Hip Pain and Sciatica

Pain around the hip region may originate from the hip or a pinched nerve in the back. Hip pain commonly results from wear and tear arthritis of the hip joint. A pinched nerve or sciatica results from compression or irritation of the nerve roots in the back. While both conditions may present similarly, their differentiation is important for correct treatment.

Hip pain

The hip joint is formed, but the upper part of the thigh bone and the pelvis. The joint is located behind the groin area and is involved in various activities such as sitting, walking, running, standing, etc. The hip joint may be involved in wear and tear arthritis known as osteoarthritis. The hip joint’s other afflictions may be avascular necrosis of the hip, rheumatoid arthritis, trauma/injury, etc.

Sagittal section of the lumbosacral spine on MRI.

The pain from the pathologies of the hip joint commonly present in the front of the hip joint, i.e., the groin area. The pain may also be present on the sides or the back of the hip joint, i.e., the buttocks. At times, the hip pain may radiate down the thigh towards the inner side of the knee, but it is rare for the hip pain to present below the knee.

The hip pain due to underlying arthritis is usually worse with activity and gets better with rest. The patients may find it increasingly difficult to perform activities such as walking or climbing stairs. The pain of avascular necrosis of the head of the femur may present at rest and gets worse with activity.

Sciatica

Sciatica is a myriad of symptoms caused by a pinched nerve in the back. The sciatic nerve is the largest nerve in the human body, starting from the back and dividing into various branches till the toes. The sciatic nerve is formed by the spinal nerves L4, L5, S1, S2, and S3.

The sciatic nerve exits the pelvis in the buttock and travels in the back of the thigh. The nerve divides into two branches just above the back of the knee joint. The two branches give rise to various nerves that supply the calf and the feet.

The sciatic nerve is responsible for coordinating the movements of the muscles in the legs and feet. The nerve also carries nerve signals of sensation such as touch, pressure, and temperature from the lower extremities to the brain.

A pinched nerve results from compression or irritation of any of the nerve roots that form the sciatic nerve. The nerve may also be compressed as it passes beneath the piriform muscle (piriformis syndrome).

Sciatica presents as a pain in the buttocks that may go down the back of the thigh and calf. There may be an associated feeling of pins and needles in the legs. If the nerve roots’ compression is severe, there may be a progressive weakness of the legs, and patients may complain of difficulty in walking, getting up from a chair, or navigating stairs. The weakness may be accompanied by numbness in the legs and toes.

The pain may be aggravated by activities such as bending forward, sitting, coughing, sneezing when the herniated intervertebral disc is the cause of sciatica. Similarly, when the cause of sciatica is spinal canal stenosis, the symptoms may be aggravated on activities that require a patient to bend backward, such as walking downhill.

In rare instances, the compression of nerve roots in the spinal canal may lead to cauda equina syndrome symptoms. Cauda equina syndrome involves weakness and numbness of lower extremities, numbness of the saddle area, and bowel and bladder control loss.

Hip pain Vs. Sciatica

As there may be a significant overlay of hip pain and sciatica symptoms, it becomes important to examine and diagnose the root cause of pain. Pain in the buttocks may be caused by hip pathologies or may be a symptom of sciatica.

The buttock pain that radiates down the back of the thigh, along with back pain, is usually due to spine pathology. Meanwhile, buttock pain may or may not be associated with groin pain, and that gets worse with activity may indicate hip arthritis.

The pain of hip pathology usually is centered at the groin, and it is rare for it to radiate below the knee joint. Sciatica symptoms may, on the other hand, may radiate down the legs into the toes. Secondary to the hip joint pathology, patients may walk with a limp, and in severe cases of arthritis, there may be leg length discrepancy.

Usually, the attending orthopedic surgeon will examine the patient and extract a history leading to the symptoms. The physician may perform physical examinations to find out the part of the spine or the hip leading to the symptoms.

Radiological examinations for the hip usually include an X-Ray, which may or may not be followed by an MRI or a CT scan. The diagnosis of spinal pathologies causing sciatica usually requires an MRI investigation. An MRI is able to differentiate between the soft tissue structures such as nerves, ligaments, intervertebral disc, etc.

The management of hip disease usually depends upon the diagnosis and the age of the patient. The management of advanced arthritis and avascular necrosis is usually a total hip replacement surgery. Younger patients with mild arthritis may benefit from hip arthroscopic procedures.

The management of sciatica is usually conservative in the form of medications, heat or cold therapy, physical therapy, etc. In some cases, patients may require decompression surgeries such as microdiscectomy or laminoplasty. Patients with the instability of the spine may require lumbar fusion surgeries.