Sciatica vs. Piriformis Syndrome: What's the Difference?

Pain Down Your Leg Doesn't Always Mean Sciatica

Many people assume that any pain traveling down the leg is "sciatica." While sciatica is common, another condition called piriformis syndrome can produce similar symptoms. The good news is that a thorough physical therapy evaluation can usually determine the source of your symptoms and guide the right treatment.

At Apex Physical Therapy & Wellness in St. Joseph, Michigan, we frequently evaluate patients with leg pain and numbness. Understanding where the pain is coming from is the first step toward effective treatment.

What Is Sciatica?

Sciatica refers to irritation or compression of the sciatic nerve, most commonly caused by a herniated disc or narrowing around the spinal nerves (spinal stenosis).

Common symptoms include:

• Pain beginning in the low back or buttock

• Pain traveling down the back or side of the leg

• Numbness or tingling

• Burning or electric shock sensations

• Weakness in the leg or foot

• Pain that worsens with prolonged sitting

  
  

What Is Piriformis Syndrome?

The piriformis is a small muscle located deep in the buttock. In some people, irritation or tightness of this muscle can place pressure on the sciatic nerve.

Symptoms often include:

• Deep buttock pain

• Pain after prolonged sitting

• Tenderness over the buttock

• Pain that may travel down the leg

• Discomfort when crossing your legs

Unlike true sciatica, piriformis syndrome usually does not involve significant muscle weakness or changes in reflexes.

How Are They Different?

Sciatica	Piriformis Syndrome
Usually starts in the spine	Usually starts in the buttock
Often associated with disc problems	Muscle irritation is the primary issue
May cause numbness or weakness	More localized buttock pain
Often changes with spinal movement	Often worsens with prolonged sitting or hip rotation

Sometimes patients have features of both conditions, which is why a detailed evaluation is important.

How Physical Therapists Tell the Difference

Rather than relying on MRI findings alone, physical therapists examine how your symptoms respond to movement.

Your evaluation may include:

• Range of motion testing

• Nerve mobility testing

• Muscle strength assessment

• Walking analysis

• Hip mobility examination

• Special orthopedic tests

• Functional movement assessment

These findings help determine whether your symptoms are coming from the spine, hip, or surrounding muscles.

Treatment

Treatment depends on the underlying cause.

For sciatica:

• Direction-specific exercises

• Nerve mobility exercises

• Core strengthening

• Manual therapy

• Activity modification

For piriformis syndrome:

• Hip mobility exercises

• Glute strengthening

• Movement retraining

• Manual therapy

• Progressive return to activity

  
  

When Should You Seek Care?

You should be evaluated if:

• Leg pain lasts longer than one week

• You develop numbness or tingling

• Walking becomes difficult

• Symptoms continue getting worse

• Pain limits work, exercise, or sleep

  
  

Sciatica Treatment in St. Joseph, Michigan

At Apex Physical Therapy & Wellness, we don't simply treat symptoms—we identify the source of your pain. Whether your symptoms are coming from your lower back, piriformis muscle, or another structure, we'll develop an individualized treatment plan to help you return to the activities you enjoy.

“If you’re dealing with hip pain while running, our physical therapy team in St. Joseph can help you find the cause and build a plan to get back to running.”