Is It True Sciatica or a Sciatica-Like Syndrome? Know the Difference—and How to Treat Both

Written By Agnes Mlynarska

If you've ever experienced sharp, radiating pain down your leg, chances are someone has told you, "That sounds like sciatica."

But here’s the catch: not all leg pain is true sciatica. Sometimes, what feels like sciatica is actually a sciatica-like syndrome—a different type of nerve or muscular dysfunction that mimics classic sciatic nerve pain.

Knowing the difference matters. It not only influences the diagnosis, but also determines which treatments will give you real, lasting relief. Let’s break it down.

What Is True Sciatica vs Sciatica-Like Syndrome?

First, let’s define both side-by-side.

True sciatica is caused by irritation or compression of the sciatic nerve, which originates from spinal nerve roots in the lower back (L4–S3) and runs down the buttock, thigh, and leg.

Sciatica-Like Syndrome refers to conditions that mimic sciatic pain but don’t involve direct compression of the sciatic nerve at the spine.

Understanding the Difference: True Sciatica vs Sciatica-like Syndrome True Sciatica Sciatica-like Syndrome Common Causes:
• Herniated or bulging disc
• Spinal stenosis
• Spondylolisthesis
• Degenerative disc disease
• Lumbar radiculopathy (nerve root irritation)
Common Causes:
• Piriformis syndrome: tightness or spasm of the piriformis muscle compressing the sciatic nerve in the buttock
• Gluteal trigger points: referral pain from myofascial knots in the glute medius or minimus
• Hamstring or adductor tension: muscular pain referring into the leg
• Sacroiliac (SI) joint dysfunction
• Entrapment neuropathies (like peroneal or tibial nerve entrapment lower down the leg)
Classic Symptoms:
• Radiating pain from the lower back or glute down the leg
• Numbness or tingling in the foot or calf
• Weakness in the leg or foot
• Pain worsens with sitting, coughing, or bending
Symptoms May Include:
• Pain that starts in the buttock, not the low back
• Pain that radiates down the leg but doesn't go past the knee
• Symptoms that vary with posture or gluteal activation
• Tenderness over glute muscles or SI joint
Key Features:
• Originates from spinal nerve root compression
• Pain typically extends below the knee
• Often includes neurological symptoms (numbness, tingling, weakness)
• May require imaging (MRI) for diagnosis
Key Features:
• Originates from muscle tension or joint dysfunction
• Pain usually stops at or above the knee
• Primarily muscular pain patterns
• Often diagnosed through physical examination and palpation

Why Understanding the Difference Matters

Proper assessment is key! Treating true sciatica like a muscular issue—or vice versa—can delay healing.

If your pain originates from spinal nerve root compression, you need to calm nerve inflammation and decompress the nerve.

If your pain is myofascial or peripheral in origin, focusing on muscle release, nerve glide, and movement correction may provide faster, more effective relief.

How Neuropuncture Can Help

Neuropuncture is a neuroscience-based approach to acupuncture that targets specific nerve roots and pathways. Using electrical stimulation (e-stim) through acupuncture needles, it can:

  • Reduce inflammation around spinal nerve roots

  • Normalize pain signaling through the dorsal columns and spinal cord

  • Activate motor points to restore communication between nerve and muscle

  • Shift the body out of “threat mode” (sympathetic dominance)

For true sciatica, Neuropuncture helps decompress nerve roots, calm inflammation, and restore normal nerve conduction. For sciatica-like syndromes, it can regulate local nerve entrapments, reduce pain sensitization, and support motor retraining.

That said, there are limitations to what Neuropuncture can do:

  • If your pain is caused by structural changes—such as a large disc herniation, advanced spinal stenosis, or significant vertebral slippage (spondylolisthesis)—acupuncture may relieve symptoms but won't reverse anatomical changes.

  • If you at the stage where nerve compression has already led to damage, Neuropuncture can modulate pain perception and enhance nerve signaling, but it cannot regenerate a severely damaged nerve and cancel pain.

This is why an accurate diagnosis and integrative treatment plan—sometimes in collaboration with imaging, physical therapy, or orthopedics—is so essential.

How Dry Needling Can Help

Dry needling targets trigger points in muscles that may be referring pain or compressing nearby nerves—especially helpful in sciatica-like syndromes.

By inserting a thin needle into these tight, irritable areas, dry needling:

  • Releases tension in the piriformis, glutes, hamstrings, and calves

  • Interrupts pain cycles

  • Improves blood flow and oxygen delivery

  • Stimulates peripheral nerves to reset motor and sensory feedback

For example: if your pain is due to piriformis syndrome, dry needling that muscle can provide rapid relief and restore proper gluteal function.

What a Session Might Look Like at ArTeva Acupuncture

Your treatment will be personalized based on your symptoms and root cause. A session may include:

  • Neuropuncture targeting lumbar nerve roots (L4–S3) and/or peripheral nerves (tibial, peroneal)

  • E-stim to reduce nerve sensitivity and encourage motor recovery

  • Dry needling of the piriformis, glutes, or hamstrings

  • Cupping therapy to decompress the fascia and improve circulation

  • Movement recommendations for glute activation, pelvic alignment, or nerve glides

Bottom Line

Not all leg pain is the same. Knowing whether you’re dealing with true sciatica or a sciatica-like syndrome can make all the difference in getting the right treatment.

Neuropuncture and dry needling offer a powerful one-two punch—regulating both the nervous system and muscular system to resolve pain at the root.

Ready to stop guessing and start healing? Let’s work together to get you moving without pain.

References:

  • Ropper, A. H., & Zafonte, R. D. (2015). Sciatica. New England Journal of Medicine, 372(13), 1240–1248.

  • Boyajian-O'Neill, L. A., McClain, R. L., Coleman, M. K., & Thomas, P. P. (2008). Diagnosis and management of piriformis syndrome: an osteopathic approach. Journal of the American Osteopathic Association, 108(11), 657–664.

  • Dommerholt, J. (2006). Dry needling in orthopedic physical therapy practice. Orthopedic Physical Therapy Clinics of North America, 15(2), 301–309.

  • Cummings, T. M., & White, A. R. (2001). Needling therapies in the management of myofascial trigger point pain: a systematic review. Archives of Physical Medicine and Rehabilitation, 82(7), 986–992.

  • Neuropuncture Institute. (2021). Clinical protocols and applications of Neuropuncture for nerve root and peripheral nerve conditions.

 

Agnes Mlynarska

Founder of ArTeva Acupuncture in New York City, Agnes is a licensed acupuncturist and massage therapist. ArTeva Acupuncture is medical acupuncture clinic specializing in modern, research-based acupuncture techniques.

https://www.artevaacupuncture.com/
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