Many patients who have pain in the hip will immediately claim “I have sciatica!” Often this is not the case. This blog entry will help you differentiate between hip pain and true sciatica.
The sciatic nerve is made up of the peripheral nerves L4, L5, S1, S2 and S3. Somewhere near the buttocks these 5 nerves combine into one “hose” of nerves and we call this bundle the Sciatic Nerve.
The sciatic nerve then weaves its way through the muscles of the back of the hip (buttocks region) in order to run down the leg. One of the big muscles that can put pressure on the sciatic is the piriformis muscle. Although any muscle can irritate the sciatic, it is typically the piriformis. This is why pressure on the sciatic nerve is sometimes confused with piriformis syndrome, a condition in which the piriformis is injured or strained and emits posterior hip pain but does not necessarily impact the sciatic nerve. Buttocks or hip pain without pain going down below the knee region is not sciatica.
Interestingly, the sciatic nerve often has two branches before combining into a single branch below the buttock and one or both of these branches can run over, under or through the pififormis muscle. Either way a tight piriformis will pressure the sciatic nerve and cause symptoms all the way down the leg because that is exactly where all these nerves end up.
A single nerve — such as L4 — only “feels” a small section of skin sensation down your leg, so if you are pinching the L4 nerve, only the stripe of skin innervated by L4 will be numb, in pain or give a burning sensation. But because the sciatic nerve contains several nerves combined into one large bundle, the skin region affected by sciatic nerve pressure covers larger areas of skin (sometimes most areas) than a single nerve would. So, often, most of the leg is affected and undergoes changes in region and sensation.
So, if you can check off the following, you may be suffering from sciatica.
1. pain in the back of the hip (buttocks)
2. pain, numbness or burning sensation travelling farther down than the knee region
3. pain, numbness or burning sensation that covers a large area of skin (e.g.: both sides of calves/foot/thigh)
If you suspect you are indeed suffering from this condition the clinician you visit for confirmation and treatment should apply the following:
1. active release to the hip muscles to break down scar tissue and loosen the muscle(s) off the sciatic
2. PNF stretching of the posterior hip muscles to loosen the muscle(s) off the sciatic
3. teach you proper lifting/sitting ergonomics to keep the hip muscles from tightening up again.
4. prescribe home exercises and therapies to keep the hip muscles from re-aggravating the sciatic nerve.
Best of luck!