In orthopedics, it is often believed that when someone experiences leg pain, that the source is usually “sciatica” originating from your back. Although this scenario can happen, there are several other conditions that can mimic those symptoms.
Sciatica, defined as inflammation to the sciatica nerve, is often as a result of a disc herniation between the last two vertebrae. The disc will push onto the nerve causing inflammation and, depending on extent, can lead to pain and often numbness along the back part of your leg and thigh, sometimes as far as your foot. Nerve pain like this tends to be sharp and can be triggered by certain spine positions. It may also be triggered by coughing, sneezing or laughing hard, as these activities can put pressure on the trunk area and compress the spine temporarily.
In addition to nerve and disc origins, leg pain can also be referred from other structures such as muscle or ligaments. The piriformis is a triangular muscle deep in your hip, underneath the buttock. It is responsible for hip rotation strength and also serves as a pelvic stabilizer. In about 15% of the population, females more than males, the sciatic nerve will run through the muscle belly of the piriformis. Tightness or weakness of this muscle can compress the sciatic nerve and often mimic the symptoms of a disc herniation.
The sacroiliac joint is where the tailbone and pelvis meet. It is located in close proximity to lumbar vertebrae #5 and shares ligaments with it. Often seen in our practice, patients with low back, buttock, and thigh pain can often have alignment issues with their pelvis and sacroiliac joint. There are several ligaments and muscle groups that directly attach to the pelvis, and their collective actions help keep it aligned. Treatment consists of skilled manual therapy techniques, as well as specific stretching and strengthening exercises.
Osteoarthritis of the hip joint itself can often refer pain into the front, inner and occasional back of thigh, referring down as far as one’s knee. Pain is usually dull and deep but can also be sharp with certain motions. In addition, moderate to severe arthritis nearly always comes with loss of joint rotation. Lack of appropriate joint rotation can place undue stress on the adjacent joints, including low back. Manual stretching and specific joint mobilization techniques to the hip may redistribute force off of the lower spine and decrease the pain associated with that stress.
Another common muscle origin of leg pain is one’s hamstring. It is located on the back part of the thigh and attaches at both the knee and underneath the buttock onto the pelvis. It serves as a pelvic stabilizer as well as controlling knee motion. When strained, pain can be sharp or dull and occur most often when the leg is loaded in standing or walking.
Any of the above scenarios, or combination of these conditions, can contribute to leg pain symptoms. It is important to determine the exact origin of the symptoms, as the treatment for each can vary greatly. If you are experiencing any of these symptoms, I recommend that you get an evaluation from a licensed medical professional to guide you as to the best course of treatment. Physical Therapy, diagnostic imaging, injections, or possibly even surgery may be necessary to eliminate your symptoms. In most studies, conservative treatment that addresses inflammation, restoring joint mobility and alignment, and appropriate strengthening have been shown to yield the best short and long term management of the above conditions.
Michael Dow MSPT is CEO/ Director of Amity Physical Therapy, now with three offices in Woodbridge, Hamden and Branford. He received his degree from Fairfield University and is recognized by the U.S. Dep’t of Health and Human Services for his work with the National Multiple Sclerosis Society. He works with patients of all ages, pediatrics to geriatrics, as well as local high school and college athletes. Michael can be reached at 203-389-4593 or www.amitypt.com.