Pain that starts in your buttock and travels down your leg can be frustrating — and confusing.

Many people assume they have sciatica, while others are told they have piriformis syndrome. Although these conditions can cause similar symptoms, they are not the same. Knowing the difference is important because the most effective treatment depends on identifying the true source of your pain.¹

At Kriz Mobility and Vitality, we frequently evaluate active adults throughout Bonita Springs and Southwest Florida who are experiencing leg pain. In many cases, a thorough examination can help distinguish between these conditions and guide an individualized treatment plan.

What Is Sciatica?

Sciatica is not a diagnosis itself. Instead, it describes symptoms caused by irritation or compression of the sciatic nerve, usually where the nerve exits the lower spine.²

The sciatic nerve is the largest nerve in the body. It begins in the lower back and travels through the buttock, down the back of the thigh, and into the lower leg and foot.

Common causes of sciatica include:

• Lumbar disc herniation
• Degenerative disc disease
• Spinal stenosis
• Bone spurs (osteophytes)
• Degenerative changes affecting the spinal joints²

In other words, the source of the problem is typically the lower back, even if most of the pain is felt in the leg.

What Is Piriformis Syndrome?

The piriformis is a small muscle located deep in the buttock. It helps rotate and stabilize the hip during walking, climbing stairs, golfing, tennis, and pickleball.

In some individuals, the piriformis muscle may become tight, irritated, or inflamed and place pressure on the sciatic nerve as it passes nearby. This is commonly referred to as piriformis syndrome.³

Unlike lumbar sciatica, the source of symptoms is within the buttock, not the spine.

Although piriformis syndrome is widely recognized in clinical practice, researchers continue to debate how frequently it occurs, because there is no single definitive diagnostic test.³

Symptoms of Sciatica

Sciatica often produces symptoms that extend below the knee because the nerve is irritated closer to its origin in the spine.²

Common symptoms include:

• Sharp, burning, or electric-like pain
• Pain traveling into the calf or foot
• Numbness or tingling
• Muscle weakness
• Pain that worsens with coughing or sneezing
• Difficulty standing after prolonged sitting
• Pain that increases with prolonged sitting or driving

Many people notice that their back pain improves while their leg pain becomes more noticeable as the nerve becomes irritated.¹

Symptoms of Piriformis Syndrome

Piriformis syndrome usually causes pain that begins deep within the buttock and may radiate down the back of the thigh.³

Common symptoms include:

• Deep buttock pain
• Tenderness over the piriformis muscle
• Pain when sitting for long periods
• Pain while climbing stairs
• Discomfort after running or walking uphill
• Increased pain when crossing the affected leg
• Symptoms reproduced by stretching or contracting the piriformis muscle

Leg numbness and significant muscle weakness are generally less common than with lumbar nerve root compression.³

Sciatica vs. Piriformis Syndrome: Key Differences

Feature	Sciatica	Piriformis Syndrome
Primary source	Lower spine	Buttock muscle
Pain location	Back, buttock, leg	Mostly buttock and upper thigh
Pain below the knee	Common²	Less common³
Numbness and tingling	Common²	Sometimes present³
Muscle weakness	May occur²	Uncommon³
Back pain	Frequently present²	Often minimal
Sitting	Often painful	Frequently very painful³
Coughing or sneezing	May worsen symptoms²	Usually no change
Imaging	May identify spinal causes	Usually normal³

How Is the Diagnosis Made?

There is no single test that confirms either condition. Instead, diagnosis relies on:

• A detailed medical history
• Assessment of symptom behavior
• Neurological examination
• Muscle strength testing
• Reflex testing
• Range of motion assessment
• Functional movement evaluation
• Special orthopedic tests²

If symptoms suggest significant nerve compression or another serious condition, imaging such as an MRI may be appropriate. However, routine imaging is not recommended for most people with uncomplicated low back pain, because age-related changes are very common — even in people without symptoms.⁴

Can You Have Both?

Yes. Some individuals have a lumbar disc problem and irritation of the piriformis muscle.

Pain can also cause surrounding muscles to become tight and protective, making it difficult to determine which structure is contributing most to the symptoms.

This is one reason a comprehensive physical examination is often more valuable than relying on imaging alone.¹

Treatment for Sciatica

Current clinical guidelines recommend beginning with conservative treatment for most people.²·⁵ Treatment may include:

• Education about staying active
• Individualized exercise
• Walking programs
• Manual therapy when appropriate
• Progressive strengthening
• Mobility exercises
• Neural mobility (“nerve gliding”) exercises
• Activity modification

Most people improve significantly without surgery.²·⁵

Treatment for Piriformis Syndrome

Treatment focuses on reducing irritation of the muscle while restoring normal movement patterns. A rehabilitation program may include:

• Gentle stretching when appropriate
• Hip mobility exercises
• Gluteal strengthening
• Core strengthening
• Walking progression
• Manual therapy
• Movement retraining

It is important to note that aggressive stretching is not always beneficial, particularly if the muscle is already irritated. A thorough evaluation helps determine the most appropriate approach.³

When Should You Seek Medical Attention?

Seek prompt medical evaluation if you experience:

• Progressive leg weakness
• Loss of bowel or bladder control
• Numbness around the groin or saddle area
• Severe pain following trauma
• Fever with back pain
• Unexplained weight loss
• A history of cancer with new, persistent back pain²

These symptoms may indicate a more serious condition requiring immediate medical attention.

How We Help at Kriz Mobility and Vitality

At Kriz Mobility and Vitality, we understand that leg pain is not always caused by the same condition. Our evaluation focuses on identifying why your symptoms developed rather than simply treating the location of your pain.

Depending on your examination findings and goals, your individualized treatment plan may include:

• Therapeutic exercise
• Manual therapy
• Functional movement retraining
• Balance and gait training
• Neuromodulation when clinically appropriate
• Radial shockwave therapy when indicated
• Photobiomodulation (light therapy) when appropriate

Our goal is to help you return to the activities you enjoy — whether that’s golfing, pickleball, traveling, walking the beach, or simply living with greater confidence.

Frequently Asked Questions

Can piriformis syndrome cause pain below the knee?

Yes, it can — although pain extending below the knee is generally more characteristic of lumbar sciatica.²·³

Can an MRI diagnose piriformis syndrome?

Not usually. Diagnosis is primarily based on a detailed history and physical examination, because imaging is often normal.³

Does everyone with sciatica need surgery?

No. Most individuals improve with conservative treatment, including exercise, education, and activity modification.²

Is walking good for sciatica?

For many people, yes. Walking is often encouraged as part of an individualized rehabilitation program, provided it does not significantly worsen symptoms.²

Download Our Free Back Pain Guide

If back or leg pain is limiting your ability to stay active, download our Free Back Pain Guide. You’ll learn:

• Common causes of back and leg pain
• Evidence-based strategies for reducing flare-ups
• Exercises that may improve mobility and confidence
• Questions to ask before considering injections or surgery

Schedule a Free Telephone Consultation

If you’re unsure whether your symptoms are coming from your back, hip, or piriformis muscle, we’re here to help. Schedule a complimentary telephone consultation with the team at Kriz Mobility and Vitality to discuss your concerns and determine the next best step toward returning to an active lifestyle.

References

1. Hartvigsen J, Hancock MJ, Kongsted A, et al. What Low Back Pain Is and Why We Need to Pay Attention. The Lancet. 2018;391(10137):2356-2367.

2. George SZ, Fritz JM, Silfies SP, et al. Interventions for the Management of Acute and Chronic Low Back Pain: Revision 2021. Journal of Orthopaedic & Sports Physical Therapy. 2021;51(11):CPG1-CPG60.

3. Hopayian K, Song F, Riera R, Sambandan S. The Clinical Features of Piriformis Syndrome: A Systematic Review. European Spine Journal. 2010;19(12):2095-2109.

4. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. American Journal of Neuroradiology. 2015;36(4):811-816.

5. Qaseem A, Wilt TJ, McLean RM, Forciea MA; Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of Internal Medicine. 2017;166(7):514-530.

This material is educational in nature and is not a substitute for individualized medical advice, diagnosis, or treatment. Consult a qualified health care provider with any questions regarding a medical condition.