“I have ‘Sciatica’ pain!” This is a common complaint heard from any person who suffers from shooting pain down his or her leg. Most of the time they are mistaken. The Sciatic nerve exits the Lumbar spine (L5, S1,S2) and penetrates the Sciatic notch in the hip and goes down the back of the thigh to the foot. This nerve may be compressed by the disk between the lumbar vertebrae, or entrapped by the Piriformis muscle. Most of the time it is the latter. There are a few muscles in the hip which will mimic the pain commonly but incorrectly referred to as “Sciatica”.

These three nerves may be trapped by spastic muscles in the neck, under the collarbone and under the armpit and cause these symptoms.

These muscles are:

  • Piriformis – This deep muscle is located in the center of the buttocks. It originates in the front side of the sacrum (tail bone) and connects to the hip joint. When the piriformis is in a spasm it will compress the thigh bone into the hip socket increasing the pressure on the joint.. Also, when this muscle is spastic it will compress different nerves roots which exit the Sacrum (tail bone) , including the “famous” Sciatic nerve. The piriformis muscle syndrome is frequently characterized by such bizarre symptoms that may seen unrelated. One characteristic complaint is a persistent severe, radiating low back pain extending from the sacrum (tail bone ) to the hip joint, over the gluteal region and the posterior of the upper leg , and behind the knee.. In the most severe cases the patient will be unable to lie or stand comfortably, and changes in position will not relieve the pain. Intense pain will occur when the patient sits or squats since this type of movement requires external rotation of the upper leg and bending the knee.When the Sciatic nerve is involved, the patient will also experience tingling and numbness in the calf and foot.
  • Tensore fasciae latae – This small muscle on the side of the hip connects the hip bone to the femur ( thigh bone ) from the side. Since 90% of the time during walking the body weight is carried by one hip , the hip muscles are forced to work harder which make them susceptible to get in a spasm. When this muscle is spastic , pain would be referred to the side of the thigh and calf. It would be very painful, sometimes impossible to put any weight on the hip.
  • Gluteus maximus, medius and minimums – These superficial hip muscles cover the whole hip from the waist to the hip joint itself. When they are spastic , pain would be felt in the hip and referred to the back and side of the thigh and calf. It would be very painful , sometimes impossible to put any weight on the hip.
  • Deep rotators– These five deep muscles connect the hip joint to the bottom of the pelvis from the back. When they are in a spasm the pain would be felt in the hip and sacrum ( tail bone ).Sitting would be very uncomfortable.
  • Lumbar ligaments– These three ligaments connect the hip joint to the lumbar spine (low back) and the sacrum (tail bone) When they are spastic, pain would be felt in the low beck hip and would be referred to the back of the thigh.

Sciatica Pain Referral Patterns