Piriformis Syndrome & Herniated Disc: Similarities and Differences

Originally Medically Reviewed by Dr. Sony Sherpa, (MBBS) - July 26, 2024

Fact Checked and Updated by Dr. Asif Baliyan, MD - May 04, 2026

Introduction

Piriformis syndrome and herniated discs are painful conditions of the back. Both can cause sciatica. Sciatica is a type of pain that affects your lower back and legs. It occurs due to an irritated or compressed sciatic nerve. The sciatic nerve travels down the back to the legs.

Piriformis syndrome is often misdiagnosed as a herniated disc and vice versa.

Here, we explore the similarities and differences between piriformis syndrome and a herniated disc.

What Is Piriformis Syndrome, and What Are Its Symptoms?

Piriformis syndrome causes pain in the hip, buttock, groin, and leg. It occurs when the sciatic nerve next to the piriformis muscle is irritated or pinched.

The piriformis muscle and sciatic nerve are close to each other. Thus, any irritation or swelling in the muscle can compress the sciatic nerve.

Estimates suggest that nearly 6 percent of patients with sciatica have piriformis syndrome.

Piriformis syndrome is sometimes associated with Deep Gluteal Syndrome, a condition characterized by pain and/or dysesthesia (abnormal sensation) in the buttock, hip, or posterior thigh due to non-discogenic and extrapelvic entrapment of the sciatic nerve in the deep gluteal space.

Apart from sciatica, piriformis syndrome can cause:

• Long-term pain in the buttocks and hip that may radiate to the leg
• The pain usually becomes worse with activity
• Numbness and tingling sensations in the buttocks
• Problems with sitting for a prolonged time

What Is a Herniated Disc, and What Are Its Symptoms?

A herniated disc refers to a condition in which one or more spinal discs are displaced from the space between two vertebrae. It is also known as a slipped disc.

Spinal discs are small, rubbery pads situated between the bones that make up your spine. They provide cushioning for these bones. The discs contain soft materials enclosed in a tough fibrous covering.

Increasing age and injuries can weaken or destroy the covering. In some people, the soft materials inside the discs push through weaker parts in the covering. This is known as a herniated disc or disc herniation.

The soft materials that come out of the covering can press or irritate the sciatic nerve. This causes sciatica.

Herniated discs affect people of all ages, but most commonly between the ages of 30 and 50. The symptoms vary depending on the location of the herniation.

General Symptoms:

• Back pain that spreads to the thigh and sometimes the lower leg
• Pain in the buttocks
• Muscle weakness: The muscles controlled by the affected nerves become weak

Emergency Symptoms (rare but require immediate medical attention):

• Loss of sensation in the groin or inner thighs (“saddle” area)
• Reduced or loss of sensation in the buttocks
• Loss of voluntary control over bladder or bowel function

These signs can also indicate Cauda Equina Syndrome, which requires urgent medical evaluation and treatment.

Piriformis Syndrome and Herniated Disc: What Are the Similarities?

The most important similarity between piriformis syndrome and a herniated disc is that both can cause sciatica.

The other similarities include:

• Pain that occurs when you move or continue a standing or seating position for a prolonged time
• Most often, the pain becomes worse with activities like getting out of bed
• Numbness or tingling sensations in the buttocks and legs
• A weakness of the legs in severe cases
• Temporary relief of pain while lying on the side or in a fetal position

Piriformis Syndrome and Herniated Disc: What Are the Differences?

Many symptoms of piriformis syndrome and a herniated disc are similar. For a patient, it can be extremely difficult to distinguish one condition from another.

The same problem may occur with clinicians, too. This is the reason why these two conditions are often misdiagnosed.

Below is a list of key differences between piriformis syndrome and a herniated disc.

• Location of the Pain

The piriformis muscle is located in the buttocks. Thus, pain in piriformis syndrome begins in the buttocks.

However, a disc herniation can occur in any part of the spine. For this reason, pain due to a disc herniation can occur in regions other than the lower back. For example, the shoulder and arm.

• Occurrence

A herniated disc affects 5 to 20 out of every 1000 adults. On the other hand, piriformis syndrome affects 0.3% to 6% of all cases of low back pain. From this data, we may say that a herniated disc is more common than a disc herniation.

• Gender Differences

Piriformis syndrome is more common in women. Studies show that the female-to-male ratio for its occurrence is 6:1.

A herniated disc is more common in men. Estimates suggest that the male-to-female occurrence ratio is 2:1.

• Risk of Recurrence

Both piriformis syndrome and a herniated disc can return after successful treatment. However, the rates of recurrence are different.

With treatments combining medications with rehabilitation exercises, piriformis syndrome rarely comes back.

On the other hand, recurrent herniated discs (after surgery) are more common, affecting 1 to 21 out of every 100 patients.

• Treatment

Treatment for piriformis Syndrome primarily aims at muscle relaxation and increasing flexibility, while treatment for a herniated disc focuses on reducing inflammation and relieving nerve pressure.

Surgical Procedures for Piriformis Syndrome

• Piriformis Muscle Release

This involves cutting or releasing the piriformis muscle to relieve the pressure on the sciatic nerve. When performed with the help of an endoscope, it is known as Endoscopic Piriformis Release.

• Sciatic Nerve Neurolysis

This involves the surgical removal of scar tissue or adhesions that may be compressing the sciatic nerve.

• Botulinum Toxin (Botox) Injection

Although not a surgical procedure, they can be used to paralyze the piriformis muscle temporarily, providing relief from nerve compression.

Surgical Procedures for Herniated Disc

• Microdiscectomy

This minimally invasive procedure removes a small amount of bone or disc material to ease pressure on a pinched nerve and allow it to heal properly.

• Endoscopic Discectomy

In this procedure, an endoscope is used to remove the herniated disc material causing nerve compression.

• Laminectomy

This surgery involves removing the lamina. It is often performed when spinal stenosis causes the compression of the nerve roots.

• Artificial Disc Replacement

This procedure involves replacing the damaged disc with an artificial one.

• Percutaneous Discectomy

This involves using a needle to remove the damaged portion of the disc through the skin.

The Bottom Line

Piriformis syndrome and a herniated disc can cause pain in the lower back. It is often difficult to distinguish one condition from another. This is because most symptoms are common to both conditions.

Besides, treatments may also be similar for less severe cases. Surgery is the last resort of treatment. Patients who do not get better with conservative treatments may need surgery. Conservative treatments involve the use of pain medications and physical therapy.

However, the type of surgery may be different for piriformis syndrome and disc herniation.

There are some major differences between the two conditions. They are the rates of occurrence and relapse, the location of the pain, and gender differences.

Differentiating these two conditions may require specific diagnostic tools. For example, an ultrasound scan, MRI, CT, or EMG.

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Also Read:

• Adult Scoliosis: Types, Latest Advancements, Living With, and More
• All About Crepitus: Joint Sounds and What They Mean
• Bertolotti Syndrome: A Commonly Overlooked Cause of Lower Back Pain

 

 

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