Lumbar Radiculopathy vs Piriformis Syndrome

Lower back pain is one of the most common disabilities suffered by Australians with the Australian Institute of Health and Welfare stating that 70-90% of the population will suffer from it at some point in their life. While exact data on the rates of Lumbar Radiculopathy (sciatic pain) and piriformis syndrome are lacking it is estimated that 5-10% of lower back pain cases can be attributed to these conditions.

The Sciatic nerve is the widest and longest peripheral nerve in the human body and is made up of Spinal nerve roots L4-S3, after exiting the spinal cord/ cauda equina the nerve root merge to create the sciatic nerve, which passes down through the musculature of the hip and down to the knee where it splits into the peroneal and tibial branches.

If the sciatic nerve is compressed or irritated it can result in sciatic pain or sciatica which is often described as a sharp, stabbing and intense pain as opposed to a general ache we often see in chronic lower back pain. There are 2 main causes of sciatic pain;

  • Lumbar radiculopathy; so when the nerve roots feeding the sciatic nerve are either compressed or irritated by lumbar disc herniation or degeneration at the level of L4, L5 or S1 disc or vertebrae. This would often present with fairly intense central lower back pain maybe slightly off to the side of complaint and accompanying leg numbness, tingling or weakness. The pain or symptoms would be able to be reproduced through orthopaedic testing of the lumbar spine and some neural testing of the sciatic nerve which would help confirm the diagnosis of Lumbar radiculopathy and depending on the case the lumbar spine segments at which the pain is originating.

  • Piriformis Syndrome; this presents very similarly to, and is often mistaken for Lumbar radiculopathy though the difference is the origin of the sciatic irritation. The anatomy of the hip and pelvis is such that when the sciatic nerve is formed and exits down into the hip it must pass through a fair bit of musculature. It passes underneath the piriformis muscle which is an external rotator of the hip, it passes so closely to the muscle that if there is any irritation to that piriformis whether it be a strain, spasm or just general tightness the sciatic nerve can be put under some increased pressure resulting in a localised pain in the central buttock very similar to the pain experienced in the lower back during lumbar radiculopathy and then similar accompanying leg symptoms as stated above.

It is very important to note that 'sciatica' itself is not a diagnosis, it is a symptom usually of one of the two conditions described above but can be caused by other issues arising in the pelvis or leg. For appropriate treatment to be administered a proper diagnosis must be made as treating the lower back will not fix piriformis syndrome and treating the hip will not improve lumbar radiculopathy. For both conditions joint mobilisation and soft tissue work around the affected muscles usually display good results but as each case is different and depending on the exact cause of the pain it is difficult to state how long recovery generally takes.

Along with treatment from your chiro a stretching and rehabilitation plan should be administered in order to reduce the likelihood of reoccurence.

If you have any further questions about your 'sciatica' don't hesitate to contact us here at Synergy Healthcare on (02)9522 2125 or via email: as we would be more than happy to help.