Pseudo Sciatica

Pseudo Sciatica, or “fake” sciatica, is a term that describes conditions whose pain symptoms resemble those of real sciatica. Symptoms include radiating pain down the leg and numbness on the posterior aspect of the thigh (1). An individual might experience pain while sitting, standing, walking, and performing other everyday motions.

Potential Causes

Many causes for pseudo sciatica have been put forth including piriformis syndrome, trigger points in the gluteus minimus muscle, and sacroiliac ligament weakness.

Piriformis Syndrome: This condition is characterized by compression or irritation of the sciatic nerve by the piriformis muscle. The piriformis muscle is deep under the gluteus maximus and proximal to the sciatic nerve. This muscle helps support lower body movement, gait, posture and stabilize the hip.

When the piriformis muscle is inflamed or spasms it compresses the sciatic nerve near and triggers the symptoms of sciatica (2). When the nerve becomes irritated by compression the symptoms worsen and the pain becomes more frequent.

Trigger Point in Gluteus Minimus: The gluteus minimus muscle, like the piriformis, is deep in the glutes and close to the sciatic nerve. When a trigger point (or “knot”) develops in this muscle it can irritate the area and it becomes inflamed (1). This inflammation leads to referred pain that is similar to that of sciatica.

Sacroiliac Ligament Weakness: The sacroiliac joint and ligaments are key to stabilizing the hip and supporting the upper body. Pain referral patterns from injured or weak sacroiliac ligaments resemble those of sciatica (3). It is likely that injury to the sacroiliac ligament is the real cause of radiating pain and numbness of the leg.

Treatments

When the problem lies in gluteus minimus or piriformis muscles exercise and manual therapies can resolve pain symptoms. Exercise helps strengthen muscles and promotes lymphatic drainage which reduces swelling in the area- stretches help relax these muscles if irritated or tense.

Manual therapies like trigger point therapy and osteopathic manipulations can help pinpoint the problem and resolve the structural tension of the area. If the problem lies in the sacroiliac ligament, then prolotherapy is the best choice. This treatment works to strengthen and tightens the injured ligament thereby treating the pain.

In conclusion, it is important to accurately diagnose pseudo sciatica to avoid getting the wrong treatment. Not only will these not work, but they can be costly and discouraging.

References-

1. Pseudo Sciatica-It’s the Condition We Really Treat Better …www.omicsonline.org/open-access/pseudo-sciaticaits-the-condition-we-really-treat-better-than-medicine-2165-7025-1000327.pdf.
2. “Piriformis Syndrome: A Frequently Misdiagnosed Pain in the Buttocks.” The DO, 1 Sept. 2017, thedo.osteopathic.org/2017/09/piriformis-syndrome-frequently-misdiagnosed-pain-buttocks/.
3. Alderman, Donna. “Prolotherapy for Low Back Pain.” Practical Pain Management, www.practicalpainmanagement.com/pain/spine/prolotherapy-low-back-pain.