Lower back and leg pain?
Are you suffering from lower back or leg pain? You might also be experiencing tingling or numbness in your leg? Did you know it’s not always what we call sciatica? Other conditions such as cruralgia or piriformis syndrome could be the problem.
A little bit of anatomy:
You may have heard the term sciatica before. Many people suffer from symptoms like sciatica. Sciatica comes from the name of the sciatic nerve. The sciatic nerve is the longest nerve in the body. It starts its course from your lower back in your spine and runs through your buttock and down the back of the leg all the way to the foot. This nerve is in charge of the sensation on the skin of the buttock, and back of the thigh and leg and the foot as well as making the muscles of the leg function. Other nerves from your lower back go to different areas of the body. For example, the femoral (or crural) nerve that also starts from the lower back and spine will go to the front of the thigh.
You are suffering from some of those symptoms but how would you know if it is sciatica or not?
What is Sciatica?
Sciatica is not as common as we would think. It affects between 1 to 5% of the UK population at least once in their lifetime. Sciatica is described as pain and symptoms in the areas distributed by the sciatic nerve.This commonly happens in the buttock and the back and side of the thigh and leg. Sciatica can be often associated with lower back pain since some conditions that can cause sciatica include a disc bulge in the spine or a disc herniation or bone formation compressing the sciatic nerve. The piriformis syndrome is a type of sciatica where the nerve compression is in the buttock and not around the spine. Symptoms of sciatica tend to be worse when moving, overall bending the spine forward, sneezing or coughing. Instead, it improves with spinal extension (sphynx or cobra pose). The pain can be shooting down or electric. Tingling, numbness and pins and needles are possible along the course of the sciatic nerve. Considering the inner structure of the nerve, the pain or the neurological symptoms should be linear without skipping one area. For example the pain can shoot from the buttock to the foot but cannot skip the calf or the hamstrings. If this is the case, probably the root cause is only a peripheral nerve entrapment or combination of them.
Emotionally the sciatic pain can be related to feeling hurt, abandoned, betrayed.
What is Piriformis syndrome?
Piriformis syndrome is an uncommon disorder affecting the sciatic nerve. The piriformis muscle is located in the buttock region and externally rotates the hip. Symptoms of piriformis syndrome can be very similar to the symptoms of sciatica since it generates a similar nerve compression. Those can include pain in the buttock region which can travel in an electric or burning pain, more often very dull, eventually shooting down the back of the leg. Sometimes piriformis syndrome can also cause numbness or tingling along the course of the sciatic nerve in the buttock or the back of the leg and thigh.
Piriformis syndrome arises when the piriformis muscle is irritated, inflamed or too tight. This can be a result from an injury or sitting for long periods of time and this will affect the sciatic nerve running just beneath it. Statistically 30% of people have the sciatic nerve that runs directly through the piriformis and will get irritated and compressed when the muscle is being used or if restricted. Typical causes of restriction can be an imbalance between hip internal and external rotators with the seconds too strong or an imbalance in the gluteus recruitment with a flat and weak gluteus maximus so that the gluteus medius, minimus and piriformis have to compensate, getting very tight, short and fatigued. It is very common the triad of muscle weakness in the gluteus (buttocks), quadriceps and abdominal/lumbar (core) muscles.
Emotionally the piriformis syndrome is related to feeling in charge of too many or sudden responsibilities like taking care of a relative with dementia or if suddenly the partner passes away leaving alone the person that then has to face the mortgage or a business, the daily routine and raising the children. Also sudden financial issues or commitments can be the root cause behind the biomechanics.
It can be very difficult to differentiate between piriformis syndrome and sciatica symptoms as those can be very similar. However, piriformis syndrome is usually much easier to treat since there is no spinal component.
The piriformis syndrome usually gets worse standing or walking too long, squatting, getting up or externally rotating the leg while improves stretching the buttocks like when sitting, bringing the ankle from the affected side over the opposite knee, pushing the same side knee down and leaning forward with the trunk.
A musculoskeletal expert will ask you questions regarding your problem and assess you to give you a better understanding of your symptoms.
What is Cruralgia?
Cruralgia is described as pain and symptoms arising from the crural, sural and femoral nerve. Those nerves start from the lower back and travel to the side and front of the thigh. Symptoms can vary between electric, burning or shooting pain, often very dull, tingling and numbness in the front or lateral thigh region and sometimes running from the lower back to the front. Opposite to the sciatica, it gets worse with spinal or hip extension (bringing the knee backwards behind the spine or buttocks line) and improves with spinal flexion.
Similarly to sciatica, cruralgia can be caused by various conditions such as a herniated disc or the nerves being compressed along its course.
Emotionally the cruralgia relates to a tendency to hold things, most often related to the past, generating a sense of resentment, bitterness, feeling betrayed. In this way the past is holding the person back, preventing him/her from moving forward, being anxious or poorly confident, with a lack of support. Often there is also a connection with difficulties in living intimacy and sexuality, generating anger and frustration or worries to become a parent since this will reactivate past traumas.
Who can help with my pain?
To summarise, it can be difficult to differentiate between piriformis syndrome, cruralgia and sciatica symptoms as those can be very similar if you are not an expert. However, sciatica tends to start from the lower back while piriformis syndrome tends to start from the buttock and both usually run down the back of the thigh and leg. Cruralgia pain on the other hand tends to start from the lower back and run to the front and side of the thigh and sometimes to the knee or shin.
If you suffer from leg or back pain and want to get better, manual therapy and exercises are a good way to help your problem.
Book an appointment with a qualified musculoskeletal specialist such as a physiotherapist or osteopath near you. The specialist will assess you and give you a better idea of what is going on. Using a holistic approach such as hands on treatment, acupuncture or exercises will help get rid of your pain and help prevent it in the future.
References:
Gray’s Anatomy, 2020, 42nd Edition, Editor Susan Standring
100 CASES in Orthopaedics and Rheumatology , 2012 Parminder J. Singh and Catherine Swales
https://www.nhs.uk/conditions/sciatica/
https://www.ninds.nih.gov/health-information/disorders/piriformis-syndrome
https://www.ncbi.nlm.nih.gov/books/NBK448172/
