Is Hip Pain Radiating Down the Leg Due to a Slipped Disc Pressing on Nerves?

Sciatica Pain is a type of pain that typically starts in the lower back or hip area and radiates down the back of the leg. In some cases, it may extend to the calf or foot. This condition is often diagnosed as being related to nerve compression, which could be caused by a herniated disc pressing on the nerve, age-related spinal degeneration, muscle spasms in the hip, or other causes. Usually, the pain is experienced in one leg, but in rare cases, it can affect both legs.

To better understand, let’s first explore the body’s internal structure. The nerve commonly involved is the Sciatica Nerve, which originates from the lower spine (lumbar area) and extends through the hip, back of the thigh, calf, and down to the foot. If any part of this pathway is compressed—whether it’s due to a herniated disc in the lower spine or other spinal conditions—pain can radiate along the nerve’s path from the lower back to the leg.

Sciatica Nerve Pain: From the Lower Back to the Hips and Legs

Sciatica pain does not always result from a herniated disc pressing on the nerve. This article will break down the causes of sciatica into two main categories:

 Pain Originating from the Back

• Herniated Disc (Herniated Nucleus Pulposus):

This is a common cause of sciatica. The spine in this region bears significant weight and undergoes frequent movement, which can cause a disc to rupture or bulge, pressing on a nerve. Symptoms typically include lower back pain that radiates through the hip and down one leg, possibly accompanied by numbness or weakness in the leg or foot.

It is most common in people between the ages of 30 and 50. Risk factors include heavy lifting, being overweight, smoking, and improper bending or twisting.

• Spinal Stenosis or Degenerative Disc Disease:

This condition is often seen in older adults and is commonly referred to as “bone pressing on the nerve.” It can cause pain that radiates down one or both legs, accompanied by numbness or weakness in the legs. The pain worsens when standing or walking for extended periods and is relieved by sitting.

This is caused by degenerative changes in the spine, where bone spurs or disc degeneration compress the spinal nerves.

 Pain Not Originating from the Back

• Piriformis Syndrome:

The piriformis muscle, located in the deep hip region, is near the sciatic nerve. If the piriformis muscle becomes tight or develops adhesions, it can press on the sciatic nerve, causing deep, aching pain in the hip that radiates down the leg. This pain worsens when sitting for long periods, or after prolonged walking or standing.

Common causes include sitting for extended periods in poor posture, sports injuries, or long-distance running.
Piriformis syndrome is less common and often needs to be differentiated from other similar conditions, such as a herniated disc or degenerative spinal conditions.

• Hamstring Strain:

The hamstring muscles, located from the hip to the knee, can become strained, leading to pain in the back of the thigh. The pain usually remains above the knee but can worsen over time, especially with improper treatment or repetitive injury. If untreated, the pain can extend to the knee or calf.

Hamstring strains are often caused by sports activities like football, basketball, or long-distance running, especially when proper stretching isn’t performed before or after exercise.

What Should You Do if Sciatica Pain Starts Suddenly?

If you experience sudden sciatica pain, stop the activity immediately and monitor your symptoms. If the pain persists after resting, or if you experience numbness or weakness in your leg, it’s important to see a doctor.

However, if the pain is localized in the back and does not radiate to other areas, it may be a natural warning sign indicating an issue with your body. It’s essential to stop activities such as heavy lifting or vigorous exercise to prevent further injury to your muscles or spine.

Treatment and Physical Therapy for Sciatica Pain

If the pain continues after rest, it is advisable to consult a physician for a thorough evaluation. Depending on the diagnosis, the following treatments may be recommended:

1.Pain Management Medication

Various medications are used to manage pain from different causes and tailored to the patient’s medical conditions, ensuring safe and effective relief.

2.Physical Therapy

• Exercise to Stretch and Strengthen Muscles: Focused on core muscles and back muscles, exercises can help relieve pressure on the spine and improve flexibility. It’s important to consult with a specialist to ensure that exercises are personalized to your specific condition.
• Medical Equipment for Rehabilitation: Various tools, such as heat packs, ultrasound therapy, laser treatment, shockwave therapy, or acupuncture, can be used to relieve pain and relax the muscles.

Moreover, exercises performed in a pool “Aquatic Therapy” help reduce the impact on joints and spinal pressure while supporting muscle recovery. This can be an effective rehabilitation method.

3.Surgical Intervention

There are different surgical approaches, including traditional open surgery and minimally invasive (endoscopic) surgery, which offers smaller incisions, less tissue damage, faster recovery, and better outcomes.

Sciatica pain is a condition that requires careful attention. Ignoring minor symptoms or continuing inappropriate activities could worsen underlying issues. Whether it’s a herniated disc or nerve compression, early diagnosis and proper care can help prevent further damage and improve quality of life. Remember to always follow correct body mechanics to avoid unnecessary strain on the spine and joints.

Q&A Section

Q: Why does sciatica pain typically affect only one leg?

Sciatica caused by a herniated disc usually affects just one leg. This is because, when a disc herniates, it tends to bulge in one direction, compressing the nerve on only one side. This leads to pain, numbness, or tingling radiating down one leg.

Rewritten by Asst. Clinical Prof. Warayos Trathitephun, M.D.