True Sciatica or Piriformis Syndrome?

Sciatica refers to irritation of the sciatic  nerve that arises from nerve roots in the lumbar spine. The most common cause of sciatic nerve irritation, or “true” sciatica is compression of one or more of its component nerve roots due to disc herniation or spinal degeneration in the lower lumbar region. Depending on the severity of the compression and/or inflammation of the sciatic nerve components, sciatica may extend into the buttock area, into the thigh, or sometimes all the way down the leg to the foot.

Piriformis syndrome, also known as “pseudo-sciatica” (meaning “false sciatica”), is actually referral pain and other symptoms (tingling, numbness, etc.) caused by tightness and knots of contraction in the piriformis muscle, which runs from the upper femur bone to the edge of the sacrum, the triangular pelvic bone that is below the lumbar spine. The symptoms of piriformis syndrome are very similar and may be indistinguishable from true sciatica.

Only a qualified health professional can distinquish between the two conditions. Once you have received a diagnosis of Piriformis Syndrome, there are several treatment options your health care provider may suggest:

  • Physical Therapy – Emphasis on stretching and strengthening the hip rotator muscles
  • Rest – Avoid the activities that cause symptoms for at least a few weeks
  • Anti-Inflammatory Medication – To decrease inflammation around the tendon
  • Deep Massage – Advocated by some physicians

Here are some examples of simple exercises to stretch the piriformis muscle:

  • Sitting Cross-Legged:  One of the easiest ways to keep your hips open and stretch your piriformis muscle is by sitting cross-legged on the floor for several minutes a day.
  • Piriformis Chair Stretch:  Another easy way to stretch out the piriformis, especially if you have a desk job, is to cross one leg over the other with your ankle resting on the knee of the opposite leg. Gently press down on the inside of the knee and slowly lean forward until you feel a mild stretch in the hips.
  • Lying Piriformis Stretch:  A more intense stretch can be performed while laying on your back on the floor. Cross the right leg over the left, with the right ankle resting on the left knee. Slowly lift the left foot off the floor and toward you while you apply gentle pressure to the inside of the right knee. Hold 20 to 30 seconds, and repeat on the other side.

Before beginning any treatment plan, consult with your health care provider. If you would like more information how massage therapy can help with Piriformis Syndrome, please contact Emma Nicholson, CMT  in Charlottesville, VA.


Elizabeth Quinn, Sports Medicine Guide

Jonathon Cluett, M.D., Orthopedics Guide

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