Sciatica is a common diagnosis of lower back, hip and leg pain. The cause of sciatica is often a herniated disc in the lower back, but could also be related to other conditions like SI joint dysfunction or piriformis syndrome. Since sciatica is a common cause of radiating pain, it is easy for other conditions that cause such pain to be misdiagnosed as sciatica. Misdiagnosis means mistreatment.
As a patient or a medical professional, it is important to be aware of all possible causes of pain to ensure proper diagnosis and treatment. The following conditions may mimic aspects of sciatica.
Bursa is a fluid sac that allows two body parts to move smoothly over one another. A tendon passes over the outside of the upper thigh bone and a bursa rests between them to prevent friction. Inflamed hip bursa causes hip bursitis. The tendon moves across the bursa and hip with every leg movement; if the bursa is inflamed, this motion will cause pain. This pain can radiate through the pelvis, affecting the lower back, buttocks and groin.
Hip bursitis is only common in athletic people who do a lot of running and those who have had hip surgery. It may also appear in people who have fallen hard on the hip. Many of its symptoms are similar to those of sciatica, and it may be misdiagnosed as such. People with hip bursitis usually have visible infection at the site of the bursa and feel pain when this area is touched; This is not a symptom of sciatica and can be used to distinguish between the two conditions.
Femoral Nerve Entrapment
The femoral nerve leaves the spine at the second, third and fourth lumbar vertebrae and travels down the front of the thigh. This nerve supplies sensory and motor function to the groin and the front of the thigh.
On its journey from the lower back to the leg, the femoral nerve passes through the psoas muscle. This muscle stretches from the top of the thigh bone to the lumbar spine and assists in movements that bring the lower and upper body closer together. If the psoas muscle is tight and inflamed, it can compress the femoral nerve, which causes referred pain through the groin and down the leg.
The femoral nerve may also be compressed at the groin fold due to static “frog leg position,” such as when riding a horse. It can be compressed by wearing tight belts or by impact. The radiating pain caused by femoral nerve compression can be mistaken for a symptom of sciatica. Pain radiating from the femoral nerve will likely occur on the front of the thigh, whereas sciatica pain tends to be more focused on the back of the thigh. This can help decipher the true cause.
Trigger points are knots that form in the connective tissue of muscles. They are composed of tissue in isolated spasm, and generally occur through overuse of a muscle over time. Trigger points can refer pain to other parts of the body. When these knots form in the muscles of the lower back or buttocks, they can refer pain along the same path as the sciatic nerve. See the blog by neuromuscular therapist Christina Abbott at http://abbottcenter.com/bostonpaintherapy/?p=3447 for more on this.
Hip bursitis, femoral nerve entrapment and trigger points in muscles of the core can cause sciatica-like symptoms. Avoiding common diagnosis errors will help ensure that you get proper treatment for the cause of your pain.