Hip Pain/Sciatica

Very often clients will come to CHIRO H3 seeking help with Hip pain and the more debilitating Sciatica pain.

Before we dive in and analyse the driving influences of the 2 disorders its important to get an understanding of the common symptoms associated;

Hip pain

• As the name implies pain around the Hip and Groin Region
• Hip Stiffness and reduced motion
• Limping
• Swelling and tenderness of the hip
• Difficulty sleeping on the Hip

Sciatica pain

• Pain radiating down the path of the Sciatic nerve - can feel like an electric shock
• Pain in buttocks, down the back of the leg and even the foot sometimes
• Usually can be accompanied by tingling, pins and needles or numbness
• When persistent can cause a weakness of the affected leg
• In rare circumstances can cause loss of control over the bladder and bowels

In order to further understand the cause of these symptoms we need to look at the anatomy of the surrounding structures and how they can influence hip dysfunctions and Sciatic symptoms. We begin by first looking at the spine, which from a front and back view needs to be straight. The lumba-sacral junction is the articulation of L5 and S1 and thus forming the stable pelvic base which from a front and back view needs to be flat and horizontal without any tilting. The Pelvis supports the spinal column and connects the upper body to the lower extremities via the Hip articulations, which need to be aligned horizontally. When we look from the side on, there should be a C shaped curve to the lower back so that the upper extremities are sitting a top the pelvis and are not too far forward or backward. The upper body has a big influence on the lower back and pelvic alignment and changes in too much or not enough curve can lead to hip and sciatic pains.

The Hip joint is a weight bearing joint that has a lot of fluid movement and can withstand repeated motion. As we use our hips in everyday life, for example going for a run or playing soccer, there is a cushion of cartilage (Acetabulum) which helps prevent friction as the hip bones move in its socket. Hip pain of a musculoskeletal source can be attributed to the cartilage wearing down or becoming damaged, muscles and tendons in the hip becoming overused as well as pelvic and lower back issues referring pain into the hip region.

Arthritic changes in the Hip are relatively common especially in the elderly, with symptoms like difficulty walking, stiffening, pain in the region that can be either sharp stabbing pain or a dull achy pain. A thorough history and special imaging like Xray’s provide a good starting point in determining the onset. Hip arthritis problems are often due to long standing stress on the hip joint itself and clients often present with history of high impact sports.

In practice we are seeing more and more the impact of pelvic misalignments that gradually over the course of a number of years can load and stress one or both hip joints either being overloaded or over working to compensate the misalignment. This can also run risk of developing a labral tear, a tiny rip in the ring of cartilage (Labarum) that follows the outside rim of the socket of your hip joint. Acting as a cushion for your hip joint, the labrum is like a rubber seal or gasket to help hold the ball at the top of your thighbone securely within your hip socket.

Athletes and people who perform repetitive twisting movements are at higher risk of developing this problem, especially if in a faulty movement patter or misalignments at the pelvis or lower back. Chiropractic care is a great alternate method to alleviate the immediate pain with gentle corrections to the pelvis and hip itself to restore the normal movement and thus function.

Muscle or tendon strains around the hip are a very common complaint. Repeated activities can put strain on the muscles, tendons, and ligaments that support the hips. When they become inflamed due to overuse, they can cause pain and prevent the hip from working normally. While muscles can be the source of the pain, it’s important to identify and address the cause of the muscle dysfunction. Muscles have a primary job to help the hip move or to help the hip and pelvis stabilise and more often we see muscles over compensate as a reaction to a pelvic misalignment. As we adopt an altered postural position and repeatedly load through our lower back and pelvis our muscles are required to exert more energy and become fatigued. The simple task of holding us upright becomes a burden. While aiming at reducing the symptoms, we also focus on addressing the underlying cause and developing long term solutions.

Sciatic symptoms on the other hand are lot more painful and are characterised by a shooting referring pain, pins or needles and a numbness down the leg, usually one sided. The Sciatic nerve is the largest single nerve in the body. It starts by branching from the spine at the L4 to S3 sacral segments and the collection of nerve fibres unite to form the sciatic nerve in front of the piriformis muscle. Commonly the sciatic nerve becomes symptomatic when its irritated or compressed at or near its point of origin.

Sciatica is very commonly seen in middle age with peak at 40-50 years, current research shows at least 43% of the population will be affected at some point and is not necessarily due to an injury or event, rather a development over time. At Chiro H3 we see a large portion of clients affected by sciatica to be either in a high labor jobs with repetitive stress or sedentary lifestyles where there is less inactivity and lots of loading from sitting. The most common cause of sciatica is impingement and the location of the referral, the leg pain, numbness, tingling, weakness and radiating symptoms into the foot are indicative of the level of the disc problem. If we take a lumbar segment 5 (L5) as an example, any impingement here can cause weakness of the extension of the big toe and even in the ankle. The types of disc problems may include disc bulge, disc protrusion and disc prolapse. Disc problems are often a result of long standing stress on the lower back and clients generally present with a history of lower back pain. The pelvis and spine are very important in disc issues, any misalignment with the pelvis or change in the lumbar curve (lordosis) can cause extra loading through the discs and potentially cause sciatica.

Another three common causes of sciatica include Sacroiliac joint dysfunction, piriformis syndrome and pregnancy. The sacroiliac joint is located at the bottom of your spine and acts to articulate the pelvis to the sacrum, located on each side. It’s a very heavy loading joint and can become stressed with repeated loading and thus irritate the L5 nerve which lies on top of the Sacroiliac joint, causing sciatic type of symptoms. The Piriformis is a muscle that acts to externally rotate the hip and if it irritates or pinches a nerve root that comprises the sciatic nerve, it can produce sciatic type of symptoms. When looking at sacroiliac dysfunction and piriformis syndrome, it is very important to assess the pelvis and spine as a whole, any misalignment or extra pressure can make the sacroiliac joint work harder and put more pressure on the piriformis. Likewise, Pregnancy has a lot of changes that come along with it, such as weight gain, shift in the center of gravity and hormonal changes which can cause sciatica. As the body begins to change and shift during pregnancy sciatic can be due to disc loading, sacroiliac dysfunction and even piriformis syndrome.