Most of the people who are referred to me suffering with back pain will more often than not have some form of sciatica and having “been there, done that and brought the t-shirt!” I know first-hand the discomfort and pain this far too common problem brings.
Sciatica refers to irritation or inflammation of the sciatic nerve which arises from nerve roots in the lumbar spine. The most common cause of sciatic nerve irritation is compression of one or more of its component nerve roots due to disc herniation, bulging discs or spinal degeneration in the lower lumbar region. Pregnancy can also cause sciatica if the position of the baby or shape of the uterus presses on the nerve. Sciatica usually begins in the buttock area and, depending on the severity of the underlying nerve compression and inflammation, may extend down the entire leg to the ankle and foot.
There is another cause of Sciatica though and whilst it often referred to as “pseudo-sciatica” (false sciatica) the pain and discomfort are pretty much identical with pain, tingling, burning and/or numbness down the leg to the foot. However, the second cause of sciatic pain is caused by tightness and knots of contraction in the piriformis muscle and is called Piriformis Syndrome. Even though in most cases it is the muscle causing the pain some people (approximately 20%) do have true sciatic nerve irritation from this muscle because the sciatic nerve may run underneath or even directly through the muscle.
So here is the problem, both give almost identical symptoms, both tend to be related to biomechanical functional problems in the joints of the back and pelvis and both can be present simultaneously in the same person. However, treatment is totally different for both so determining the correct diagnosis is paramount in knowing what treatment you should seek and what movements are safe for you to do.
Two simple maneuvers will distinguish sciatica from piriformis syndrome. Please be aware though that these maneuvers will only identify a difference between the two when the problem is one versus the other and not both conditions at the same time as mentioned above.
• Take a seated position
• Straighten the leg on the painful side (so that the leg is parallel to the floor)
If the sciatica symptoms increase, this is usually an indication of true sciatic nerve irritation.
The second maneuver is done in two parts.
• Take a seated position
• Bend the leg and pull the knee on the painful side towards the same-side shoulder.
In all but the most severe cases, there is usually no major increase in pain 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.
It is important to distinguish between sciatica and piriformis syndrome, because the treatment for the conditions varies, and getting the diagnosis right typically leads to more effective treatment.