By Steve Sarro and Cindy Lohmann
The story is all too common. One day you experience a sharp, burning pain in the back of your thigh. You assume that you injured your hamstring muscles, clearly overdoing it when you were running or playing soccer the previous day. And considering the location of your pain and that the hamstrings are the most frequently strained muscle in the body,1 your attempt at self-diagnosis seems quite convincing.
You begin the RICE protocol—rest, ice, compression, and elevation. When the pain refuses to retreat several days later, you seek out the advice of a health professional, who also pinpoints a hamstring strain. You then proceed with a treatment program set out by your healthcare provider, or perhaps you start seeing a massage therapist to target any muscle tissue adhesions. And finally, you recommit to stretching your hamstrings, every day, without a question.
Weeks go by. Your hamstring muscles should be feeling at least somewhat better by now. But they’re not. The pain is still ever present. And at times, like when you stretch or sit, the pain is now even worse.
“What is going on?” you ask, understandably frustrated.
Actually, your hamstring muscles may in fact not be the culprit at all. Instead, you may be experiencing what is called sciatica.
What is sciatica?
On each side of your lower back, five different nerve roots—named L4, L5, S1, S2, and S3—branch off the spinal cord for a short ways and then join together to form the longest, thickest nerve in your body.2 This nerve is called the sciatic nerve. It makes its way through the buttock, down the back of the thigh, and into the lower leg and foot. It provides dual action: controlling muscles as well as providing sensation.
The term sciatica, which was first used more than 2000 years ago by Hippocrates,3 refers to pain that radiates anywhere along the path of your sciatic nerve. The pain can vary from a mild ache to a more intense burning sensation and is usually limited to one side of your body. It can also be accompanied by tingling, numbness, and weakness.4 When the pain occurs along the part of the sciatic nerve that courses through the back of your thigh, it can easily be mistaken for a hamstring strain.
What causes sciatica?
The most common cause of sciatica is a herniated disc between the vertebrae in your spinal column.4 When the gel-like material within a disc bulges out and comes in contact with one of the nerve roots, it can cause irritation, pain, and swelling. Which nerve root is affected will determine the location of your symptoms. For example, an irritated or compressed S1 nerve root may lead to an abnormal Achilles tendon reflex, weakness in your calf muscle, and pain in the heel of your foot, the side of your calf, and the back of your thigh.1,5
Sciatica can also result from other, less common causes. Your healthcare provider can help to establish a definite diagnosis.
How can I distinguish sciatica from a hamstring injury?
Here’s a test, called the slump test, to determine whether you are experiencing sciatica:6
Sit up straight on the edge of a table. Bend your head forward. Extend one leg straight out. Then flex your foot back, bringing your toes towards you (see figure). Repeat the same positioning steps with your other leg. If you experience more pain or other symptoms such as tingling or numbness on your affected side upon entering this position, you most likely have sciatica.
When should I see a physical therapist?
It might be time to see a physical therapist if the following applies to you:
What might physical therapy treatment consist of?
One of the main focuses of physical therapy treatment will be to unload—or decompress—the lower spine. The logic behind this is that by reducing the pressure on the disc between the vertebrae, the herniated gel-like material has a chance to move back into place. This then lessens whatever local reaction the gel-like material was causing and quiets any inflammation that was irritating the nerve root.
So your treatment might consist of a combination of the following, all with the goal of unloading the spine:
1 Placzek JD, Boyce DA. Orthopaedic Physical Therapy Secrets. 2nd ed. St. Louis: Mosby Elsevier, 2006.
2 Marieb, EN. Human Anatomy & Physiology. 4th ed. Menlo Park: Benjamin/Cummings Publishing, 1998.
3 Pearce J. A Brief History of Sciatica. Spinal Cord 45: 592-596, 2007.
4 Mayo Clinic. Sciatica. www.mayoclinic.com/health/sciatica/DS00516. Last accessed September 12, 2009.
5 Campbell WM, Pridgeon RM. Practical Primer of Clinical Neurology. Baltimore: Lippincott Williams & Wilkins, 2002.
6 Konin, JG, Wiksten DL, Isear JA, et al. Special Tests for Orthopedic Examination. 2nd ed. Thorofare: SLACK Incorporated, 2002.
© Do not reproduce without permission from SSPT.
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