Tip! To complicate matters, although sciatica pain is usually in the back of the legs or thighs, some people may feel pain in the front or side of the legs or even in the hips.

What is True Sciatica?

True sciatica is caused by pressure on the sciatic nerve. This nerve, the largest in the body, travels from the lumbar spine through the buttocks, and down the back of the thigh, where it divides into two branches in the lower leg. Those suffering from true sciatica might experience sensations along this path including pain, tingling, or numbness which can travel down as far as the foot. The most common causes of pressure on the sciatic nerve are a bulging disc, which compresses the nerve near the spine, or soft tissue, such as the piriformis muscle in the buttocks, which can entrap the sciatic nerve.

True sciatica, then, is caused by compression or entrapment of the sciatic nerve which results in referred pain. This is called a nerve root referral.

True Sciatica or Trigger Point Referral?

Tip! As a Board Certified Chiropractic Neurologist, I take a different approach to the treatment and prevention of sciatica. After a thorough neurological exam, I determine which part of the nervous system is not functioning properly.

When there is pain in the lower back, the buttocks or down the back of the leg, sometimes traveling as far as the foot, sciatica is often the first condition suspected. But in a high percentage of cases, this pain is not caused by compression or entrapment of the sciatic nerve but by chronically tight muscles, which can set up another type of referred pain: referred pain from myofascial trigger points.

Tip! There are six typical causes of Sciatica.

Myofascial Trigger Points

The term myofascial is derived from myo which means muscle, and fascia which is the connective tissue that envelopes muscles, tendons, and joint capsules. In their 2-volume work, Myofascial Pain and Dysfunction: The Trigger Point Manual, Drs. Janet Travell and David Simons offer this definition:

Myofascial Trigger Point: A hyperirritable spot, usually within a taut band of skeletal muscle or in the muscle’s fascia, that is painful on compression and that can give rise to characteristic referred pain.

While referred pain is a common sensation caused by trigger points, other sensations can be elicited as well. Tingling, numbness, thermal sensations (hot/cold), achiness, or the feeling that the area “just isn’t right” are all possible symptoms of trigger point referrals.

A Common Trigger Point Referral

One of the most common muscle groups to develop trigger points are the gluteal muscles, especially the gluteus medius and minimus. The gluteal muscles can become chronically contracted due to:

Tip! The most common cause of sciatica is a prolapsed (slipped) disc, pinched nerves or some form of arthritis. It usually starts with back pain which sometimes improves only to be followed by hamstring or calf pain.

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