Pain patterns can look very similar even when the underlying cause is very different. This series explains commonly confused conditions, how they differ, and why accurate assessment matters for effective treatment.

Pain that travels from the low back or buttock into the leg is often labeled “sciatica.” While this term is commonly used, it describes a pattern of symptoms, not a single diagnosis. In many cases, similar leg pain can originate either from the spine or from structures deep within the hip. Understanding the difference matters, because treatment strategies can differ significantly.

What Is Sciatica?

Sciatica refers to pain, numbness, tingling, or weakness that follows the path of the sciatic nerve, typically traveling from the lower back into the buttock and down the leg. In true sciatica, symptoms arise when one or more spinal nerve roots in the lower back are irritated or compressed.

Common causes include disc bulges or herniations, spinal stenosis, arthritic changes, or other conditions that reduce space around the nerve roots before they form the sciatic nerve.

Sciatica is also referred to medically as lumbar radiculopathy.

What Is Deep Gluteal Syndrome?

Deep gluteal syndrome describes irritation of the sciatic nerve after it exits the spine, usually within the buttock region. Rather than being compressed at the spine, the nerve is affected by surrounding muscles or connective tissues in the deep hip.

The piriformis muscle is often involved, but other structures such as the obturator internus, gemelli, quadratus femoris, or surrounding fascial tissues can also contribute. For this reason, deep gluteal syndrome is considered a broader and more accurate term than “piriformis syndrome” alone.

How the Symptoms Often Feel Different

Although both conditions can cause leg pain, there are patterns that may help differentiate them.

Sciatica is more commonly associated with:

• Pain that begins in the low back and travels into the buttock and leg

• Symptoms that extend below the knee, sometimes into the foot or toes

• Tingling, numbness, burning, or electric sensations

• Pain that worsens with bending, coughing, sneezing, or prolonged sitting

• Changes in symptoms with spinal movement or posture

Deep gluteal syndrome is more commonly associated with:

• Buttock pain as the primary complaint, sometimes with hip discomfort

• Pain that worsens with sitting, driving, or prolonged pressure on the buttock

• Symptoms triggered by hip rotation, crossing the legs, or climbing stairs

• A deep, aching sensation rather than sharp or electric pain

• Less consistent change with spinal movement

That said, overlap is common, and some people experience features of both.

Common Triggers and Contributing Factors

Sciatica is often triggered or aggravated by activities that increase spinal load or compression, such as repeated bending, heavy lifting, or prolonged sitting with poor lumbar support.

Deep gluteal syndrome is more often associated with prolonged sitting, repetitive hip loading, running or hiking hills, sudden changes in training volume, or poor hip stability during movement.

In both cases, symptoms may persist not because of ongoing injury, but because the nervous system and surrounding muscles remain sensitized or poorly coordinated.

The Role of Posture and Movement Patterns

Posture and movement patterns play a significant role in both conditions, either as contributing factors or as adaptations that develop in response to pain.

Lower Crossed Syndrome, characterized by tight hip flexors and low back muscles with inhibited glutes and deep abdominal support, can increase stress on the lumbar spine and reduce effective hip control.

Limited hip mobility or poor glute activation can cause deep hip muscles to overwork as stabilizers, increasing pressure around the sciatic nerve in the buttock region.

Altered gait patterns, prolonged sitting, and asymmetrical weight-bearing can further reinforce these patterns, allowing symptoms to persist even after the original irritation has settled.

How Acupuncture Fits

Acupuncture can be particularly effective for sciatica-like symptoms because it can address both nerve-related irritation and muscle-driven contributors, depending on the source of symptoms.

For spinal-driven sciatica, treatment often focuses on calming irritated nerve roots and reducing protective muscle guarding around the lumbar spine. Segmental approaches, including Hua Tuo Jia Ji points, can influence spinal nerve input, while addressing deep stabilizing muscles such as the multifidi helps improve spinal support and movement control. Electro-acupuncture may be used to enhance pain modulation and support nerve recovery when symptoms are persistent or severe.

For deep gluteal syndrome, treatment commonly emphasizes releasing tension in deep hip muscles that surround or compress the sciatic nerve. Motor point and trigger point acupuncture can help normalize muscle activation patterns, reduce excessive tone, and improve coordination of the gluteal muscles so deeper stabilizers no longer overwork. When appropriate, electro-acupuncture may be paired with these techniques to reinforce neuromuscular regulation and reduce sensitivity.

In many cases, a combined approach is used, especially when both spinal and hip-related factors are contributing.

Why Accurate Assessment Matters

Because sciatica and deep gluteal syndrome can feel very similar, treatment based solely on symptom location may miss the true source of irritation. Stretching or strengthening the wrong area can sometimes worsen symptoms rather than help.

A careful assessment that considers spinal mechanics, hip function, posture, and movement patterns allows treatment to be targeted appropriately and adjusted as symptoms change.

When to Seek Further Evaluation

If you’re experiencing persistent buttock, hip, or leg pain and are unsure of the source, particularly when symptoms interfere with activity, sleep, or quality of life, a focused musculoskeletal evaluation can help identify the underlying contributors and guide appropriate treatment.

Key Takeaway

Not all sciatic-type pain is the same. Deep Gluteal Syndrome and true sciatica involve different underlying mechanisms, and acupuncture offers a non-surgical way to address both spinal nerve-related and deep peripheral contributors when applied with careful assessment and clinical reasoning.