Buttock or leg pain isn’t always “just sciatica.” While sciatica and piriformis syndrome can feel almost identical, they have very different causes and treatments. Knowing the difference can speed up recovery, reduce flare-ups, and stop you wasting time on the wrong exercises. This guide explains how to tell them apart and when physiotherapy can help.

👉 If leg pain is affecting your sitting, walking, or exercise, this blog will give you clarity—and a plan.

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Why Sciatica and Piriformis Syndrome Are So Often Confused

Sciatica is one of the most commonly misused terms in healthcare. Many people use it to describe any pain that travels from the buttock down the leg.

In reality:

• Sciatica is a symptom, not a diagnosis
• Piriformis syndrome is a specific condition involving a muscle in the buttock

Both involve irritation of the sciatic nerve, which is why the pain pattern can feel very similar. The challenge is identifying where along the nerve the irritation is coming from.

That distinction matters—because the treatment approach is completely different.

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What Is Piriformis Syndrome?

Piriformis syndrome occurs when the piriformis muscle—located deep in the buttock—compresses or irritates the sciatic nerve.

The piriformis helps stabilise the hip and rotate the leg outward. When it becomes tight, overworked, or dysfunctional, it can place pressure on the sciatic nerve as it passes nearby (or, in some people, directly through the muscle).

Common causes of piriformis syndrome include:

• Prolonged sitting (desk work, long commutes)
• Running or walking with poor hip control
• Sudden increases in training load
• Weak gluteal muscles
• Previous lower back or hip injury
• Falls or direct trauma to the buttock

Importantly, the spine itself is often not the source of pain.

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What Is Sciatica (From the Spine)?

Sciatica describes pain caused by irritation of one or more spinal nerve roots in the lower back.

This commonly occurs due to:

• Disc bulge or disc herniation
• Spinal stenosis
• Degenerative disc changes
• Facet joint irritation

In these cases, the sciatic nerve is irritated before it even reaches the buttock.

This is why spinal sciatica often behaves differently to piriformis syndrome, particularly with spinal movements.

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Key Differences: Sciatica vs Piriformis Syndrome

Feature	Piriformis Syndrome	Sciatica (Spinal)
Primary pain area	Deep buttock	Lower back + leg
Back pain	Minimal or absent	Common
Sitting tolerance	Often painful	Variable
Walking	Often improves pain	May worsen or improve
Bending/arching spine	Usually pain-free	Often aggravates
Cause	Muscle compressing nerve	Nerve root irritation

No single sign is definitive—but patterns matter.

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Symptoms That Point More Towards Piriformis Syndrome

You may be dealing with piriformis syndrome if you notice:

• Deep ache or burning pain in the buttock
• Pain that travels down the back of the thigh
• Minimal or no lower back pain
• Symptoms worse with sitting or driving
• Pain when climbing stairs or running
• Tenderness when pressing into the glute region
• Relief with standing or gentle walking

Many patients describe it as feeling like the pain is “stuck deep in the hip” rather than coming from the spine.

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Why Stretching Alone Often Makes Things Worse

One of the biggest mistakes we see in clinic is people aggressively stretching their glutes or lower back without knowing the true cause.

With piriformis syndrome:

• Overstretching can further irritate the nerve
• The real issue is often poor hip control, not flexibility
• Weak glutes and pelvic instability overload the piriformis

With spinal sciatica:

• Stretching may flare nerve symptoms
• Certain spinal positions can worsen disc-related pain

This is why self-diagnosis frequently delays recovery.

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How Physiotherapy Diagnoses the Difference

At our Frenchs Forest clinic, physiotherapists assess far more than just where it hurts.

A proper assessment may include:

• Detailed history of symptom behaviour
• Lumbar spine movement testing
• Hip mobility and strength assessment
• Nerve tension tests
• Functional movement analysis (walking, squatting, running)
• Load and activity review

This allows us to pinpoint whether the nerve is irritated at the spine, the buttock, or both.

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Physiotherapy Treatment for Piriformis Syndrome

Treatment for piriformis syndrome focuses on reducing nerve compression and correcting the underlying cause.

This often includes:

• Targeted soft tissue techniques to the piriformis
• Progressive strengthening of the glutes and hip stabilisers
• Pelvic and trunk control exercises
• Gradual re-exposure to sitting and activity
• Running or walking technique correction (if relevant)
• Advice on desk setup and sitting habits

The goal isn’t just pain relief—it’s preventing recurrence.

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Physiotherapy Treatment for Spinal Sciatica

If symptoms are coming from the lower back, treatment may involve:

• Direction-specific spinal exercises
• Core and spinal stabilisation
• Nerve desensitisation strategies
• Education around flare-ups and posture
• Graded return to activity and exercise

Again, very different approach—same nerve.

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Real Patient Example From Our Clinic

Recently, we treated a 42-year-old office worker who travelled from Forestville, a surrounding suburb to Frenchs Forest NSW, after struggling with ongoing buttock and leg pain.

They had been told they had “sciatica” and were stretching their lower back daily, but symptoms were worsening—especially with sitting and driving.

After assessment, we identified piriformis syndrome, driven by:

• Prolonged sitting
• Weak gluteal muscles
• Poor pelvic control during walking

Physiotherapy focused on:

• Reducing piriformis tension
• Strengthening glutes and hips
• Improving sitting tolerance
• Gradual return to gym training

Within 4 weeks, leg pain had resolved and sitting tolerance returned to normal. Most importantly, they understood how to prevent it coming back.

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When Should You See a Physio?

You should book a physiotherapy assessment if:

• Leg or buttock pain lasts longer than 1–2 weeks
• Pain keeps returning with sitting or exercise
• You’re unsure whether it’s sciatica or piriformis syndrome
• Symptoms are limiting work, sleep, or activity
• You’ve tried rest or stretching without success

🚨 Seek urgent medical attention if you experience:

• Progressive leg weakness
• Loss of bowel or bladder control
• Numbness in the saddle or groin region

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Can Piriformis Syndrome Go Away on Its Own?

Mild cases sometimes settle—but many become persistent or recurrent if the underlying movement issue isn’t addressed.

Without physiotherapy, piriformis syndrome can:

• Flare repeatedly with sitting
• Limit exercise and walking
• Lead to chronic nerve sensitivity

Early treatment usually leads to faster, more complete recovery.

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Final Takeaway

• Sciatica and piriformis syndrome feel similar—but are not the same
• Piriformis syndrome involves muscle-based nerve compression
• Spinal sciatica involves nerve root irritation
• Correct diagnosis is essential for effective treatment
• Physiotherapy provides long-term solutions, not just short-term relief

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Frequently Asked Questions (FAQs)

Is piriformis syndrome the same as sciatica?

No. Piriformis syndrome is one possible cause of sciatica-type pain, but true sciatica often originates from the lower back.

How do I know if my pain is piriformis syndrome?

Deep buttock pain, minimal back pain, and symptoms worse with sitting are common signs, but a physio assessment is needed to confirm.

Can massage alone fix piriformis syndrome?

Massage may provide temporary relief, but without strengthening and movement correction, symptoms often return.

How long does piriformis syndrome take to heal?

With physiotherapy, many people improve within 3–6 weeks depending on severity and activity levels.

Should I keep exercising with piriformis syndrome?

Usually yes—but exercise needs to be modified. A physiotherapist can guide safe loading and recovery.

References & Further Reading

• Cleveland Clinic – Piriformis Syndrome
  https://my.clevelandclinic.org/health/diseases/15608-piriformis-syndrome
• Physiopedia – Piriformis Syndrome
  https://www.physio-pedia.com/Piriformis_Syndrome
• Better Health Channel (Vic Health) – Sciatica
  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/sciatica
• X-Physio Blog – Sciatic Pain Treatment Options
  https://xphysio.com.au/sciatica-how-physio-can-ease-the-pain/

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Ready to Get Answers and Start Recovering?

Give us a call today on 9806 3077, or book online, just
CLICK HERE

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