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Pain in the Butt?? It Could be "Pseudo-Sciatica!"

A patient comes into my office complaining of pain starting in the low back radiating into the buttocks and down the back of her leg into the calf, and her toes are tingling. Sounds like a classic disc herniation patient where we’re going to decompress the disc with traction to relieve pressure from the nerve it’s compressing, right? Well the patient says that the first chiropractor at a decompression clinic she went to did that and it didn’t help…

Ok, ok I got it now! Piriformis syndrome causing sciatica! The sciatic nerve is being compressed underneath the piriformis muscle and it’s producing her symptoms. We need to relax the piriformis with some muscle work, stretching, and dry needling; problem solved! Turns out the PT she went to after the first failed chiropractic attempt did that same thing and it only temporarily helped her problem. Well, shoot, what else could it be?

Ahhh of course! How could I not realize it sooner? Lumbar spine subluxation! See, this x-ray she brought with her proves it. She has a mild spinal curve in the lumbar spine and that’s interfering with the ability of the nervous system to flow freely. Some good ole chiropractic manipulation of the low back and pelvis will fix it right up… Oooh the last chiropractor she saw did that too and it didn’t help either? Hmmm, what are we missing!?

What is “Pseudo-Sciatica?”

In general, sciatica refers to any symptom associated with the compression of the sciatic nerve, either from the spine or in the soft tissues. The prefix “Pseudo-“ means “false” but in the medical field also relates to conditions that “deceptively resemble” other conditions. “Pseudo-sciatica” is a complex multi-layered condition most times, but simply put, my most fitting definition is pain that deceptively resembles sciatica.” These patients present with familiar disc-like referral pain or sciatica-like complaints: low back pain starting around the sacroiliac joint, a burning or deep aching pain in the buttocks, radiating into the back of the thigh, and sometimes into the calf and foot. Many times, these patients complain the pain is worse in the leg than in the back. They may feel like the leg is “weak” and they cannot lift their leg while walking.