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At some point in our life we will most likely come across a painful sensation in our buttock region with some referral down the back of our leg. This presentation is a common complaint that clients seek Remedial Massage treatment for, as many people will automatically self-diagnose themselves as having 'sciatica', due to the location.
What one may not be aware of is that there are different ways that the body can ‘mimic’ sciatica, as it may present itself in a similar pattern. Let me explain:
The Sciatic nerve starts in the low back (L4-S3), travels under a glute muscle (Piriformis) and down the back of the leg. This is the longest nerve in the body and at its thickest circumference it is roughly the width of your thumb. How cool is that?! As this nerve originates in the lumbar spine and travels through structures down the posterior leg, there are many areas and conditions that can compress (put pressure on) the nerve along the way, creating a sharp, electric, ‘zinging’ sensation, often resulting in numbness.
‘True’ Sciatica is classified as a compression of the Sciatic nerve in the lumbar region. Some examples would be due to a lumbar disc herniation or bulging, spinal degeneration, inflammation, injury and/or inflammatory conditions in the area (ie. arthritis, ankylosing spondylitis, lumbar spine fracture, etc.), just to name a few.
Piriformis Syndrome is another form of Sciatic nerve pain due to the Piriformis muscle contracting or spasming over a prolonged period of time, which in turn impinges the nerve. In most people, the Sciatic nerve travels underneath the Piriformis muscle, however, there are a percentage of those whose nerve pierces through the Piriformis creating a higher sensitivity to impingement if not self-managed correctly. In both cases, when the Piriformis muscle becomes too tight, it will put pressure onto the nerve and re-create the ‘Sciatic pain’ down the leg. Some examples that can cause Piriformis Syndrome are:
- Prolonged sitting (ie. desk jobs, driving, cycling)
- Sitting with a wallet in back pocket
- Leg length discrepancies
- Compensating gait (possibly due to an injury in the leg, ankle or foot pain-ie. Morton’s Neuroma)
- Injuries to the Sacro Iliac Joint
- Hip surgery
It is often found that if someone has Piriformis syndrome, climbing the stairs, squatting and sometimes running may exacerbate the symptoms.
It is important to keep in mind that Sciatica itself is not a diagnosis, but a symptom of an underlying condition.
Lastly, muscle referrals, also known as Trigger Points, can ‘mimic’ the sensation and direction of the pain. A Trigger Point is a muscle contraction within the muscle, understood more commonly as a ‘knot’. Each trigger point has a specific referral pattern and is described as a dull ache, compared to a nerve sensation which will feel like an electric jolt. The Quadratus Lumborum (QL), Gluteus Minimus and Gluteus Medius are common culprits in recreating a similar referral pattern due to the same path the Sciatic nerve travels.
For example, when there are trigger points in the QL, a referral sensation in the ipsilateral (same side) glutes will appear. Gluteus Medius and Gluteus Minimus on the other hand, are muscles also known as ‘Pseudo-Sciatica’ as their referral patterns mimic the Sciatic pathway interchangeably.
Now you may be thinking; ‘how can I tell whether the pain is Sciatic or a trigger point, if it is travelling in the same direction’? Well, Sciatic pain will refer down the back of your leg to your heel and foot, feeling sharp, electric and sometimes numb. Trigger points in your Gluteus Medius will refer to the back of your leg to just above the knee, and Gluteus Minimus will refer to your calf and outside ankle, both feeling dull and achy. It is quite common for the Glute Medius/Minimus trigger points to be confused and misinterpreted for Sciatic pain, especially if the intensity of the referral is high.
We’re here to help.
If you feel or know of someone who may be experiencing symptoms, having them assessed by one of our Remedial Massage Therapists or Physiotherapists will provide an understanding of what is presented. As we can agree how much of a pain in the…glutes it can truly be (so to speak)! Get in touch now.