Is it Sciatica or Piriformis Syndrome?

Tell someone you have sciatica and chances are they will know you have shooting leg and buttock pain.  Tell someone you have piriformis syndrome and they don’t know what you’re saying.

 

The term “Sciatica” is so over used and common that to some people the first sign of buttock pain automatically means it is sciatica.   The term sciatica is more of a description than a clinical diagnosis but it is so common doctors have accepted the term and use it freely.   “Sciatica” is actually an irritation of the sciatic nerve.  This large nerve runs from the back through the buttock muscle and continues down into the back of the leg, splitting when it gets to the back of the knee cap.   True sciatica is irritation of this nerve. The nerve can be irritated by joints in the low back, a disc herniation, or a muscle entrapement.   Each one of these scenarios has its own proper clinical term which accurately defines the reason for the “sciatica”.  

When the sciatic nerve becomes entraped in the piriformis muscle the resulting pain is called  Piriformis Syndrome.  Piriformis syndrome, in addition to causing gluteal pain that may radiate down buttocks and the leg, may also present with pain that is relieved by walking with the foot on the involved side pointing outward. This position externally rotates the hip, lessening the stretch on the piriformis and relieving the pain slightly. Piriformis syndrome is also known as “wallet sciatica” or “fat wallet syndrome,” as the condition can be caused or aggravated by sitting with a large wallet in the affected side’s rear pocket

There are several ways a doctor or chiropractor can assess where the sciatic pain is coming from.  Often that means ruling out conditions like joint problems, disc herniations, spinal stenosis and lumbar muscle strain and performing tests that stress and stretch the piriformis muscle.

Below are a few of the tests for piriformis syndrome:

Freiberg’s maneuver of forceful internal rotation of the extended thigh elicits buttock pain by stretching the piriformis muscle, and

Pace’s maneuver elicits pain by having the patient abduct the legs in the seated position, which causes a contraction of the piriformis muscle.

Sciatic notch tenderness elicits pain by manual pressure on the sciatic nerve where is exits at the back bony pelvis (ilium bone) and passes under the piriformis muscle. 

Dr. Beatty, in a 1994 journal article,  proposed another test, where the patient is lying with the painful side up, the painful leg flexed, and the knee resting on the table. Buttock pain is produced when the patient lifts and holds the knee several inches off the table.  It relies on contraction of the muscle, rather than stretching, which the author believes better reproduces the actual syndrome.

 

 

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