Diagnosis Sciatica, Or is it?

By: Jen Fleming

I’m gonna share a little bit of an ongoing success story with you.  We will call my patient Scott.  Four weeks ago Scott’s wife sacrificed her scheduled treatment with me so he could come in.  For seven months he’d been suffering with pain, sometimes debilitating, in his left hip.  He had seen countless other professionals – doctors, specialists, and other health care professionals – to try and figure out just what was going on, and everyone seemed to agree, sciatica.

For those of you who don’t know, sciatica is a nerve dysfunction.  The sciatic nerve exits the lower lumbar and upper sacral vertebrae and travels through the muscles of the buttocks, down the back of the thigh, does a little twist around the outside of the knee where another branch splits off, curves across the front of the lower leg, and into the first three digits of the foot.  Like the previous sentence, it is a long nerve.  The longest in the body, in fact.  An impingement, or other injury to the nerve, is called sciatica.  And it hurts.  A lot.  Like cut-off-your-leg a lot.  The pain is searing, electric like zingers that run basically the entire course of the nerve.  Pretty much constantly.  It’s awful.  Don’t get it if you can avoid it.

But the problem with Scott was NOT sciatica.  Not even a pseudo sciatica.  Nope, it’s been a whole different ball game.  And for 7 months, he was receiving treatments that may have been effective for sciatica, but were totally ineffective for what was going on with him.  What a little information would have done for him 7 months ago…  So I present to you, a brief differential guide for Sciatica and other pain’s in the hip/butt.

Symptom: Burning hot pain in the hip and buttock, stops about where the thigh attaches to the hip.
What it could be: Psoas (major hip flexor) spasm or strain (like Scott’s case), gluteal muscle pain, piriformis spasm, bony misalignment of pelvic joints.

Symptom: Burning pain in the front of the hip that travels down the front of the thigh.
What it could be: Compression of the anterior transcutaneous femoral (front of thigh skin and surface muscle) nerve.  Compression usually happens in the inguinal region, where the front of your thigh connects to the hip.  Can also be a psoas spasm or strain, which can cause compression of the ATF nerve.

Those two symptom sets are the most common for a misdiagnosis of sciatica.  True sciatica will involve pain down almost the entire length of the nerve.  Where it ends can depend on which nerve roots are involved.  Sometimes it goes all the way to the big toe and can involve the second and third digits, and sometimes it stops at the knee.  But it will always involve the back of the thigh and hip.  And NEVER the front of the thigh and hip.

P.S. – After a few treatments with me, and a quick referral out to my go to Osteopathic Student and super awesome RMT, Kevin Deiroff for a proper diagnosis, Scott is well on his way to pain free mobility.  Yay for proper assessment and diagnosis!