Problem
Sacral pain, gluteal pain and false sciatica
Pain that doesn’t always start in a disc.
Some types of pain resemble sciatica, but they do not always originate from a slipped disc.
Pain may start in the sacrum or buttocks and radiate down the back of the leg.
Sometimes the MRI scan is normal.
Or it shows changes that do not fully explain the whole pattern.
The deep gluteal region
The sciatic nerve passes through an area containing deep rotator muscles, fascia and other structures.
The concept of deep gluteal syndrome encompasses various non-disc-related causes of sciatic nerve entrapment or irritation in that region.
The piriformis muscle may be part of the problem, but it is not the only possibility.
Sacrum and sacrumiliac joint
The sacrumiliac region can also cause referred pain in the buttocks and thigh.
To identify the issue, it is important to observe how the pain behaves and which movements or pressures cause it to change.
It is not the same as a hernia
Discogenic radiculopathy can cause pain, sensory disturbances, loss of strength or changes in reflexes, depending on the affected nerve root.
If the symptoms match these, the assessment changes.
Nor is it the pudendal nerve
The pudendal nerve belongs to a different nerve distribution area.
Your symptoms are mainly related to the pelvic/perineal region and tend to present with different characteristics.
It is not advisable to confuse the two simply because there is discomfort when sitting.
How I work
Depending on what we find, we can assess:
- lumbar
- sacrum
- pelvis
- hip
- deep gluteal muscles
- fascia
- neural mobility
- I work on the pelvic floor indirectly when the pattern calls for it and within the scope of my practice.
If you also notice any changes in your abdomen or digestion, we’ll take these into account too.
The aim
Identify which pattern best fits the case and focus on the structures that may be contributing to the problem.
If the pain radiates down the leg, it is also worth investigating where it originated.