Antonio,
Texas. For more information, check out Dr. Best's free
e-book and online video course to assist in understanding
and treating sciatica and piriformis syndrome, including
in-depth instruction on sciatica exercises at
http://www.SciaticaSelfCare.com .