Sciatica or Piriformis Syndrome? Understanding the Difference
Updated: Sep 22
Written by John A. Wilson, Certified Advanced Rolfer®
Published May 12th, 2024
Updated Sept 22nd, 2026
Many people experience pain in the lower back, hips, glutes, or legs that may feel “sciatic.” These symptoms can affect movement, sleep, work, and everyday activities.
However, sciatic-type pain does not necessarily mean that someone has a specific condition called sciatica. Several different structures and movement patterns can produce similar symptoms. Understanding those possibilities can help create a more thoughtful and individualized approach.
What is sciatica?
The term sciatica generally refers to symptoms associated with irritation or compression of the sciatic nerve or one of the nerve roots that contribute to it. It is more accurately understood as a description of symptoms than as a single diagnosis.
The sciatic nerve begins from nerve roots in the lower back and travels through the pelvis and gluts before continuing down the leg. Because of its length and the number of structures surrounding it, symptoms may arise from different areas.
Sciatic-type symptoms can include:
Pain in the lower back, hip, or glutes
Pain that travels down the back or side of the leg
Tingling or numbness
Burning or electric sensations
Weakness or changes in coordination
These symptoms can have many possible contributors, and similar symptoms do not always have the same cause.
What can cause sciatic-type pain?
Sciatic-type pain may be associated with irritation of a lumbar nerve root, including irritation related to a disc. Other possible contributors include narrowing around the spinal nerves, changes in the joints of the lower back, or the way the spine and pelvis respond to movement and load.
The hip and deep gluteal region may also play a role. Restrictions or sensitivity in the hip rotators, surrounding muscles, connective tissues, or joints can sometimes produce pain in the glutes or symptoms that travel down the leg.
Possible contributing factors may include:
Lumbar disc-related nerve irritation
Spinal stenosis or reduced space around nerve structures
Irritation of nerve roots in the lower back
Hip-joint or surrounding soft-tissue contributors
Piriformis or other deep-posterior hip involvement
Limited hip mobility
Repetitive movement or loading patterns
Changes in how the pelvis, spine, and legs coordinate
This does not mean that one of these factors is always the cause. Different conditions can produce similar symptoms, and more than one contributor may be present at the same time.
What is piriformis syndrome?
The piriformis is a relatively small muscle located deep in the gluteal region. It connects the sacrum to the upper part of the femur near the greater trochanter. Its position allows it to contribute to hip rotation and to the coordination of the pelvis and leg.
The sciatic nerve usually passes beneath the piriformis, but the relationship between the nerve and the muscle varies among individuals. In some people, portions of the nerve may pass through or around the muscle.
When the piriformis or other structures in the deep gluteal region become sensitive, restricted, or heavily loaded, they may contribute to pain or symptoms that resemble sciatica. This is sometimes referred to as piriformis syndrome, although identifying the piriformis as the primary contributor can be complex.
It is important not to assume that every symptom in the hip or leg comes from the piriformis. A careful assessment should consider the lower back, pelvis, hip, nerve structures, movement patterns, and the person’s overall history.
Sciatica and piriformis syndrome: how are they different?
Sciatic nerve or nerve-root irritation | Piriformis or deep-gluteal involvement | |
Where symptoms may be felt | Lower back, buttock, and leg | Often the buttock or hip, sometimes extending down the leg |
Possible contributing structures | Lumbar spine and nerve roots | Piriformis, deep hip rotators, and surrounding tissues |
Can symptoms overlap? | Yes | Yes |
Can symptoms have multiple contributors? | Yes | Yes |
This comparison is not intended to replace a medical evaluation. It illustrates why symptoms alone may not identify a single structure or diagnosis.
Why does the pain keep coming back?
Sometimes a painful area continues to be irritated because the broader movement pattern has not changed. For example, the hip may have limited mobility, the pelvis may not organize easily over the legs, or the lower back may be doing more work than it can comfortably manage.
In my practice, I may explore:
The relationship of the pelvis to the legs
Hip mobility and the movement of the hip rotators
How the pelvis organizes during standing and walking
How the lower back participates in movement
Habitual movement and loading patterns
How different structures share work throughout the body
This whole-body perspective does not assume that the painful area is the only problem. Instead, it asks how the different parts of the body relate to one another and whether some areas are compensating for others.
When I work with someone experiencing sciatic-type pain, I may explore the hip and surrounding tissues as part of the assessment. If the piriformis or other structures in the region appear to be contributing to the person’s movement pattern, hands-on work and movement may be useful ways to explore that relationship.
The goal is not simply to work on the painful spot. It is to help the person understand how they are moving and how the body may be distributing load. In some cases, changes in organization and movement may reduce strain and make it easier for the body to move with greater comfort and adaptability.
A whole-body approach
Rolfing® Structural Integration looks at relationships throughout the body rather than assuming that one isolated structure is always responsible for pain.
The work may include the hips, pelvis, legs, lower back, rib cage, and other areas that influence how a person stands and moves. The process is individualized and may include myofascial work, movement awareness, and exploration of new ways of organizing the body.
This approach is not intended to diagnose or treat every possible cause of sciatic pain. Rather, it offers one way to investigate how posture, movement, connective tissues, and habitual patterns may influence a person’s experience.
About The Author
John Wilson is a Certified Advanced Rolfer® with more than 20 years of experience studying the relationships between fascia, posture, movement, and chronic pain. Through thousands of client sessions, he has developed a whole-body approach to Structural Integration that emphasizes identifying the underlying compensatory patterns that contribute to discomfort rather than focusing solely on the site of pain. His writing reflects both clinical experience and an ongoing commitment to anatomy, biomechanics, and movement education.
Credentials
Certified Advanced Rolfer®
Structural Integration Practitioner
Over 20 years of clinical practice
Specializing in posture, chronic pain, fascia, and biomechanics
Serving Denver and Tucson
Editorial Note: Articles on this website are written by John Wilson based on his clinical experience as a Certified Advanced Rolfer®, continuing professional education, and published research. They are intended for educational purposes and should not replace individualized medical advice
This is very useful, especially as my sciatic pain has disappeared since I started having sessions with John.