Lower back and hip pain that radiates down the leg. Ouch. Many of us experience this kind of pain, and the good news is in some cases there is something we can do about it at home.
Sometimes things are not quite what they seem. If you have ever felt pain in the lower back that shoots down your leg, you have probably heard the term sciatica. It is a diagnosis given by a physician that means you have a pinching of the nerve that runs down your leg. The diagnosis is required in order to really claim that you have sciatica because, as we will learn today, sometimes it's not really sciatica!
Your sciatic nerve comes out of the spinal column and runs down your leg, branching out to all the other little nerves. Anytime it gets pinched you will get tingling, numbness, pain, or even muscle failure of any area "down-stream" of the nerve.
Before we go any further, remember if you have any serious symptoms you need to see a licensed healthcare professional because there are a bunch of other things that could possibly be going on in this case and it's really important that you rule out some of the more serious things that might be blocking the nerve here.
The term "pseudo" means "fake", meaning it is not true sciatica. The terminology here is just a language quibble, but here's what it means: "True sciatica" is the nerve pinch as it comes out of the spinal column, and "fake sciatica" is the same nerve being pinched anywhere outside of the spinal column. The same nerve is being pinched in both terms, but to you the distinction is important: fake sciatica can be treated at home and with massage, stretching, and exercise... whereas true sciatica often requires medical intervention (you are dealing with the spinal column here, don't mess around with it if you don't really know what you're doing!).
One appropriate term we can use is "Piriformis syndrome" because it is often the piriformis muscle (a muscle that helps rotate your hip) that is actually pressing on the nerve.
A quick test that might help you determine whether you have true sciatica: the straight leg test.
You will simply raise (or have a professional assist in raising) the leg why lying down, and see if your symptoms occur/intensify as a result of the movement. If this test is positive (your symptoms are reproduced) then read no further, call your family physician or physical therapist and get a professional evaluation (please).
If that does not reproduce the symptoms, then you can poke around the hip bone and see if it's really tender. If it is, you probably are experiencing tightness of the piriformis muscle. Now let's get to fixing it!
Addressing the cause of the problem:
Pseudo-sciatica often comes from sitting at a desk too long, especially with a wallet in your back pocket. Holding one posture for a long period of time can make the rotators of the hip take on more of a postural role, causing it to tighten. Conversely, too much exercise can result in a type of overuse injury that also causes the muscle to tighten, especially if the exercise is a repetitive movement in the back/forward motion (remember the piriformis rotates the leg in the inside/outside motion) which causes the muscle to take on a postural support role. Similarly, a parent who holds their child on one hip will engage that posture shift, or a dancer who must maintain tone while the leg is extended, each have this feature of overuse in common for this particular muscle. When you know what causes the problem you can start to see the patterns that might contribute to it. For most people the first step is to add more movement to their lower body during their desk-sitting day. For athletes it means adding in some stretching and active resistance in the proper direction (the rotational plane) and regular maintenance of the hip muscles.
One of my favorite self-care tools is the tennis ball. For this trick I like to address all of the muscles that attach to the hip, but for the sake of brevity we will limit the current post to the gluteals and posterior hip rotators (just know addressing the quads and adductors is useful as well... because of the whole newtons 3rd law thing: each force has an equal and opposite reaction- in this case meaning the opposing muscles are contributing).
This self-massage is fairly simple. Place a tennis ball on the wall and lean against it. Or on the floor and lay on it... sideways, back, all around... you are feeling for some of the "X marks the spot" pictured above, and you can expect to feel radiating pain to the areas colored in red (not everyone will). You are going to find the sore spot and I would lean into the tennis ball for 15-30 seconds with moderate pressure, then ease up on the pressure and roll around a little as though you are pushing fresh blood into the area. The picture above shows gluteus medius and gluteus minimus, the one on the right shows the piriformis muscle. In the end the precision of tennis ball placement will come down to where you can feel it working. Sometimes that signal will be a sudden twitch of the muscle (it will withdraw as a protective reflex) or simply the signal will be dull radiating pain that mimics your pseudo-sciatica symptoms.
For this self-massage you don't want to over-massage the area, it will cause more harm than good (even though it might feel like you can keep going), limit yourself to 15-30 seconds in a particular area, then move to the next area around the hip joint. Wait a few hours before repeating the self-massage.
For all stretching and exercises I highly recommend employing the expertise of a Personal Trainer or Physical Therapist. Even as a therapist myself, I often find it very useful to get assistance from a colleague. So when you approach new stretches do so with caution. There are several variations for each stretch, for example if you can't do the stretch laying down, you can do it seated in a chair by crossing your ankle over your other knee, and leaning forward to stretch the hip.
Cross body stretch should only be done if there are no symptoms of lower back spinal injury. Even if you are injury free, remember you want to feel the rotation coming from the hip, do not let your lower back twist too much.
If you have a resistance band at home you can get some awesome stretches that are better than body weight alone. Again, exercise caution you don't want to pull too hard and injure the muscle. For this one you start with the band fixed to something (you can place it in the doorway if you don't have something to tie it to) and put your leg through the loop of the band, move away from the fixed point until there is some tension, then let the leg relax into the stretch.
Variations of the figure-4 stretch or pigeon pose: lying down, sitting, lunging, or even sitting in a chair. The main thing is that you get the ankle across your body while your knee rotates out. You should feel this in the back of the hip.
I hope this helps some of those frustrating instances of pseudo-sciatica! Please let me know if you have any questions or comments!
What's going on with me, research articles, interesting little blurbs. This blog is an attempt to consolidate research into an easily digestible format.
Alex Moon has been a Licensed Massage Therapist since 2012, did his undergraduate studies at Utah State, and is currently working on his Doctorate in Physical Therapy.