Sciatica hip pain is due to injury, damage, irritation or compression on the Sciatic nerve that acts like a power cable relaying all information from your brain to your toes. Nerve pain is a very distinctive pain, unlike anything you have ever experienced. It can only be described as unbearable and excruciating.

The sciatic nerve is the longest nerve in the body, originating from the lower back and sacrum, to bundle together running down to the toes, while branches break off to supply power to the structures as it travels downward. Any pain from the sciatic nerve that is experienced in the hip region is known as sciatica hip pain.

Physiotherapists can effectively treat sciatica hip pain.

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What is the Sciatic nerve?

The Sciatic nerve is a bundle of wires (nerve roots) that run out of the spinal cord at the Lumbar and Sacral vertebrae. The nerve originates in the lower spine as nerve roots exit the spinal cord (through gaps in the bones at the back of the spine), and extends all the way down the back of the leg to the toes.

The sciatic nerve is actually made up of five nerves. It is formed on the right and left hand side of the lower spine by the combination of the fourth and fifth lumbar nerves and the first three nerves in the sacral spine.

The five nerves group together on the front surface of the piriformis muscle (at the back of the buttock) and become one large nerve, the sciatic nerve. This nerve then travels down the back of each leg, branching out to provide motor and sensory functions to specific regions of the leg and foot.

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How does Sciatica happen?

Sciatica is a Symptom of nerve pain which basically means there is injury, compression or irritation on the Sciatic branch of nerves.  This can cause Sciatic nerve pain to be felt down into the hip area.

The bundle of nerve wires that run out the lower spine and sacrum come together to form a thick cable about as thick as your thumb. They converge at the back of the buttock just above the Piriformis muscle and runs between the two hamstring heads. These are two most common places where the Sciatic nerve gets pinched.

Places where the Sciatic nerve gets Pinched

It is important to note that the point of compression will cause pain radiating up the nerve, but it is more common to find the pain traveling further away (down) the nerve.

Piriformis muscle

  • This muscle turns the hip outward, it runs horizontally from the sacrum to attach onto the thigh bone (femur head).
  • Tightness, stiffness or shortening of the Piriformis can put pressure on the nerve that runs deep to it which results in Sciatica hip pain.
  • The sciatic nerve runs beneath the piriformis muscle. Piriformis syndrome develops when muscle spasms develop in the piriformis muscle thereby compressing the sciatic nerve.

Hamstrings muscles

  • This muscle extends the hip, it runs vertically downwards. The Sciatic nerve runs between the outside and inside Hamstring heads from the sitting bone(Iscium) to the back of the knee.
  • Tightness, stiffness or shortening of the Hamstrings can put pressure on the nerve that runs deep to it.
  • Repetitive Hamstring contractions like leg curls may trigger an irritation on the Sciatic nerve.
  • We also find that abnormal scar tissue (wound tissue) that is formed after a Hamstring tear may restrict the normal sliding of the nerve, and may produce a sharp pain over your hip and down the thigh.

Lower back

  • Along the spinal cord there are many structures that may move out of position or move in the space where the nerve runs. Some conditions put direct pressure onto the nerve, others restrict its normal sliding movement, which then causes an irritation.
  • A few causes of Sciatica radiating from the lowers spine into the hip:
  1. A slipped disc (Lumbar Disc bulge or prolapse)
  2. Lower back muscle spasm (Prevents the normal movement of the nerve)
  3. Intervertebral Disc Degeneration (Loss of disc height leads to less space for the nerve to run out the spine)
  4. Narrowing of the intervertebral foramen (the holes where the nerves exit the spinal cord)
  5. Osteophytes (abnormal bone growth that moves into the path of the nerve)
  6. Spondylolysthesis (Shift of a vertebrae on top of one another – misalignment of the vertebrae)
  7. Spondylosis
  8. Spinal stenosis (Narrowing of space around the spinal cord)

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How does nerve pain feel?

Sciatic nerve pain feels very different to other types of pain. Nerve pain is a very distinctive pain, unlike anything you have ever experienced. It can only be described as unbearable and excruciating.

It has been described as feeling like a knife stabbing them in their butt, like an electrical shock or a burning pain like warm coals in their hip. The nerve pain usually radiates downwards from your hip into the thigh, and in more severe cases it can travels to your knee, back of your calf, and to the sole of your foot.

Symptoms of sciatica hip pain?

  • Burning pain
  • Sharp stabbing, shooting pain
  • Electrical shock pain
  • Pins & Needles
  • Tingling
  • Numbness
  • Dead feeling over skin

Direct trauma can trigger Sciatic nerve pain

Most trauma causes a Neuropraxia. The protecting cover of the nerve gets damaged, but the strands inside are still intact. Like the plastic surrounding a power cable that gets stripped away exposing the wires on the inside.

Slipping and falling onto your butt can trigger the nerve injury. Even more so when you fall on the edge of a step while walking down. In most cases the hip muscles go into spasm which in turn compresses the Sciatic nerve in your hip.

Car accidents is one of the main culprits due to the high impact pressure on your hip causing a collection of problems at multiple areas.

A sudden over-stretch on the nerve like falling into a split or kicking, can cause a  neuropraxia. This is when the nerve is stretched along its length like a power cable being stripped, it exposes the sensitive nerve fibers inside.

Sitting on a chair on the edge of your seat for hours, may trigger nerve symptoms down your leg. Ever sat in an awkward position for a while, only to feel how your leg go ‘dead’…

Diagnosis

Our physiotherapists are experts at detecting nerve injury, irritation or compression because we spend 11 hours a day working on it. Forgive us to say “we just have the feeling for it”.

We will test your nerve’s normal length by testing its ability to be stretched, therefore evaluating the how your nerve reacts under tension and if its able to slide like it should. Our Physios scan the whole nerve along its pathway to test each of the possible points where your nerve can be pinched. We perform a series of tests, to get a clear picture of what we are dealing with, enabling us to treat you optimally.

This may involve having various tests including an X-ray or MRI scan.

Sonar (Diagnostic Ultrasound)

This will be the investigation of choice, as the soft tissue (muscles, ligaments and bleeding) can be visualised around the nerve. A sonar will show at what point the nerve is thickened or thinner than normal.

X-Rays

In some cases we may refer you for an X-ray to exclude any other problems. Remember than X-rays show only the bones and will therefore not show us whats happening with your nerve tissues. X rays will only be indicated if we suspect a fractures, avulsion fractures or stress fractures.

MRI:

An MRI is a very expensive test, but worth every cent in this case. We can see all the different structures in your hip (muscles, ligament, disc, tendons & nerves). It will become a necessity if we establish that there are multiple problems causing your pain. It is important to distinguish between each one’s impact and severity.

Sciatic Hip Pain

What not to do

Do not ignore your symptoms or attempt to treat the condition yourself as this may cause more damage and delay your recovery.

What you should do

If you recognize any of the symptoms of sciatica hip pain, it is important that you receive a professional opinion as soon as possible. When an accurate diagnosis has been confirmed, you should then see a physiotherapist to begin a tailored rehabilitation program.

Physiotherapy treatment for sciatica hip pain.

1st Phase: Protection & initial Healing

The main goal is to stop the irritation and damage to the nerve tissue therefore  we will be able to assist in guiding you what movement and positions to avoid. The inflamed tissue surrounding the nerve can be managed using a combination of muscle relaxant medications, anti- inflammatories while the nerve’s sensitivity can be suppressed using Central Nervous system suppressors.

2nd Phase: Regain Normal Nerve movement

This involves nerve mobilization techniques to free the nerve from its obstruction. Early in the rehabilitation we will teach you nerve gliding movements.

We use massage, stretches and neurodynamic mobilizations to achieve full range of movement. This will also prevent future reoccurrence.

3rd Phase: Localize the area of nerve irritation

Our goal is to pinpoint the exact part of the nerve that is causing your pain and focus our attention treating the structures surrounding it. We aim to get rid of pain that radiates down your leg hence we find that pain radiating to the bottom of your foot, only travels as far down as your thigh.

4th Phase: Prevent muscles wasting away

Due to the pain, many other protective mechanisms kick in like compensation to use the non affected leg more, however this can cause problems in the long run. The muscles in the painfull hip gets weaker and starts wasting away. This occurs in a matter of weeks. We must prevent those muscles from getting too weak to stabilize the joints, which can cause even more pain. The physiotherapist will guide and monitor the muscles reaction to normal forces like walking, climbing stairs and driving.

5th Phase: Reduce incidence & Flare-ups

During this phase the physiotherapist will guide you to return to normal activities, as well as to challenge the nerve’s ‘normal’ boundaries to determine how it reacts to different forces. We aim to reintroduce certain movements or positions that causes the nerve irritation and teach you how to treat the nerve tissue when you experience a flare up in your pain.

6th Phase: Sport Specific Training

Depending on your sport, the physiotherapist will tailor specific exercises that will help strengthen the hip muscles pertaining to your sport. A successful outcome is when you have gained knowledge throughout the rehabilitation program and can participate at full power and speed.

Sciatic Hip Pain

Physiotherapy Treatment

Physiotherapy for sciatica hip pain will depend on your symptoms and goals of treatment. Potential physiotherapy treatment includes:

  • Acute injury treatment
  • Ultrasound
  • Medications
  • Soft tissue massage
  • Electrotherapy treatment
  • Laser (Low Level Laser therapy)
  • Acupuncture & Dry Needling
  • Heat packs (Thermal therapy)
  • Kinesiology Tape
  • Rigid Strapping or taping
  • Neurodynamics (Nerve tissue mobilizations)
  • Dynamic Strapping
  • Strengthening exercises
  • Guided loading protocol
  • Stretches (Static, dynamic and ballistic)
  • Moon boot
  • Brace
  • Compression Bandage or Sleeve
  • Supportive strapping and taping
  • Biomechanical Analysis
  • Gait Analysis
  • TENS

Could there be any long-term effects from sciatica hip pain?

Sciatica hip pain can either be acute lasting up to six weeks or chronic which can persist for longer than six weeks. Physiotherapy is an effective way of treating both types of sciatica hip pain and will reduce the risk of long-term complications.

Other Causes of Hip pain

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