by Dr. Timothy J. Maggs, ©1999
One of the more difficult diagnoses to determine is that of an athlete with pain in the back of the thigh and into the buttocks. A pulled hamstring can often mimic a sciatic neuralgia, often known as sciatica. Both conditions can be debilitating and the appropriate treatment, both immediate and long term, is critical for improvement. The problem is the treatments are significantly different, so an incorrect diagnosis can delay recovery and encourage further injury.
The hamstring muscle is attached to the base of the buttocks as it attaches to the ischial tuberosity, which is that area of the butt that hurts after you've ridden your bike too much too soon. It runs down to the back of the knee. The function of the hamstring is to flex the knee, as happens during every stride when running. Every time the heel approximates the butt, the hamstring is doing it's job.
Usually, a pull will occur in one of two places--either in the belly of the muscle or at the attachment point at the top of the leg. Localized pain in either of these areas might be caused by a pulled hamstring. If activity such as walking or bending your knee increases the pain, and inactivity reduces the pain, a pulled hamstring is the likely diagnosis.
A pinched sciatic nerve is a completely different condition and should be addressed very specifically. The sciatic nerve is the largest nerve in the body. It originates as branches at the lower joints in the low back and it unites to form a nerve the size of your little finger. It then runs through the middle of the buttocks and down the back of the thighs to the knee. At the knee, it branches into two separate nerves--one continuing down the back of the calf and the other down the outside of the leg to the ankle.
Signals that suggest sciatica are varied. Radiating pain can originate in the lower back and run through the buttocks. The pain can continue down the back of the leg and possibly into the calf or the ankle, and it can be sharp. The straight leg raise (lay on your back and have someone else lift the involved leg, which remains straight, off the ground) will generally produce pain. A history of low back problems can also influence the onset of sciatica. There can also be tingling or weakness in the leg. If any of these symptoms are present, sciatic neuralgia is a likely diagnosis.
When you have a preliminary diagnosis, you can then take steps to alleviate the symptoms and the condition. Home treatment can be attempted initially. If improvements are too slow, however, or there are continued flareups, the need for professional help may be indicated.
With a pulled hamstring, the muscle has gone through overuse and needs to heal. Localized massage will provide significant benefit as it helps to flush the muscle and increase the blood flow, which will produce a more rapid healing. Stretching should be avoided initially. Ice should be used if there is pain and inflammation. Once the pain is reduced, moist heat might be beneficial, again to increase blood flow to the injured area. Some period of rest is needed to allow for healing. Also, if necessary, an elasticized brace or support may be indicated as well as physical therapy. Obviously, you always want to do as much as you can at home to reduce unnecessary costs. When treated at home, however, discipline is the key.
Sciatic nerve involvement is generally a little trickier to solve. Conservative, at home treatment might work if the condition is a first time condition. If the condition is chronic, professional help may be indicated. At home treatment consists of some period of rest, ice to the low back (15-20 minutes at a time, 4-5 times per day) and anti-inflammatories (all natural, if available), if necessary. The tennis ball technique under the buttocks muscles several times per day for deep specific massage is beneficial as it forces relaxation of the gluteal and hip muscles which often reduces pressure on the sciatic nerve.
The cause of sciatica can be from many different conditions, such as a low back strain, a degenerative disc, a protruding disc, piriformis syndrome, hip problems or some pathology. This is when an accurate diagnosis and professional help becomes critical.
Always find out the specific cause, and the likelihood for a more rapid recovery goes way up. Too often, we hope for the American dream ("Hopefully, the problem will be gone in the morning"). Very seldom does this treatment method work. Running is a repetitive motion and the low back, gluteal muscles and hamstring absorb much of the burden making the area prone to injury. Apply a little logic and patience and your career as a runner will last a lot longer. Good luck.