Sciatica, Piriformis Syndrome, or Disc Herniation: How to Tell What You Have
Pain in the lower back and or the legs is one of the most common complaints among patients visiting physiotherapy and chiropractic clinics. This pain can range in severity from mild discomfort to complex conditions that significantly affect quality of life.
Three common conditions that may present with symptoms of back pain, leg pain, or both are “sciatica”, piriformis syndrome, and disc herniation. Despite their similarity in symptoms, these conditions involve different causes, prognoses, and treatment approaches.
As an experienced chiropractic specialist, I will guide you through these three conditions to help you understand their differences and take appropriate steps for diagnosis and treatment.
What is Sciatica?
Sciatica is a broad term that is used to describe inflammation of the sciatic nerve. The sciatic nerve is a peripheral nerve that runs down the back of each leg. When irritated, it can cause pain in the back, leg, hip, pelvis, neck and buttock.
Characteristics of Sciatica or Sciatic Pain
- Sharp, shooting, or burning pain radiating from the lower back down the back of the leg
- Numbness or tingling along the sciatic nerve pathway
- Muscle weakness in the leg or toes
- Pain that worsens with prolonged sitting or sudden movements
Common Causes:
- Disc herniation
- Spinal stenosis
- Piriformis syndrome
- Traumatic injuries or tumors (rare)
What is Piriformis Syndrome?
Piriformis syndrome occurs when the sciatic nerve is compressed at the site of the piriformis muscle in the buttocks. The piriformis muscle is a small but mighty muscle in the buttocks area that helps rotate the hip joint. In most people, the sciatic nerve runs underneath this muscle, but in some, it passes through it. When the piriformis muscle becomes tight, inflamed, or spasms, it can irritate the sciatic nerve, causing symptoms similar to sciatica.
Symptoms of Piriformis Syndrome:
- Deep, localized pain in the buttocks
- Sharp pain that radiates down the back of the thigh, often stopping at the knee
- Pain that worsens with prolonged sitting or climbing stairs
- Pain that improves with rest or piriformis muscle stretching
Common Causes:
- Prolonged sitting (e.g., drivers, office workers)
- Repetitive activities like running or cycling
- Direct trauma to the buttocks
- Muscle imbalances in the pelvis or sacroiliac joints
What is a Disc Herniation?
A disc herniation happens when the jelly-like centre of an intervertebral disc protrudes through the outer layer and compresses nearby nerve roots or the spinal cord. Disc herniation commonly occurs in the lower back (L4-L5 or L5-S1) and can cause severe pain and disability. Symptoms of Disc Herniation:
- Severe lower back pain (with possible radiation to the buttocks and legs, but not always)
- Numbness or tingling in one or both legs
- Muscle weakness in the legs or difficulty walking in severe cases
- In severe cases: loss of bladder or bowel control (medical emergency)
Common Causes:
- Lifting heavy objects improperly
- Repetitive overuse
- Aging and disc degeneration
- Traumatic injuries such as a fall or a car accident
- Genetic predisposition and/or obesity
Comparison of Sciatica, Piriformis Syndrome, and Disc Herniation
| Feature | Sciatica | Piriformis Syndrome | Disc Herniation |
| Origin | Pressure on the sciatic nerve (various causes) | Spasm or inflammation of the piriformis muscle | Herniation of the intervertebral disc |
| Pain Location | Prolonged sitting, hip rotation, Sustained pressure on buttocks | Buttocks and the back of the thigh | Lower back, buttocks, and legs |
| Neurological Symptoms | Pain, numbness, tingling, weakness | Localized pain, sometimes tingling | Severe pain, numbness, and muscle weakness |
| Pain Aggravated By | Sitting, bending, and coughing | Stretching, massage, posture correction, Chiropractic, Physiotherapy | Bending, lifting heavy objects |
| Diagnosis Methods | Clinical exam, MRI, EMG | Clinical tests (e.g., FAIR test) | MRI, CT scan, clinical exam |
| Initial Treatment | Depends on the cause (Massage, physiotherapy, Chiropractic) | Rest, MRI imaging, physiotherapy, chiropractic,c and medication for inflammation | Rest, MRI imaging, physiotherapy, chiropractic, and medication for inflammation |
How to Accurately Diagnose Your Real Problem?
Accurate diagnosis requires examination by a qualified professional, such as a chiropractor or physiotherapist. In severe cases that do not respond well to treatment, this is sometimes supplemented with imaging. Here are some key points to differentiate these conditions:
- Sciatica: If pain originates from the lower back and radiates down to the toes, accompanied by numbness or weakness, nerve compression is likely. Causes may include a herniated disc, spinal stenosis, and piriformis syndrome.
- Piriformis Syndrome: If pain is localized deep in the buttocks and worsens with specific movements like hip rotation or prolonged sitting, piriformis involvement is suspected. Clinical tests like the FAIR test help confirm this.
- Disc Herniation: severe lower back pain combined with neurological symptoms like difficulty walking or lifting toes suggests disc herniation with radiculopathy. MRI is the best diagnostic tool to confirm this diagnosis.
Chiropractic Treatment Recommendations
As chiropractic specialists, we focus on providing a comprehensive physical examination to arrive at a differential diagnosis. This diagnosis will determine the best course of action for the specific condition. All treatments are non-invasive and aligned with the goals of effective chiropractic treatment sessions, aiming to restore fascial glide, improve joint movement and range of motion, and facilitate a return to daily activities. Suggested treatments for each condition include:
For Sciatica:
- Identifying and treating the root cause (e.g., disc herniation, stenosis)
- Manual therapy at the site of the sciatic nerve compression
- Appropriate nerve stretches
- Anti-inflammatory medications, if needed, and lifestyle modifications
- Co-management and collaboration with other health care providers
For Piriformis Syndrome:
- Specific stretching exercises for the piriformis muscle
- Deep tissue massage to relieve spasms
- Pelvic alignment correction with chiropractic techniques
- Use of heat or cold therapy to reduce inflammation
For Disc Herniation:
- Relative rest (not absolute rest) to reduce disc pressure in the early phases
- Chiropractic techniques to relieve nerve root compression
- Physiotherapy to improve range of motion and muscle strength
- Referral for surgical evaluation in severe cases
- Collaboration between various health care providers for the most efficient recovery
Prevention: The Key to Long-Term Health
To prevent or reduce the recurrence of these problems, follow these guidelines:
- Maintain proper posture while sitting, standing, and lifting objects
- Perform regular exercises to strengthen the back and pelvic muscles
- Avoid prolonged sitting and use ergonomic chairs
- Manage body weight to reduce excessive pressure on the spine and maintain healthy joints
Why Choose Fulcrum Therapy for Sciatica, Piriformis Syndrome, and Disc Herniation?
Chronic back or leg pain caused by sciatica, piriformis syndrome, or disc herniation can significantly disrupt your daily life. At Fulcrum Therapy Clinic, we offer personalized, non-surgical treatment solutions designed to relieve your pain and restore your quality of life.
Our expert team of chiropractors and physiotherapists uses targeted chiropractic adjustments, therapeutic massage, and specialized exercises to reduce nerve pressure and improve your body’s function. We take the time to thoroughly assess your condition and develop a customized treatment plan for your lifestyle and wellness goals.
Take the first step toward a pain-free, active life today. Call us at 604-917-0777 or visit our website today to schedule your consultation. We’re here to support your journey back to health and activity.