Is Your Sciatica Coming from Your Back or Your Piriformis?
- Nashville PT
- 2 hours ago
- 3 min read
Sciatica is one of those frustrating issues that can feel like a mystery. The pain shoots down your leg, maybe it starts in your butt, maybe your lower back is tight—and suddenly you're not sure where the real problem even is. The truth is, sciatica isn't a condition itself; it's a symptom.
And where that symptom is coming from makes all the difference in how you treat it. At Nashville Physical Therapy & Performance, we specialize in identifying the real cause of your pain and getting you back to moving well without relying on medications, injections, or unnecessary imaging.
What Is Sciatica, Really?
Sciatica refers to irritation of the sciatic nerve, the longest nerve in your body. It runs from your lower spine down through your hips, buttocks, and each leg. When irritated, it can cause pain, tingling, numbness, or weakness anywhere along its path. But where the irritation starts is key.
Two of the most common culprits are:
Lumbar Disc Issues (true sciatica): A bulging or herniated disc in your lower back compresses or irritates the sciatic nerve root as it exits the spine.
Piriformis Syndrome (pseudo-sciatica): The piriformis muscle, located deep in your buttocks, becomes tight or spasms and compresses the sciatic nerve as it passes beneath or through the muscle.
Why It Matters: The Right Diagnosis = The Right Treatment
Treating sciatica without knowing the source is like putting a band-aid on the wrong injury. If your pain is coming from your lumbar spine, you may need different exercises, manual therapy, or nerve mobilizations than if it's coming from your piriformis.
At Nashville PT, we don’t guess. We:
Perform a thorough movement assessment
Test nerve tension and mobility
Look at spinal mobility and strength
Evaluate hip and glute function
This 1:1, full-body approach helps us pinpoint the root cause of your symptoms and treat it effectively.
Key Differences Between Lumbar Sciatica and Piriformis Syndrome
What Physical Therapy Can Do (That Imaging Can't)
MRIs and X-rays are great tools, but they often show things that aren’t actually causing your pain. Many people have disc bulges and never have symptoms. PT focuses on function – how you move, what causes pain, and what restores your strength and mobility.
Your physical therapist can:
Identify your pain driver (spine, hip, soft tissue)
Provide manual therapy to ease tight areas
Guide you through specific exercises for mobility and strength
Use techniques like dry needling or nerve glides for relief
And because we’re a cash-based, one-on-one clinic, every session is fully focused on YOU.
When to See a PT for Sciatica
If you’re experiencing:
Pain that radiates from the back or butt down the leg
Numbness or tingling in the leg or foot
Weakness when walking, squatting, or climbing stairs
Pain that isn’t improving with rest
Then it’s time to stop guessing and start treating.
You don’t need a referral in Tennessee to see a physical therapist. We can help you identify the cause and create a plan to get you back to doing what you love.
Sciatica Doesn’t Have to Be a Mystery
Knowing whether your sciatic nerve irritation is coming from your back or your piriformis is the key to real, lasting relief. At Nashville PT, we believe in educating our patients and treating the whole person—not just chasing symptoms.
Book your one-on-one evaluation today and let’s figure out where your pain is coming from and how to stop it for good.
References:
Boyajian-O’Neill LA, McClain RL, Coleman MK, Thomas PP. Diagnosis and management of piriformis syndrome: an osteopathic approach. J Am Osteopath Assoc. 2008 Nov;108(11):657-64.
Stafford MA, Peng P, Hill DA. Sciatica: a review of history, epidemiology, pathogenesis, and the role of epidural steroid injection in management. Br J Anaesth. 2007;99(4):461–73.
Fishman LM, Dombi GW, Michaelsen C, et al. Piriformis syndrome: diagnosis, treatment, and outcome—a 10-year study. Arch Phys Med Rehabil. 2002;83(3):295-301.