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Leg pain. Is it really sciatica?

Is it Sciatica? Leg and buttock pain are one of the most common complaints from patients that we see in the clinic. Most people believe that their buttocks, hip and leg pain are “sciatica”. But not all leg pain is sciatica. There are many structures in your body that can cause pain down your leg, and in this blog, we are going to discuss the 5 most common ones.

  1. True sciatica is a condition that is a result of the sciatic nerve or sciatic nerve root pathology. Affected patients experience pain (including radicular pain, burning, sharp shooting pain, electric shock feeling) and paresthesia (tingling, pins and needles, numbness) in the sciatic nerve distribution or an associated lumbosacral nerve root (Image 1). Intervertebral disc herniation and foraminal narrowing are some of the possible causes for nerve irritation. Patients with radiculopathy have neural deficits and often no lower back pain.
  1. Lumbar Facet joints (zygapophyseal joint). The pain originating in a single lumbar facet joint is usually described as a unilateral dull ache in the paraspinal region (lower back), occasionally radiating to the buttocks and proximal lower extremity (Image 2). Pain from a lumbar facet joint rarely radiates below the knee, but this is not absolute. Characteristically, the referral pattern for the high lumbar facet joints (L1-2 and L2-3) are more frequently observed in the lumbar area, whereas the lower lumbar joints refer pain to the gluteal region, groin area, and posterolateral thigh. The main difference between referred pain from lumbar facets when compared to that pain produced by nerve pathology is absent of any neurological deficit.
  1. Sacroiliac joint pain due to injury or inflammation of the joint and its ligaments can cause lower back, buttocks and leg pain. The most common presentation is pain in the posterior superior iliac spine (PSIS), lower lumbar region, groin and medial thigh, posterior thigh, lower abdomen and even calf and foot (Image 3 & 4).
  1. Hip joint pathology, especially osteoarthritis, has been shown to cause pain in referral areas to the groin and thigh primarily, but also to the buttock and lower extremity distal to the knee. Foot and knee pain referred from the hip does not seem to be as common. Importantly, hip pain does not seem to radiate to the lower back (Image 4). Hip OA usually is accompanied with morning stiffness, and reduced range of motion of the hip.
  1. Greater trochanteric pain syndrome AKA Gluteal tendinopathy. Patients commonly present with lateral hip pain, localised to the greater trochanter, which is worse with weightbearing activities and side lying at night. There may be associated radiation down the lateral thigh to the knee and there is tenderness on the side of the hip (bursa/glute medius tendon) on palpation (Image 5).

Do you have leg pain and/or buttock pain and can’t figure where it comes from? It is not easy to find the origin of pain, and often times we cannot find 100% what the cause is, even with orthopaedic tests and imaging.

When dealing with leg pain, make sure you have a proper examination, performed by a health practitioner. As shown in this blog, not all leg pain is sciatica.

Do you have any questions or doubts ? Please, do not hesitate to contact us via the CONTACT FORM or call the clinic and ask to talk to your osteopath.

References

Davis D, Maini K, Vasudevan A. Sciatica. [Updated 2021 Sep 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507908/

Fukui S, Ohseto K, Shiotani M, Ohno K, Karasawa H, & Naganuma Y. Distribution of referred pain from the lumbar zygapophyseal joints and dorsal rami. Clin J Pain. 1997 Dec;13(4):303-7. doi: 10.1097/00002508-199712000-00007. PMID: 9430810.

Slipman CW, Jackson HB, Lipetz JS, Chan KT, Lenrow D, & Vresilovic EJ. Sacroiliac joint pain referral zones. Arch Phys Med Rehabil 2000;81:334-8. 

Fukui S, & Nosaka S. Pain patterns originating from the sacroiliac joints. J Anesth. 2002;16(3):245-7. doi: 10.1007/s005400200033. PMID: 14517649.

John M. Lesher, Paul Dreyfuss, Nelson Hager, Michael Kaplan, & Michael Furman. Hip Joint Pain Referral Patterns: A Descriptive Study, Pain Medicine, Volume 9, Issue 1, January 2008, Pages 22–25, https://doi.org/10.1111/j.1526-4637.2006.00153.x

Grimaldi, A & Fearon, Angela. (2015). Gluteal Tendinopathy: Pathomechanics and Implications for Assessment and Management. The Journal of orthopaedic and sports physical therapy. 45. 1-41. 10.2519/jospt.2015.5829

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