Piriformis Syndrome vs Sciatica and Tests for a Tight Piriformis

What Is That Pain In The Butt?

By Dr. Erin Boynton, MD, FRCS

piriformis syndrome vs sciatica tests

Butt pain could be a number of things, but piriformis syndrome tests can help you determine whether it’d be smart to treat sciatica stemming from disc herniation or piriformis syndrome. 

We will cover what piriformis syndrome is, how to test for it, how it’s different from sciatica due to a disc herniation, and what you can do to eliminate this particular pain in the butt.

What is Piriformis Syndrome? 

Piriformis syndrome occurs when the piriformis muscle sticks to presses on the sciatic nerve that runs through the bum and down the leg.

The piriformis muscle rests right on top of the sciatic nerve, which puts the nerve in a vulnerable position. If the piriformis ever gets misaligned, shortened, weakened, or swollen it will press on the sciatic nerve.

The sciatic nerve provides input to the skin and muscles of your lower limbs. Too much pressure on the nerve causes pain, weakness, numbness and tingling down the back of the leg. Depending upon how much pressure, and what part of the nerve is pressed, you may just feel a pain in the butt, or symptoms that mimic sciatica.

piriformis sciatica anatomy

Symptoms of piriformis syndrome include: 

  • Pain in the butt
  • Tingling, numbness, radiating pain, or “pins and needles” down the back of the thigh, knee, and/or calf
  • Low hip mobility
  • Pain when sitting
  • Pain when walking, running, or climbing stairs

Most people say the pain is worst when they’re sitting. Sitting on the piriformis can clamp it onto the sciatic nerve, causing pain. 

You’re probably thinking, “this sounds just like sciatica!” You would be right. Let’s look at what makes piriformis syndrome different. 

Piriformis Syndrome vs. Sciatica

What is sciatica? 

Sciatica is a symptom, not a diagnosis. It refers to pain starting in the butt and lower back that radiates down the back of the leg.

piriformis syndrome vs sciatica

Sometimes people describe numbness and tingling. The pain can take several forms, including shooting strikes, mild aches, and even prolonged excruciating pain. 

Sitting usually causes the most intense pain for most people. It puts pressure on the lumbar spine as well as the piriformis. 

Your doctor needs to determine the reason that there is pressure on the sciatic nerve or nerve roots. There could be several causes. One of the most common ones comes from a slipped, bulging, or herniated disc in the spine, while the rarest is a spinal tumor.

A dysfunctional piriformis also causes sciatica pain, although less commonly than herniated discs. Luckily, the piriformis is a muscle which means we can do something about it through simple exercises, improving strength, length of muscles, and range of motion. 

Piriformis Syndrome or Disc Herniation Sciatica?

You can see from the chart, that there is a lot of overlap between the symptoms from a herniated disc and piriformis syndrome. Regardless of what is causing the pain in your butt, if you determine that your piriformis is tight, then releasing it will help you to feel better.

Perform the at-home tests to check the mobility of your piriformis.

Symptom

Piriformis

Herniated Disc

Back Pain

+/-

++/-

Tight Piriformis

+++

+/-

Leg Pain

+/-

+++

Leg Weakness / Numbness

+/-

+++

The only way to conclusively determine whether you have sciatica due to disc herniation or a tight piriformis is to get an MRI of your lumbar spine. 

Regardless of what type of sciatica you have, you can start mobility exercises for your hips which should ease the pain and prevent it from flaring up again in the future.

Tests for a Tight Piriformis

Your piriformis has a couple of neat functions. When the hip is extended, it controls the outward rotation of the leg. When you’re sitting, the piriformis controls the inward rotation of your leg. Neat, right? 

A tight piriformis is the number one indicator that it’s the cause of your sciatica. 

A quick way to test for a tight piriformis is to perform the Standing Step-Behind Piriformis Stretch. 

It will immediately show you if you’re lacking in range of motion in your hips, one sign of a tight piriformis.

Resistance to movement (rotation) or tightness while you’re performing the exercise below, tells you that your hips need some mobility attention. Pain, tightness, and lack of ROM indicate that you need to address this under-loved muscle.

  1. Stand tall making sure you maintain neutral posture
  2. Step one foot behind the other and internally rotate it so that your toes move inward towards your other foot and your heel rotates outward
  3. Place the heel of your other foot on the outside of the pinky toe of the foot that is internally rotated to help hold the rotated position
  4. Squeeze your quads, glutes and abs to lock your pelvis in place
  5. Grab a wall, door frame or a pole with the arm on the same side as your internally rotated leg and use it to support the stretch
  6. Turn towards the side of the internally rotated leg, just enough to feel the stretch
  7. Hold the stretch for about 30-60 seconds and repeat 2 times per side

Good news! The same test to check for piriformis dysfunction also helps you improve the range of motion. Even standing up from your desk twice a day can help ease the pain and prevent it from coming back in the future. 

Next, we will show you some exercises to get those muscles back to work. 

Fixing The Root Causes

We want to fix why you have butt pain and leg pain. It’s not fun, so let’s put it behind us. 

The luckiest part is the root causes for piriformis syndrome and herniated discs* are similar:

  • Muscle imbalances
  • Poor movement mechanics
  • Lumbar spine misalignment and musculature
  • Pelvic mechanical dysfunction

These are almost all related to sleepy muscles in your core and hips.

Getting your psoas and glutes activated will start you on the way to solving the root causes. Next is getting proper pelvic spinal alignment. Better posture and a few ReBUT techniques while you’re sitting will help ensure this doesn’t happen again.

Your next step is starting on the 3 Piriformis Syndrome Stretches

Or, follow along with these exercises for SI joint and piriformis syndrome pain.

Finally, resolve and prevent sciatica and piriformis syndrome by improving the function of your hips. Plus, improved hip mobility and strength will prevent additional wear and tear and keep you doing what you love.  

*If you are in too much pain as a result of a herniated disc, I recommend the  7 Day Acute Low Back Pain Plan  in Spine Control.

Insert Table

About the Author

Dr. Erin Boynton, MD, FRCS is an orthopedic surgeon who was the team surgeon for the Toronto Blue Jays for 10 years and has worked with other professional teams and athletes from many different sports. She currently serves as the Chief Medical Director of the Rogers Cup WTA Tennis Tournament and is the ITF Canadian Champion in tennis for her age group (we won't say which group that is!).

>