Sciatica versus pseudo sciatica

From southplattesentinel.com

By Dr. Mark McDonald 

This week we are going to discuss the difference between sciatica and pseudo sciatica and the way to tell what you have.

Pseudo sciatica is a false sciatica that is derived from compression of the nerve and perineural tissue in the muscular spaces of the buttock and thigh which causes pain down the leg, numbness and tingling and for all the world feels like sciatica itself. However, the cause of pseudo sciatica is false. That is to say that it is not originating in the spine but is originating in the muscular spaces of the buttock (i.e. under the piriformis muscle or through the piriformis muscle) and is associated with radiating pain from the glut medius, glut minimus and piriformis muscles themselves.

When trigger points appear in the glut medius, glut minimus and piriformis, these highly sensitized muscle knots can refer pain down the leg which feels for all the world like a true “pinched nerve”. This is not true far from the truth as the nerve may itself be pinched under or through the piriformis muscle in the buttock. However, pseudo sciatica differs from sciatica in that it does not originate in the spine.

Sciatica itself simply means “an irritation of the sciatica nerve” so technically pseudo sciatica is sciatica. However, for purposes of treatment and defining the condition, it is better to clarify whether or not the condition originates in the spine or in the buttock. Many patients confuse pseudo sciatica with hip pain as they often have pain over the greater trochanter (the bump on the side of your hip) as well as pain down the buttock. Since the hip is in the front of the pelvis, nothing can be farther from the truth.

Patients with hip pain generally have pain in the groin and pain down the front of the thigh, not the back. Therefore, patients with true hip arthritis and other pathologies of the hip often have pain in the groin and the front of the thigh where the hip refers pain.

On the corollary, the piriformis and glut medius can refer to pain into the side of the hip and into the buttock and down the back of the leg to the knee and even below the knee. This is how pseudo sciatica can be identified and treated specifically for its causation.

True sciatica: True sciatica is a pain down the buttock and down the lateral hip which originates in the spine. True sciatica is caused by a “pinched nerve” in the spine either from an intervertebral disc bulge or rupture as well as from bony changes in the spine (spinal stenosis) and lateral recessed stenosis of the spine. Generally, patients with stenosis of either type have difficulty with standing and walking and get relief with sitting and bending. Patients with spinal stenosis causing sciatica have something called neurologic claudication, that is to say, that pain shoots down the leg after walking even a short period of time and goes away when the patient stops or sits down.

It should be known that patients can also have claudication symptoms with a clogged artery in the leg and therefore this should always be diagnosed by a physician. Patients with a pinched nerve in the spine that is compressing the nerve root and the nerve root sleeve will have numbness, tingling, burning pain and even weakness in the leg which shoots down the buttock, back of thigh and even beyond the knee into the foot and ankle. Your physical therapist can help determine which level is being pinched in the spine by checking for weaknesses as well as loss of reflex action in the leg.

As you can see, sciatica and pseudo sciatica are two very different types of pain in the leg and have different causes which need to be specifically diagnosed in order to treat properly. Additionally, patients with hip problems will have pain in different areas. However, if misunderstood, patients can misunderstand sciatica as a hip problem rather than a back problem. For more information on sciatica, pseudo sciatica and hip pain, do not hesitate to contact the clinic to schedule a no-cost consultation.

https://www.southplattesentinel.com/2022/02/07/sciatica-versus-pseudo-sciatica/