Sciatica: Is it Piriformis Syndrome or Your Low Back?

​When seeking answers for low back, hip, and leg pain, you may have heard the term Sciatica. This condition occurs when the sciatic nerve (the largest nerve in the body) is irritated or inflamed, causing pain, tingling, and/or numbness felt along part or all of the nerve path; most often starting in the low back or the buttock and traveling down the outer leg, even all the way down to the foot in some cases.
This irritation of the Sciatic nerve is actually quite common, and is often attributed to one of two causes, Piriformis Syndrome or a spinal abnormality in the low back; with a pretty even 50/50 split between the two.
Piriformis syndrome is when your piriformis muscle, a small muscle located deep in the buttock that starts at the lower spine and connects to the upper surface of the thighbone, irritates your sciatic nerve. The sciatic nerve runs directly under this muscle, and in some people, it actually runs right through the muscle itself.
The upper portion of the nerve, as it comes out of the spinal cord, is also prone to irritation from the spine. This could be due to stenosis (narrowing of the spinal canal) or a disc issue such as a herniated or bulging disc. Any of these spinal conditions could result in pressure on the Sciatic nerve creating that pain and irritation felt in the hip and leg.
When it comes to treating Sciatica, the key is for your healthcare provider to understand the cause of it first, because treatment plans will differ tremendously. While imaging tests may help, most often you’ll start with simple mobilizations, stretches, and exercises to see what exactly helps your pain or makes it worse. This can confirm which problem is the root cause of the issue. Then a treatment plan will be developed which may include things such as hot or cold therapies, massage therapy, low back and hip stretches, low back and hip exercises, spinal mobilizations, posture and movement re-education, pain medications, and even injections or other more invasive forms of treatment.
While differentiating and diagnosing sciatica and piriformis syndrome may be difficult, paying close attention to what you feel and being honest with your healthcare providers can make all the difference in the world.