Sciatica or not?

Posted by thracian @thracian, Apr 4, 2023

Three weeks ago, I did some high-intensity circuit training and got muscle spasm in the right-side glute muscle (probably gluteus medium). That night I had significant pain in the front right hip that prevented me from sleeping. The next I went to see a doctor, got X-ray, and a sciatica diagnosis. Then I started limping and I couldn’t walk on the heel of the right foot (a lighter version of foot drop). I went to see a physical therapist and after evaluation, I was told I don’t have sciatica but a pinched/irritated nerve between L4-L5 doesn’t send signals to some muscles, such as gluteus medium and tibialis, resulting in muscle weakness. I was told it would take 4-6 months to recover. The interesting fact is that besides the pain the first night, I haven’t had any pain since.

Then I did MRI of the spine and the orthopedic doctor questioned that the issues are coming from the spine. He qualified the symptoms as “confusing”. He gave me some piriformis muscle stretches and suggested I do an epidural spine injection to see it will evaluate the symptoms. He also suggested I see a neurologist and if I’m cleared, do an MRI hip scan.

I do see signs of progress and walking is now easier. But if this is not coming from the spine, what other condition can produce these symptoms?

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Profile picture for bannisterkl @bannisterkl

Yes, they did two MRI's. They did sacrum, coccyx and hip as well as lower back.
I had to insist. The Doc was sure it was my lumbar stenosis. He was wrong!

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Hi, bannisterkl. I realize I'm reaching out regarding an old post, but am wondering how severe your lumbar stenosis was that your doc thought all your pain was from that condition. I have severe lumbar stenosis but am convinced that there's something else going on in the glutes, possibly tendinitis such as you had. I've so far had an MRI of spine and pelvis; how did you know to insist on sacrum and coccyx, and what kind of doctor ordered those scans? Any advice would be appreciated.

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Profile picture for bayhorse @bayhorse

Hi, bannisterkl. I realize I'm reaching out regarding an old post, but am wondering how severe your lumbar stenosis was that your doc thought all your pain was from that condition. I have severe lumbar stenosis but am convinced that there's something else going on in the glutes, possibly tendinitis such as you had. I've so far had an MRI of spine and pelvis; how did you know to insist on sacrum and coccyx, and what kind of doctor ordered those scans? Any advice would be appreciated.

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The scans ordered by a pain Dr. Once his injections stopped hereferred ro a neurosurgeon whoonly wated to deal with disks then use coflex. My nephew, whoisa neurosurgeon from Mayo said he missed a lot, and that coflex was a waste of money. I went to an orthopedic surgeon ultimately did a laminectomy, a foraminotomy, and fused myspinr from L2-S1

He told me that my SI joint paint would go with this surgery. It did@

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I have pain in my left butt cheek that travels down my leg. underneath my left knee and down to my ankle. Initially, I thought it was a problem with my knee.
Now I feel like it may be sciatica. Is there a test to determine the problem.

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Profile picture for koneil @koneil

I have pain in my left butt cheek that travels down my leg. underneath my left knee and down to my ankle. Initially, I thought it was a problem with my knee.
Now I feel like it may be sciatica. Is there a test to determine the problem.

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@koneil, https://www.physio-pedia.com/Piriformis_Test
I'd see a chiropractor. You'll get a diagnosis plus some relief.

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Profile picture for koneil @koneil

I have pain in my left butt cheek that travels down my leg. underneath my left knee and down to my ankle. Initially, I thought it was a problem with my knee.
Now I feel like it may be sciatica. Is there a test to determine the problem.

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It sounds exactly like sciatica nerve.
I've had it several times and with such pain. Went to ER once. Nothing they could do about it. I had to just walk it out. Could take months.
I was told once that if it traveled to your feet that it was time to see the doctor.
IDK

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Profile picture for koneil @koneil

I have pain in my left butt cheek that travels down my leg. underneath my left knee and down to my ankle. Initially, I thought it was a problem with my knee.
Now I feel like it may be sciatica. Is there a test to determine the problem.

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@koneil Spine issues can create sciatica symptoms, but so can issues with pelvic alignment issues. Here is a technical article that explains the issues. Perhaps a physical therapist could evaluate and try to sort it out. If PT doesn't help, perhaps it is spine related.
https://mskneurology.com/identify-treat-lumbar-plexus-compression-syndrome-lpcs/

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Profile picture for koneil @koneil

I have pain in my left butt cheek that travels down my leg. underneath my left knee and down to my ankle. Initially, I thought it was a problem with my knee.
Now I feel like it may be sciatica. Is there a test to determine the problem.

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Sciatica can be caused by spine issues. If you have bulging discs, one can be pressing on the sciatic nerve. If you are in a lot of pain, I would suggest you seeing an orthopedic doctor who specializes in the back. An MRI of your spine may be suggested as to see why you are experiencing the pain and exactly what is causing it. Good luck and feel better! Nothing worse than back pain and not knowing what is causing the pain.

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Profile picture for koneil @koneil

I have pain in my left butt cheek that travels down my leg. underneath my left knee and down to my ankle. Initially, I thought it was a problem with my knee.
Now I feel like it may be sciatica. Is there a test to determine the problem.

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Thank you very much for your reply. After numerous imaging of my left leg and lumber spine my doctor came to this conclusion. I have a left knee thats bone on bone and needs replacing as well as an entrapment of the sciatic nerve. My doctor recommended a total knee replacement and corticosteroid injections for my static nerve.
I do plan on seeking another opinion on these issues.
I would have never guessed that my pain could be from my pelvic nerve.
I see my doctor today to discuss this as a possible cause of my pain.
Thank you again for sharing the article.
Respectfully
Ken

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Profile picture for koneil @koneil

Thank you very much for your reply. After numerous imaging of my left leg and lumber spine my doctor came to this conclusion. I have a left knee thats bone on bone and needs replacing as well as an entrapment of the sciatic nerve. My doctor recommended a total knee replacement and corticosteroid injections for my static nerve.
I do plan on seeking another opinion on these issues.
I would have never guessed that my pain could be from my pelvic nerve.
I see my doctor today to discuss this as a possible cause of my pain.
Thank you again for sharing the article.
Respectfully
Ken

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Yes yes, get second opinion. Medicare pays for up to 3.

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Profile picture for koneil @koneil

I have pain in my left butt cheek that travels down my leg. underneath my left knee and down to my ankle. Initially, I thought it was a problem with my knee.
Now I feel like it may be sciatica. Is there a test to determine the problem.

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Good afternoon and thank you, germania for your reply. I did get a second opinion and the orthopedic surgeon agreed that my knee is bone on bone, and I need a knee replacement. The x-rays on my left knee show my knee as bone on bone. I've had my right knee replaced a few years ago and I do not remember the pain in the back of my knee going down my leg. The doctor said it was referred pain from my knee. I'm looking for a third orthopedic surgeon to confirm the other two. I do not want to wait too long. Having the surgery at 68 years old is far better than at 78 years old. Thank you again for the information.

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