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Sciatica vs Piriformis Syndrome

Today I am writing about sciatica and piriformis syndrome. Both of these conditions affect the sciatic nerve and are very common. If you or someone you know has ever experienced "sciatica" then you understand how debilitating it can be. As a former sufferer of sciatic nerve pain, I can attest that it is just about the worst type of pain that I have ever gone through. Because of my close personal relationship with sciatica, I am very passionate about the subject, and I know that I will be able to provide valuable insight. I want to share just about everything that I can with you and as an LMT (Licensed Massage Therapist), I absolutely love working on people that are suffering from the same condition that I once did. If you have not ever heard of sciatica or piriformis syndrome - consider yourself fortunate in this regard.

The very first thing I will address is the fact that yes, I will be covering two separate conditions. Why? It is because they are so closely related, that it would be better suited for you, the reader to learn about them at the same time.

So, why do I have a "Condition of the Week" blog as well as an "Education" blog? Aren't they both educational? Yes and no. I'll explain.

For a couple of reasons:

1. Although the "Education" blog is educational, the articles are also a place to let your mind wander a bit and think about the many sides of massage therapy; the artistic side, the historical side, the philosophical side, the ethical side, and of course the energy side.

2. Although, I am a licensed healthcare practitioner, I am not a doctor, and it is not within my scope of practice as an LMT (Licensed Massage Therapist) to formerly educate anyone regarding Human Biology, Anatomy, Kinesiology, Pathology or anything else. However, I am allowed to give you solid, professional advice based on my level of education. Also, I am not in the business of diagnosing conditions or prescribing treatment. I say the very same thing to all my clients that have questions or concerns about a variety of matters; Talk to your doctor.

So, let's begin with a simple explanation of how these two conditions are related. Easy enough; they share very similar symptoms. Both of these conditions send similar aches and pains along the sciatic nerve in the buttocks, down the leg, and may even enter the foot. The pain may be characterized by aching or cramping sensations and/or shooting or burning pain.

Sciatica is defined as inflammation of the sciatic nerve. Okay, great. The problem with that definition is that it is non-specific. It doesn't tell me where the inflammation occurs. The nerve may be affected in the lumbar spine (where the vertebral discs are), the glutes (where the piriformis muscle is), or somewhere else further along the pathway of the nerve. The general public often refers to all of their sciatic pain as sciatica when in-fact it may not be "proper sciatica".

Piriformis Syndrome is defined as inflammation or compression of the sciatic nerve via piriformis muscle. The key difference between the two conditions is the location at which the nerve compression occurs. The reason the piriformis muscle has its own syndrome is because of the sciatic nerve's relationship to the piriformis muscle. In most people, the sciatic nerve passes under the muscle, but in many others, the sciatic nerve actually passes through the muscle making it very easily irritated and inflamed. This is very common phenomena.

Okay, great. Now you know the difference. So why is that important to you - the patient, and why is that important for me - the therapist? I am so glad you asked.

For the patient:

It is important for you (the patient) to know the location of the nerve irritation because if your spine is not healthy, you may be putting yourself at risk for further injury as you carry on with your everyday life. Talk to your doctor.

For the practitioner:

It is important for us to know the location of the nerve irritation because "proper sciatica" involves irritation of the sciatic nerve near its root at the spinal cord and cannot be treated by a massage therapist. As an LMT, I cannot determine where the nerve is being affected. In order for a person to know whether or not they have proper sciatica and not piriformis syndrome, they need a professional diagnosis. Talk to your doctor. I can, however, determine where I will be working along your sciatic nerve based on objective and subjective information obtained from a series of questions during our intake.

Relax. All I am doing during our intake, is gathering the basic data needed so that I do not cause further injury by applying too much pressure or by moving your limbs past a comfortable range of motion. To be honest, I treat all sufferers of sciatic pain pretty similarly. My goal as an LMT is to loosen tight muscles and bring comfort to the client. If it's definitely a diagnosed disc issue, I will employ methods of massage that will keep the lumbar spine and sacroiliac joints as immobile as possible and use very light pressure in the surrounding areas. I will refuse to work on people if there is inflammation in the area intended to be worked on or if too much discomfort is present.

Here are the main points:


  • Pain, tingling, numbness, or burning in the back of the thigh that may also extend down the entire leg

  • Tenderness in the buttock

  • Loss of function of the leg

  • Pain that worsens when using the piriformis muscle (running, jumping, or stairs)

  • Pain that increases with prolonged sitting

  • Pain that lessens while lying flat on the back


  • Piriformis syndrome is the result of an increase in pressure placed on the sciatic nerve. This is often an overuse injury.

  • Stress placed on the nerve from a sudden increase in intensity, frequency, or duration of training.

  • Compensation of other extremity issues.

Risk Increases with:

  • Sports that involve the piriformis muscle (running, walking, or jumping)


  • Warm up and stretch

  • Allow adequate recovery between workouts

  • Maintain physical fitness


  • Talk to your doctor

  • Make sure you are all cleared by them before getting a massage by me if you are concerned about your symptoms

Generally speaking, dealing with sciatic pain is a deep subject, and I spent a lot more time on this post than I thought that I was going to. There is quite a bit of subject matter that I left out. Along with the physical pain comes a certain psychology that sets in which compounds the problem and everything becomes exacerbated from all the stress... Honestly, I could probably write a short book about sciatica and all of its physical and mental effects.

If you would like to know how I overcame my sciatic pain, I'd be happy to share my story. I will tell you what changes I had to make in order to stay pain free for the last several years. I will also tell you how I am making sure (as best as I can) that I never have to go through that awful and scary experience again. Since becoming an LMT, I have worked on several people suffering from sciatica pain, and they have had some pretty amazing results with the help of massage therapy. Please contact me if you have any questions. Thank you very much and be well.


The contents of this article cannot and should not be used as a basis for diagnosis or choice of treatment. If you have concerns about your health, you are strongly advised to contact a licensed physician who will be trained in observation and interpretation of symptoms and will be able to provide a proper diagnosis based on a knowledge and understanding of all aspects of your condition and your medical history.

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Very good read. Dan

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