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Forum Name: Spinal problems and back pain

Question: Sciatica or Piriformis Syndrome?


 TDK - Sun Feb 12, 2006 6:25 am


male, 45, sciatica, no surgeries, no current medication.
I injured myself playing tennis...serving specifically. I felt a knot in my hip and my leg almost
went dead on me. (it didn't want to go) I limped to the car and had to help my left leg up into
the car when I was getting in. It was painful for several days until I saw my Orthopaedic Dr.
and for several days after starting medication.
His diagnosis was sciatica.
My Dr. gave me a steroid pack and some hydrocodone. About 6 days later after finishing the
steroids I was feeling much better until I felt a pain in my lower back when straightening up
after bending over. It was a shooting pain that was gone in a few seconds but it still shocked
me as I've never felt anything quite like that before. I can't say for sure if it went from my back
to my hip or my hip to my lower back. I have not felt that pain since...about a week ago.

I went in for a MRI on my lower back and it showed a 1 or 2 mm herniation on my L4-5.
My Dr. wanted to give me a Epidural Lumbar Injection but after some research on the
procedure, I don't think it's worth it.

Is it possible the L4-5 1 to 2 mm buldge is not the cause of my pain but rather
Piriformis Syndrome? My pain has been 99% in my buttock/hip/leg and I have noticed a
burning aching pain there occasionally for several months usually after serving.
From what I have read this can be tricky to diagnose...even if a MRI shows a herniation it may
not be the cause of ones pain especially if minor.
The knot in my buttock is much better but still tender and my range of motion is somewhat
limited in my left leg. I can walk fairly normal and manage up and down stairs without pain.

Who would be best able to pinpoint the cause of my problem?
My Orthopaedic Surgeon is a spine specialist.
I am scheduled for physical therapy but do you think I should see a neurologist first?
 Dr. Safaa Mahmoud - Fri Aug 11, 2006 6:11 pm

User avatar Hello,

The sciatic is nerve is formed of a group of nerves that come out between the lumbar segments and the sacral segments as follows:
Lumbar segment 4 and lumbar segment 5 (L4 and L5) is named the L4 nerve root.
The second between the L5 and Sacral segment and is named the L5 nerve root.
The third group of nerves from the sacral foramen are called the S1, S2 and S3 nerves.

Sciatica occurs due to a nerve root (sciatic nerve) compression in the lower (lumbar) spine. The condition is due to a herniated disk in most of the cases in the low lumber spine.
This compression results in pain along distribution of the muscles innervated by that nerve, so the pain radiates from your lower back to the buttock down to the back of the legs.
However, associated Muscle spasm alone can cause or aggravate the pain and the condition.

In most of the cases with back pain the primary cause is muscle spasm.


The piriformis muscle is a small muscle located behind the gluteus maximus, the sciatic nerve passes directly below this muscle.
When thepiriformis muscle is in spasms it exerts pressure on the sciatic nerve , a condition known as Piriformis syndrome. Individuals with Piriformis syndrome give similar to sciatica pain like:
A dull ache in the mid lower back
Radiating down to the back of the leg
Pain starts on walking up stairs or after prolonged sitting
Typically, rotation of hip reinduce the pain.

Diagnosis is by exclusion when MRI vertebrae does not show any significant spinal changes.

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