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Sciatica vs piriformis syndrome: differences, signs, what to do

2026-02-10 • 12 min

Sciatica vs piriformis syndrome: differences, signs, what to do

Understand true sciatica (nerve) vs pseudo-sciatica (often glute/piriformis): symptoms, red flags, safe self-check cues, and what helps.

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Pain going down the leg isn’t always “sciatica”.

Why the difference matters

Many people call any buttock/low-back pain that travels down the leg “sciatica”. In reality, there are different causes. True sciatica involves nerve irritation/compression. Pseudo-sciatica can feel similar but often comes from glute/piriformis tension and trigger points. The right move: look for key signs and avoid aggressive self-treatment.

Quick definitions

Sciatica (nerve)

Pain linked to irritation/compression of a nerve root (often lumbar) or the sciatic nerve. It may feel electrical/burning, with tingling, numbness, and sometimes weakness.

Pseudo-sciatica (often piriformis/glute)

Sciatica-like pain that more often comes from glute muscles (piriformis, glute med), fascia and trigger points. It tends to feel more muscular and tender to touch.

Helpful cues: sciatica vs pseudo-sciatica

Criteria

Pain quality

Sciatica (nerve)

Often sharp/electrical/burning; can be very specific.

Pseudo (glute)

More deep ache/tight pull; “deep muscle” feeling.

Criteria

Neurological signs

Sciatica (nerve)

Tingling, numbness, weakness can appear.

Pseudo (glute)

True weakness is uncommon; more stiffness and pressure tenderness.

Criteria

Buttock pressure

Sciatica (nerve)

Not always reproduced by pressing a precise point.

Pseudo (glute)

Often reproducible on a specific tender spot (trigger point).

Criteria

Sitting

Sciatica (nerve)

Can worsen (varies with cause).

Pseudo (glute)

Often worsens with long sitting/compression on the glute.

Criteria

Path down the leg

Sciatica (nerve)

More “nerve-like”, sometimes down to the foot.

Pseudo (glute)

Often buttock → back of thigh, less commonly to toes.

These are cues, not a diagnosis. Nerve irritation and muscular tension can also coexist.

Red flags: don’t ignore these

  • Weakness (foot drop, trouble walking on heels/toes)
  • Significant or progressing numbness
  • Severe sudden pain or pain consistently waking you at night
  • Bladder/bowel changes, saddle numbness (medical emergency)
  • Fever, unexplained weight loss, major history + new pain
If you have red flags, seek medical advice promptly. Massage can help muscular tension but doesn’t replace medical evaluation.

Safe self-check cues (no aggressive testing)

Without doing medical tests, you can observe a few indicators:

  • Is it mainly deep buttock muscle pain, tender to touch?
  • Any tingling/numbness or true weakness?
  • Does long sitting clearly trigger it (glute compression)?
  • Does gentle walking improve it a bit (often a good muscular sign)?
If you suspect nerve involvement (tingling, numbness, weakness), avoid deep pressure and aggressive stretching — it can irritate further.

What helps (useful, progressive approach)

1) Calm irritation (48–72h if flare)

Reduce triggers (long sitting, heavy load, sudden movements). Prefer gentle walking and comfortable positions.

2) Gentle mobility (hips + low back)

Slow, non-sharp movements often help: hip mobility, gentle rotation, low-back comfort, lower breathing.

3) Offload the glute (if pseudo)

Moderate self-pressure (ball) on 1–2 points, 60–90s, breathable. Then walk/move gently.

4) Gradual strengthening

As pain decreases: glute/core strengthening (bridges, light abduction) with clean form.

  • Max pain 6–7/10, keep breathing.
  • Avoid aggressive piriformis stretches if it flares symptoms.
  • If neurological signs: be cautious and get assessed.
  • Consistency (small often) beats one big session.

Massage: when it’s relevant

If pain is mainly muscular (glute/piriformis) without concerning neurological signs, massage can help reduce tone, improve mobility and calm the nervous system.

  • Often works best as a chain approach: glute + hips + low back.
  • Slow, breathable pressure reduces guarding.
  • Gains tend to hold better when you move gently afterwards.

Sciatica / piriformis FAQ

How do I know if it’s true sciatica?

Cues: electrical pain, tingling, numbness, weakness. Only a professional can confirm — if you have these, be cautious.

Is piriformis stretching always good?

Not always. If it irritates symptoms (especially nerve sensitivity), prefer gentle mobility and gradual strengthening.

Massage ball on the glute: yes or no?

Yes if muscular: moderate, slow, breathable, 1–2 points then walking. Avoid if neurological symptoms are significant.

How long does it last?

If mostly muscular, improvement can happen within days to weeks with consistency. If it worsens or persists, get assessed.

Buttock/leg pain: want a tension-focused check?

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