You’ve got that deep, nagging pain in your butt that shoots down the back of your leg. Google says sciatica. Your neighbor says piriformis syndrome. Your doctor might have said one, but the treatment doesn’t seem to be working. Sound familiar?
These two conditions are genuinely easy to confuse — and research suggests they’re confused pretty often, even by clinicians. Understanding the difference can save you a lot of time, frustration, and ineffective treatment.
Before we go further: as massage therapists, we’re not in a position to diagnose either of these conditions. That’s the job of your physician or physical therapist. What we can tell you is that both conditions respond well to soft tissue work — and we see clients dealing with both of them regularly here in Kitsap County.
What Is Sciatica?
Sciatica is actually a symptom, not a diagnosis in itself. Technically called lumbar radiculopathy, it refers to pain that originates from compression or irritation of one or more nerve roots in the lower spine — typically L4 through S1. Those nerve roots eventually bundle together to form the sciatic nerve, the longest nerve in the body.
Common causes include herniated discs, bone spurs, and spinal stenosis. Because the problem starts at the spine, sciatica often produces:
- Lower back pain alongside leg pain
- Pain, numbness, or tingling that travels from the low back through the glute and down the leg
- Pain that may extend all the way into the foot or toes
- A positive straight leg raise test (lifting the leg while lying flat reproduces the pain)
What Is Piriformis Syndrome?
Piriformis syndrome is a different animal. In this case, the sciatic nerve isn’t being compressed at the spine — it’s being irritated by the piriformis muscle, a small but powerful muscle deep in the glute that helps rotate your hip. The sciatic nerve runs just beneath (and in some people, directly through) this muscle, which means when the piriformis is tight, inflamed, or in spasm, it can put direct pressure on the nerve.
Piriformis syndrome tends to look and feel a little different from true sciatica:
- Deep buttock pain is the primary complaint, often more so than low back pain
- Pain that worsens with sitting, especially for prolonged periods
- Tenderness on direct palpation of the piriformis (deep in the glute)
- Pain with hip movements — particularly flexion, adduction, and internal rotation
- Neurological tests and imaging often come back normal
Why It Gets Misdiagnosed So Often
Here’s where it gets tricky: both conditions produce sciatic-type pain, and there’s no single definitive test for piriformis syndrome. Imaging like MRI and X-ray will often show nothing abnormal, which can lead clinicians to either default to a sciatica diagnosis or dismiss the symptoms entirely.
Research published in the National Institutes of Health’s PubMed database has found that piriformis syndrome is frequently over-diagnosed, under-diagnosed, or confused with other conditions involving the pelvic region. One review found that multiple muscles and structures near the sciatic nerve — not just the piriformis — can produce identical symptoms, which makes accurate diagnosis genuinely challenging without a thorough clinical evaluation.
To make things more complicated, some people have anatomical variations where the sciatic nerve actually passes through the piriformis muscle rather than beneath it — making them inherently more susceptible to this type of compression. Add in factors like prolonged sitting, overuse from hiking or running (very relevant here in Kitsap!), or a history of hip or low back trauma, and you’ve got a condition that can look like several different things at once.
The bottom line: if you’ve been told you have sciatica but haven’t responded to standard treatment, it’s worth asking your provider whether piriformis syndrome might be part of the picture.
How Sports Massage Can Help — For Both Conditions
Again, we want to be clear: diagnosing either of these conditions is outside our scope of practice as massage therapists. What we can do is work with the soft tissue — and there’s a lot we can address.
For piriformis syndrome specifically, targeted massage and myofascial release of the piriformis and surrounding deep hip rotators can reduce muscle tension, decrease compression on the nerve, and restore hip mobility. Many clients notice significant relief fairly quickly with consistent work.
For sciatica stemming from spinal issues, massage won’t fix a herniated disc — but it can absolutely relieve the surrounding muscle guarding, reduce tension in the low back and glutes, and make the recovery process a lot more manageable. We work alongside your medical team, not instead of them.
Dealing With Buttock or Leg Pain in Kitsap? Let’s Talk.
Whether you’ve got a diagnosis or you’re still trying to figure out what’s going on, the team at Trailblazer Sports Massage in Poulsbo is here to help. We work with clients across Kitsap County — from Silverdale to Bainbridge Island — who are dealing with exactly these kinds of issues. We’ll listen to what’s going on, work thoughtfully with your body, and help you move and feel better.
Book your session online or give us a call — we’d love to help you get to the bottom of it.