You’re sitting at your desk when it hits—that familiar shooting pain from your lower back down through your leg. Or maybe you’re getting out of your car when the burning sensation strikes. “It’s my sciatica acting up again,” you tell yourself. But what if it’s not actually sciatica at all? Dr. Elaine McNally at Chiropractic Care Clinic has treated many Montgomery residents over her 30+ year career who were surprised to learn their “sciatica” was actually piriformis syndrome—a condition that mimics sciatica but requires a different treatment approach.
Your sciatic nerve is the longest nerve in your body—about as thick as your thumb. It starts in your lower back, travels through your pelvis, and branches down each leg all the way to your toes. When this nerve gets irritated or compressed anywhere along its path, you experience sciatic nerve pain. But where the nerve gets compressed determines whether you have true sciatica or piriformis syndrome—and that location changes everything about how it’s treated.
True sciatica (lumbar radiculopathy) occurs when the nerve roots forming the sciatic nerve are compressed in your lower spine, typically at L4-L5 or L5-S1.
Patients often describe true sciatica as:
Common causes include herniated discs, spinal stenosis, spondylolisthesis, and degenerative disc changes.
The piriformis is a small muscle deep in your buttock that helps rotate your hip. In most people, the sciatic nerve runs underneath this muscle. However, research including a systematic review published in Cureus (2020) found that in a significant proportion of the population, the sciatic nerve runs through or over the piriformis muscle (PMID: 33354475). When the piriformis spasms or tightens, it can compress the sciatic nerve, creating symptoms nearly identical to true sciatica.
Patients with piriformis syndrome often report:
Common triggers include prolonged sitting, direct trauma, overuse from physical activity, and muscle imbalances.
The source of pain dramatically affects which treatment works. One patient spent months treating “sciatica” with exercises targeting disc problems. When examined at Chiropractic Care Clinic, piriformis syndrome was identified. With targeted treatment addressing the correct structure, her symptoms improved significantly over the following weeks. Individual results vary and are not guaranteed.
For true sciatica:
For piriformis syndrome:
It is possible to have both conditions simultaneously—nerve compression at multiple points. This is why comprehensive evaluation is important. One patient presented with both a herniated disc and piriformis syndrome. Treating only one source would have left them in partial pain; a multi-modal approach addressed both. Individual results vary and are not guaranteed.
Suggesting true sciatica:
Suggesting piriformis syndrome:
Incorrect diagnosis can lead to inappropriate treatment, wasted time, and progressive worsening of the actual condition. A comprehensive evaluation—including detailed history, physical examination, movement assessment, and diagnostic X-rays where indicated—gives the clearest picture of what is actually driving your symptoms.
Living with nerve pain affects every aspect of daily life. Whether your pain stems from true sciatica or piriformis syndrome, accurate diagnosis is the essential first step. Dr. McNally and the team at Chiropractic Care Clinic have the diagnostic experience and treatment options to identify and address your specific condition.
This article is for educational purposes only. Pain radiating down your leg can have various causes, some requiring urgent attention. Always seek professional medical evaluation for proper diagnosis and treatment.
