Piriformis Syndrome vs. Lumbar Nerve Impingement: How to Tell Which Is Causing Your Sciatica

By Dr. Boris Nektalov, DNM, DC, Chiropractor & Enzyme Nutrition Specialist · Nektalov Chiropractic & Wellness, Forest Hills, Queens NY

Published: October 29, 2026 · Last reviewed: October 29, 2026

Quick answer: Piriformis syndrome and lumbar nerve impingement can both cause sciatica, which is pain, tingling or numbness running from the buttock down the back of the leg. Lumbar nerve impingement (lumbar radiculopathy) irritates a spinal nerve root in the lower back, often from a herniated disc or spinal stenosis. Piriformis syndrome irritates the sciatic nerve deeper along its path, in the buttock near the piriformis muscle. Because the source is different, the right treatment can be different too, so an accurate diagnosis should come first.

Have you ever had sharp, shooting pain that starts in your buttock and travels down the back of your leg? Perhaps you feel burning, tingling, numbness or an electric-shock sensation that makes sitting, walking or even sleeping uncomfortable. Most people immediately assume they have sciatica caused by a herniated disc in the lower back. But what if the problem isn’t coming from your spine at all, and the sciatic nerve is being irritated by a muscle deep inside your buttock?

I am Dr. Boris Nektalov, and one of the most common things I hear from patients at our Forest Hills chiropractic office is: “Doctor, I have sciatica, but I don’t know whether it’s coming from my back or my hip.” That distinction can make a significant difference in choosing the right care. At Nektalov Chiropractic & Wellness, we believe successful treatment begins with an accurate diagnosis, not simply treating the area where you feel pain.

What Is Sciatica?

Sciatica is a pattern of symptoms, not a single diagnosis: pain, tingling, burning, numbness or weakness that travels along the path of the sciatic nerve.

The sciatic nerve is the largest peripheral nerve in the human body. It forms from nerve roots in the lower lumbar and sacral spine, primarily L4 through S3, then travels through the pelvis and buttock and down the back of the thigh before dividing into branches that supply parts of the lower leg and foot.

When the sciatic nerve, or one of the spinal nerve roots that forms it, becomes irritated, symptoms can radiate down the leg. That irritation may start at a nerve root in the lumbar spine or farther along the nerve’s pathway. Two possible causes are lumbar radiculopathy and piriformis syndrome. They can feel remarkably similar, but their anatomy and mechanisms are different.

What Is Lumbar Nerve Impingement (Lumbar Radiculopathy)?

Lumbar radiculopathy is irritation or compression of a spinal nerve root in the lower back, and it is one common cause of sciatica.

The lumbar spine has five vertebrae separated by intervertebral discs, which help absorb mechanical loads and allow movement. Spinal nerve roots exit through openings between the vertebrae and contribute to the nerves supplying the legs. Several conditions may irritate these nerve roots:

• Herniated disc: disc material extends beyond its normal boundaries and irritates a nearby nerve root.
• Degenerative changes: the openings through which nerves travel may narrow.
• Spinal stenosis: the space around neural structures is reduced.
• Other inflammatory or mechanical processes may also contribute.

For example, an L5-S1 disc herniation may irritate the S1 nerve root, producing pain from the buttock down the back of the leg toward the outer foot. An L4-L5 herniation may cause L5 nerve-root symptoms, potentially involving pain or altered sensation along the outer leg and top of the foot. The exact distribution varies, and symptoms don’t always follow textbook patterns, which is why identifying the affected nerve root is an important part of herniated disc treatment.

What Is Piriformis Syndrome?

Piriformis syndrome is irritation of the sciatic nerve associated with the piriformis muscle, a small muscle located deep within the buttock.

The piriformis runs from the sacrum toward the greater trochanter of the femur and helps rotate and stabilize the hip during movement. In most people the sciatic nerve passes beneath the piriformis (in more than 80% of the population, according to StatPearls), although anatomical variations exist. When the piriformis or surrounding deep gluteal tissues become irritated, the sciatic nerve may become irritated too, producing buttock pain that sometimes travels down the leg.

Piriformis syndrome is considered a relatively uncommon cause of sciatica: StatPearls estimates it may account for 0.3% to 6% of all cases of low back pain and/or sciatica (Hicks, Lam & Varacallo, StatPearls).

Piriformis syndrome vs. deep gluteal syndrome

Clinicians increasingly use the broader term deep gluteal syndrome, described in the literature as buttock pain caused by sciatic nerve entrapment outside the spine and pelvis that is not due to a disc (Martin et al., Journal of Hip Preservation Surgery, 2015). The distinction matters because the piriformis is not the only structure that can irritate the sciatic nerve outside the spine; other muscles, fibrous bands or anatomical structures may also contribute.

Piriformis syndrome can be difficult to diagnose because there is no single definitive examination test, and its symptoms overlap with other causes of buttock and leg pain.

Why Are These Two Conditions So Easily Confused?

Imagine two patients walking into our office:

• Patient 1 has pain that begins in the lower back and travels into the buttock and down the leg.
• Patient 2 has pain that begins deep in the buttock and travels down the same leg.

Both describe burning, both have occasional tingling, both have difficulty sitting, and both believe they have sciatica. Yet the first patient’s symptoms may come from a lumbar disc irritating a spinal nerve root, while the second patient’s may be associated with sciatic nerve irritation in the deep gluteal region.

Although the pain patterns overlap, the treatment approach may differ substantially. Treating every sciatica patient as though they have a herniated disc can be a mistake, and so can assuming that every patient with buttock pain has piriformis syndrome. A proper evaluation is essential.

How Can You Tell Piriformis Syndrome From a Pinched Nerve in the Back?

Certain symptoms and examination findings may help distinguish lumbar radiculopathy from piriformis syndrome:

These differences are useful clues, but none can establish the diagnosis alone. A patient with piriformis syndrome may also have lower back discomfort, a patient with lumbar radiculopathy may have severe buttock pain without much back pain, and some patients have more than one contributing condition.

What Does a Proper Sciatica Examination Include?

At our chiropractic clinic in Forest Hills, Queens, evaluating sciatica means more than asking where the pain travels. A comprehensive examination may include:

• Muscle-strength testing
• Reflex testing
• Sensory evaluation
• Orthopedic testing, such as the straight-leg raise or slump test, to help evaluate neural sensitivity
• Lumbar range-of-motion assessment
• Evaluation of hip mechanics

For example, irritation of the S1 nerve root may be associated with changes in the Achilles reflex or weakness during plantar flexion, while L5 nerve-root involvement may contribute to weakness in ankle or great-toe dorsiflexion. These findings can help identify possible lumbar nerve-root involvement. For suspected piriformis syndrome, the exam may include assessing deep gluteal tenderness and specific hip-position tests that reproduce the patient’s symptoms.

However, no single orthopedic test is perfectly accurate. Clinical findings must be interpreted together with the patient’s history and overall presentation.

Can an MRI Tell the Difference?

MRI can be extremely helpful in selected cases, particularly when lumbar nerve-root compression is suspected, because it may reveal disc herniation, spinal stenosis or other structural abnormalities. But imaging findings must always be correlated with symptoms and examination results.

Many people have disc bulges or degenerative changes without any pain. A systematic review of MRI findings in people without back pain found disc bulges in 30% of 20-year-olds, rising to 84% of 80-year-olds (Brinjikji et al., American Journal of Neuroradiology, 2015). So finding a disc abnormality on an MRI does not automatically prove it is causing your sciatica. Conversely, a normal lumbar MRI does not necessarily mean you have piriformis syndrome; other causes of leg pain and peripheral nerve irritation must also be considered.

When symptoms persist, the diagnosis remains uncertain or significant neurological findings are present, additional evaluation may be appropriate. In selected cases, electrodiagnostic testing or specialized pelvic imaging may help clarify the source of nerve dysfunction. In short, imaging is most valuable when it answers a specific clinical question or changes treatment decisions.

How Is Sciatica From Lumbar Nerve Impingement Treated?

When sciatica comes from lumbar nerve-root irritation, treatment focuses on the underlying spinal condition and the patient’s neurological findings. For selected patients, conservative care may include chiropractic spinal manipulation or mobilization, therapeutic exercise, activity modification and rehabilitation.

Spinal manipulation may help some people with mechanical lower back pain; the American College of Physicians’ 2017 guideline lists it among initial treatment options for low back pain, but that guideline addresses non-radicular back pain (ACP guideline summary, American Family Physician). Evidence specifically supporting manipulation for lumbar radiculopathy is more limited. Not every patient with a herniated disc is an appropriate candidate for manipulation; symptom severity, neurological findings and the clinical diagnosis must guide treatment.

Patients also ask about non-surgical spinal decompression. Mechanical decompression is sometimes used for disc-related symptoms, but research on its effectiveness is mixed, and it has not been established as a universally superior treatment for lumbar radiculopathy. Some patients may do well with a structured rehabilitation program without decompression. Others may need evaluation by a spine specialist, medication management, injections or surgery when clinically indicated. Our priority is to determine which approach is appropriate for you.

How Is Piriformis Syndrome Treated?

When symptoms appear to originate from the piriformis or surrounding deep gluteal structures, treatment may focus more on the hip and pelvis than the lumbar spine. For selected patients, care may involve:

• Gentle soft tissue treatment
• Hip mobility exercises
• Progressive strengthening and movement retraining
• Modifying prolonged sitting and other activities or positions that reproduce symptoms

Hip muscle strength and control may be especially important. Weakness or poor endurance in the surrounding gluteal muscles can contribute to altered movement patterns, although these findings do not necessarily establish the cause of piriformis syndrome.

Chiropractic adjustments to the lumbar spine, pelvis or hip may be considered when the examination identifies relevant joint dysfunction, but an adjustment is not automatically necessary just because someone has piriformis syndrome. The main objective is to reduce irritation of the sciatic nerve while improving your ability to move comfortably. Some patients with persistent deep gluteal syndrome may need further specialist evaluation or image-guided interventions.

Why Doesn’t Stretching Always Help Sciatica?

A common mistake is assuming that all sciatica needs aggressive stretching. Patients search online for piriformis stretches, hamstring stretches and nerve stretches. Sometimes these provide relief; other times they make the pain worse.

That’s because different sources of sciatic pain respond differently to mechanical loading. Certain positions may increase tension on an already irritated nerve root, and aggressive stretching of the deep gluteal region may aggravate symptoms in some patients with sciatic nerve irritation. For some people gentle nerve mobilization may be useful; for others, hip strengthening or modified spinal exercises may be more appropriate.

The goal is not simply to stretch the painful area. It is to understand which movements help and which increase irritation, and to choose exercises based on your clinical findings and symptom response.

Can Sitting Make Both Conditions Worse?

Yes, but potentially for different reasons. Prolonged sitting increases pressure on the buttock and keeps the hips flexed, which may aggravate irritation around the sciatic nerve in deep gluteal syndrome. In certain lumbar disc-related conditions, prolonged sitting may also increase symptoms because of spinal position and mechanical loading. That’s why both conditions can flare during long car rides, desk work or extended sitting.

Because sitting aggravates both, it does not distinguish the two conditions on its own. At our Forest Hills office we look at your work environment, daily habits and movement patterns to find factors that may be contributing, and many patients benefit from ergonomic recommendations, posture work and regular movement breaks.

What Happens When Sciatica Becomes Chronic?

Many episodes improve with time; Ireland’s national health service notes that sciatica usually gets better in 4 to 6 weeks, though it can sometimes last longer (HSE). Sciatic pain can become persistent when nerve irritation, mechanical contributors and pain-related changes in activity continue over time. Patients may start avoiding exercise, their muscles may weaken, they may become fearful of certain movements, and sleep may be disrupted. Over time, these factors can contribute to reduced physical function and increased pain sensitivity.

That’s why chronic sciatica often requires more than temporary symptom relief. A comprehensive plan may include rehabilitation, progressive strengthening, activity modification and education about safe movement. In some cases, a multidisciplinary approach involving chiropractic care, physical therapy, pain management or medical specialists may be appropriate. The objective is to restore function while addressing the specific source of your symptoms whenever possible.

Do Shockwave Therapy or Red Light Therapy Help Sciatica?

At Nektalov Chiropractic & Wellness, we offer several conservative options for appropriately selected musculoskeletal conditions, including shockwave therapy and red light therapy, which some patients consider as part of a broader treatment plan. It’s important to understand that neither is an established first-line treatment for lumbar nerve-root compression.

• Shockwave therapy has been studied for certain musculoskeletal conditions, and research in piriformis-related pain is still early; high-quality evidence is insufficient to consider it a definitive treatment for sciatic nerve entrapment.
• Red light therapy (photobiomodulation) has been investigated for various pain conditions, but evidence specifically supporting its use for lumbar radiculopathy or piriformis syndrome remains limited.

These therapies should be considered only when there is an appropriate clinical indication, never as replacements for diagnosis, rehabilitation or necessary medical treatment.

Does Nutrition Play a Role in Sciatica Recovery?

As an enzyme nutrition specialist, I recognize that recovery from musculoskeletal problems depends partly on overall health. Adequate nutrition, hydration, sleep and physical activity support normal tissue function and recovery, and many patients appreciate an approach that addresses nutrition and lifestyle alongside musculoskeletal treatment.

However, no specific diet, enzyme supplement or nutritional protocol has been established as a cure for piriformis syndrome or lumbar nerve-root compression. Nutrition should support a comprehensive treatment plan, not replace appropriate clinical care.

When Is Sciatica a Medical Emergency?

Most episodes of sciatica do not require emergency surgery, and many patients improve with conservative treatment. However, seek emergency medical care right away if you have:

• New loss of bladder or bowel control
• Numbness in the groin, genitals or “saddle” region around the bottom
• Sciatica in both legs, or weakness or numbness in both legs that is severe or getting worse
• Rapidly progressive leg weakness

These may indicate serious neurological compression, including cauda equina syndrome (red flags as listed by Ireland’s Health Service Executive). Severe pain with fever, significant trauma or other concerning medical findings also warrants prompt evaluation. For persistent neurological deficits or symptoms that fail to improve, referral to an appropriate medical specialist may be necessary. Responsible chiropractic care includes recognizing when another type of medical evaluation or treatment is needed.

The Biggest Mistake: Treating All Sciatica the Same Way

Perhaps the most important message is that sciatica is not one single condition. Two patients may have nearly identical leg pain with completely different underlying problems:

• One may have a lumbar disc herniation irritating a spinal nerve root.
• Another may have sciatic nerve irritation in the deep gluteal region.
• A third may have spinal stenosis, hip-related pain, peripheral neuropathy or another condition that mimics sciatica.

Treating all three with the same adjustment, stretch or therapy, without evaluating the source, may delay appropriate care. That’s why diagnosis must come before treatment. If the problem originates in the lumbar spine, the plan should address the relevant spinal and neurological findings. If it involves the piriformis or surrounding deep gluteal tissues, treatment may focus more on hip mechanics, soft tissue function and rehabilitation. And if symptoms suggest a condition outside the scope of conservative chiropractic care, referral is the right next step.

Frequently asked questions

What is the difference between piriformis syndrome and sciatica?

Sciatica is a pattern of symptoms: pain, tingling, burning, numbness or weakness that travels along the sciatic nerve. Piriformis syndrome is one possible cause of that pattern, in which the sciatic nerve is irritated in the deep buttock near the piriformis muscle rather than at a nerve root in the lower spine.

How can I tell if my sciatica is coming from my back or my hip?

Pain that starts in the lower back, worsens with certain spinal movements or with coughing or straining, and comes with reflex, strength or sensory changes points toward a lumbar nerve root. Pain that starts deep in the buttock, worsens with prolonged sitting or certain hip movements, and lacks a clear nerve-root pattern may point toward piriformis or deep gluteal syndrome. None of these clues is enough on its own, so a hands-on neurological and orthopedic examination is needed.

Can an MRI diagnose piriformis syndrome?

Not on its own. A lumbar MRI can show disc herniation or spinal stenosis, but a normal lumbar MRI does not prove piriformis syndrome, and a disc bulge on an MRI does not prove it is causing your symptoms. Imaging is most useful when it answers a specific clinical question.

Should I stretch if I have sciatica?

Not necessarily. Stretching helps some people and makes others worse, because different sources of sciatic pain respond differently to mechanical loading. Exercises should be chosen based on your examination findings and how your symptoms respond.

Can a chiropractor help with piriformis syndrome or a herniated disc?

For appropriately selected patients, conservative chiropractic care may include spinal or hip mobilization or manipulation, soft tissue work, therapeutic exercise and activity modification. Not every patient is a candidate, and some need referral to a spine specialist, medication management, injections or surgery.

When is sciatica a medical emergency?

Seek emergency care for new loss of bladder or bowel control, numbness in the groin or saddle region, sciatica in both legs, or leg weakness that is severe or rapidly getting worse. These can be signs of cauda equina syndrome. Severe pain with fever or after significant trauma also needs prompt medical evaluation.

Find the Source of Your Sciatica Before Choosing Treatment

If you have pain traveling from your lower back or buttock into your leg, don’t automatically assume you have a herniated disc, and don’t assume every case of buttock pain comes from the piriformis muscle. The symptoms may overlap, but the underlying causes can be very different.

If you’re looking for a sciatica chiropractor in Forest Hills, our approach at Nektalov Chiropractic & Wellness begins with a comprehensive examination to identify the most likely source of your symptoms and determine whether conservative chiropractic care is appropriate. We serve patients throughout Forest Hills and Queens, NY. Our goal is not simply temporary relief, but to identify contributing factors, improve movement, support recovery and help you return to the activities you enjoy.

Because when it comes to sciatica, the most important question isn’t just where the pain travels. It’s where the nerve irritation begins, and finding that answer can make all the difference in choosing the right treatment. Schedule an evaluation.

About the Author

Dr. Boris Nektalov is a chiropractor and enzyme nutrition specialist at Nektalov Chiropractic & Wellness in Forest Hills, Queens, NY. Learn more about Dr. Nektalov.

Sources

• Hicks BL, Lam JC, Varacallo MA. Piriformis Syndrome. StatPearls.
• Brinjikji W, et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. AJNR, 2015.
• Martin HD, Reddy M, Gómez-Hoyos J. Deep gluteal syndrome. Journal of Hip Preservation Surgery, 2015.
• Health Service Executive (Ireland). Sciatica.
• Low Back Pain: American College of Physicians Practice Guideline on Noninvasive Treatments. American Family Physician, 2017.

This article is intended for informational purposes and does not constitute medical advice. It is not a substitute for an individual medical evaluation. Always consult a licensed healthcare provider regarding your specific condition.