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What Conditions Can Be Mistaken for Sciatica?

Is that sharp searing pain in your leg sciatica? If not, what other conditions can be mistaken for sciatica? And what can you do about them?

Read on to find out what can be mistaken for sciatica, and what causes these conditions.

What is Sciatica?

Sciatica is a condition in which your sciatic nerve is compressed or irritated, medically referred to as ‘sciatic nerve entrapment’.

The resulting (sciatic) pain radiates along the sciatic nerve and down your leg. You may also get some tingling, numbness, and muscle weakness.

Sciatica can be discogenic (common), non-discogenic (uncommon) or extra-spinal (also uncommon).

Discogenic vs Non-discogenic vs Extra-Spinal Sciatica

Most sciatica (around 90%) occurs from some type of degenerative lumbar disc disease that causes the affected disc/s to pinch the roots of the sciatic nerve (discogenic sciatica). This commonly includes:

  • Herniated discs
  • Bulging discs
  • General disc degeneration

When we talk about sciatica, we are often referring to this condition. But, as we’ve mentioned, it’s not the only type of sciatica, which is worth pointing out in the context of conditions that mimic sciatica.

Some, whilst traditionally considered conditions that can be mistaken for sciatica, DO in fact directly affect the sciatic nerve.

Non-discogenic Sciatica

Non-discogenic sciatica (NDS), although not as common, refers to sciatic pain caused by something other than a dysfunctional vertebral disc.

It can originate from other lumbar spinal issues (lumbar sciatica), or further down the sciatic nerve, in which case it may be termed ‘extra-spinal sciatica’.

Lumbar spinal causes of NDS include:

  • Spondylolisthesis (severe vertebral misalignment),
  • Spinal stenosis (narrowing of the spinal canal),
  • Arthritis

However, the sciatic nerve can be compromised anywhere along its length, resulting in sciatic pain (extra-lumbar sciatica). Common causes (that directly lead to sciatic nerve entrapment) include:

  • Deep gluteal syndrome: this is a group of conditions where muscles, tendons, or connective tissue structures in the deep gluteal region compress or irritate the sciatic nerve. It includes:
    • Piriformis syndrome – the piriformis muscle is a small muscle located close to the sciatic nerve in your buttocks. In some people, the sciatic nerve lies much closer, or runs through, the piriformis muscle where it can get pinched or irritated,
    • Hamstring syndrome – hamstring tendons can compress the sciatic nerve at your ‘sit bones’ (ischial tuberosity). Typically occurs because of scar tissue and inflammation of the hamstrings from injury or overuse, and is more common in athletes,
    • Gemelli-Obturator Internus syndrome – the gemelli and obturator internus muscles are located deep in your hips. Injury and overuse from sports or activities that involve deep hip rotation movements (dancing, gymnastics, tennis, football, weightlifting etc) can cause these muscles to impinge on the sciatic nerve,
    • Fibrous bands and scar tissue – injury, inflammation, and surgery can leave scar tissue and fibrous bands in the deep gluteal muscles, which then compresses the sciatic nerve.
    • Ischiofemoral impingement – although very rare, and more likely to affect females, the sciatic nerve can get pinched between the ischium bone in the hip and a bony protrusion (lesser trochanter) on the femur due to degenerative changes within these structures (also called Ischiofemoral impingement!)
    • Vascular compression – enlarged blood vessels and vascular abnormalities close to the sciatic nerve can put pressure on the nerve, causing sciatic pain.
  • Pelvic injury or fracture
  • Tumours

When it Feels Like Sciatica, But Isn’t – Conditions That Can be Mistaken for Sciatica

Sciatica though isn’t the only condition that causes this type and location of pain, which can lead to potential misdiagnosis. So what other conditions can feel like sciatica, but really aren’t?

  1. Gluteus Medius and Maximus Pain

The gluteus medius and maximus muscles help to stabilise your hips.

When they are strained or develop trigger points (tight knots of contracted muscle), they can create referred pain that feels similar to sciatic pain in your lower back, hips, and even down your leg.

These muscles can also get tight and dysfunctional, causing compensatory movement patterns that then impact other structures. These structures may in turn affect the sciatic nerve.

For example, if the piriformis muscle is affected, it can then compress the sciatic nerve.

  1. Sacroiliac Joint Dysfunction

Your sacroiliac (SI) joint connects your pelvis to your lower spine.

Dysfunction in the SI joint can cause referred pain that starts in your lower back (like sciatica) and travels down one leg (like sciatica). As a result, SI joint dysfunction is often mistaken as sciatic nerve pain

  1. Hamstring Strain

Your hamstrings run down your leg alongside your sciatic nerve.

A hamstring strain, particularly a severe one, can cause pain that radiates down the back of your leg similar to sciatica.

  1. Femoral Nerve Pain

The femoral nerve is a major nerve that starts in your lower back, runs through the pelvis and into your front thigh muscles.

When this nerve is irritated or compressed, it can generate pain that runs down the front of your thigh. This may be confused with sciatica, even though the sciatic nerve runs down the BACK of your leg.

How to Avoid Misdiagnosis of Sciatica

If you have pain that feels like sciatica, it’s important to have it correctly diagnosed to avoid a misdiagnosis of sciatica.

Conclusion: What Conditions Can Be Mistaken for Sciatica?

Sciatica is a common diagnosis for leg pain but it’s important to know that there are other conditions with similar symptoms.

Additionally, dysfunction in other structures, particularly in the pelvic region, can also directly impact the sciatic nerve. However, the only way to know for sure if you have sciatica or something that is often mistaken for sciatica is by getting an accurate diagnosis.

Andrew Varnham

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