Similarities and Differences between a Herniated Disc and Piriformis Syndrome

14 Jun Similarities and Differences between a Herniated Disc and Piriformis Syndrome

A herniated disc and piriformis syndrome can both cause sciatica. This is a general medical term used to describe pain in the buttocks that refers down the legs due to compression of the sciatic nerve, which is the thick and long nerve that exits out of the spine at the lower back and runs through the buttocks and down the leg.

Since both these conditions can cause radiating pain down the leg from the back due to the sciatic nerve being affected, they can be misdiagnosed for each other or other conditions that can also cause this problem.

In both conditions, patients may experience similar issues such as:

• Pain occurring or being aggravated by similar movements such as sitting or standing for prolonged periods of time, rising from a seated position, or when getting up after sleeping.
• A tingling sensation or numbness in the buttocks and legs.
• If the compression is severe enough, the affected individual may complain of weakness of the legs.
• Pain improves when lying on the side or in a position where the lower back is flexed, such as the fetal position.

Herniated Disc

A herniated, or prolapsed, disc causes sciatica as follows:

• The disc that is located between the spinal (vertebral) bones of the back act as a cushion between these bones to allow for more flexibility of the back.
• When these discs rupture or leak due to various reasons, their gel-like content escapes from the capsule of the disc and can either irritate or directly compress the surrounding nerve roots that exit the spine.
• If the sciatic nerve is compressed severely enough, the affected individual may even complain of loss of sensation in their legs.

A herniated disc can be managed conservatively if the prolapsed material from the anatomy is mild. Treatment of this issue may include:

• Assisting the body to break down the disc material that has leaked out.
• Flexion-distraction therapy and the use of inversion tables which have been found to be effective in managing this issue.
• Stretches and light exercises suggested by physical therapists can decrease spasm and tension in the muscles of the lower back and improve the mobility of lower back joints.
• Physical therapists can also suggest specific exercises that help to improve the strength of the core muscles which support the lower back.
• Massage therapy has been shown to help improve blood flow and reduce tension in muscles of the lower back, buttocks, and hamstrings which aids in relieving lower back pain.
• Spinal decompression through minimally invasive or open surgery may be warranted if the conservative approaches are ineffective.

Piriformis Syndrome

Piriformis syndrome causes sciatica by directly compressing on the sciatic nerve due to swelling of the muscle as a result of injury or excessive use of piriformis which is located at the buttocks just above the hip joint. Therefore, piriformis syndrome causes sciatic nerve compression just like a herniated disc does but the location of the compression is elsewhere.

This is an important distinction to make because even though the clinical picture for both conditions is similar, the management of both issues will be different.

If the clinical picture still doesn’t help to differentiate between the two conditions, an MRI of the lower back and pelvis will help to confirm the correct diagnosis.