How do you differentiate piriformis syndrome and true sciatica?

Differentiating between piriformis syndrome and true sciatica can be challenging, as both conditions can cause similar symptoms, such as pain in the buttocks, hip, and leg. Here are some factors that can help you distinguish between the two conditions:

Location of pain:

- Piriformis syndrome: Pain is typically felt in the buttock area, often described as a deep, aching pain. It may also radiate down the back of the thigh.

- Sciatica: Pain usually starts in the lower back and radiates down one leg, through the buttocks, and into the back of the thigh, calf, and foot.

Piriformis test:

- Piriformis syndrome: The piriformis test involves flexing the hip and knee of the affected leg while lying on the back and then rotating the hip inward. Pain during this test may indicate piriformis syndrome.

- Sciatica: The sciatic nerve stretch test involves lying on the back with the knee of the affected leg extended and gently pulling the leg towards the chest. Pain during this test may indicate sciatica.

Straight leg raise test:

- Piriformis syndrome: The straight leg raise test involves lifting the affected leg while lying on the back. Pain during this test may indicate piriformis syndrome, especially if the pain is worse when the hip is rotated inward.

- Sciatica: The straight leg raise test can also be used to assess for sciatica. Pain during this test, especially if it radiates down the leg, may indicate sciatica.

Additional symptoms:

- Piriformis syndrome: Numbness or tingling in the affected buttock or leg and difficulty sitting or walking for extended periods may also be present.

- Sciatica: In addition to leg pain, sciatica can cause weakness in the affected leg, muscle spasms, and difficulty controlling bowel or bladder movements (in severe cases).

It's important to note that the diagnosis of piriformis syndrome or sciatica should be made by a healthcare professional, such as a doctor or physical therapist. They can perform a thorough evaluation, including a physical examination, to accurately identify the source of your symptoms and provide appropriate treatment.