Between 70% and 80% of the population of the world experience low back pain at some time during their lives. A subgroup of patients who experience back pain also experience sciatic pain as well, with a majority of these patients seeking evaluation from their primary care clinician. One relatively new differential diagnosis to be considered when evaluating the patient with sciatica is piriformis syndrome. Piriformis syndrome has been documented for more than 50 years. Yet its diagnosis still remains confusing at times. Using a case study for the purpose of illustration, this article outlines signs and symptoms of sciatica, as well as differential diagnoses to be considered when examining a patient with sciatica. Piriformis syndrome, diagnostic tests to be performed, treatment, education, and follow-up of the patient with piriformis syndrome are all discussed in detail. Finally, implications for primary care clinicians are presented.