Brian came into my clinic with sciatic pain in his R hip for the past 1 1/2-2 years. He also had low back pain. He did not mention any other aches and pains. Through our testing, I found some significant issues in his R hip. His hip would crack with any movement in a ratcheting fashion.
“Oh, yeah, I have an arthritic hip but I’ve had that for years”, he said.
Among other things, I found Brian had tight thigh muscles. After our third visit his sciatic pain was completely gone primarily due to lengthening his thigh muscles.
“But it keeps coming back after a couple days”, he complained.
Yet every time we stretched his thigh muscles, his pain would disappear for a couple days and then return. When I run into a pattern like this (better briefly then pain returns again) I think, “he’s doing something to cause these thigh muscles to tighten up each time”. The “he” in this instance is not so much Brian but his hip. I told him he needed to get his hip checked out by a hip specialist. Turned out Brian had significant arthritic changes in his hip and needed a total hip replacement.
“But the arthritis isn’t causing your sciatic pain” the doctor said and promptly ordered Brian to see a spinal surgeon.
This is true–to an extent. The arthritic changes happening in Brian’s hip do not in any way directly impinge against his sciatic nerve. But that doesn’t mean there isn’t a cause and effect.
The arthritis is causing the thigh muscles to contract around the painful and restricted joint, which is then causing the sciatic pain. We had already proven this through stretching his thigh muscles.
I recommended Brian please not agree to spinal surgery for now and just get the hip fixed instead. Then after rehab, we’ll see how his sciatica is. If it doesn’t clear up after the hip surgery then he can consider the spine surgery. But we have to tease out just how much this hip arthritis is contributing to his pain first.
I’ll keep you posted on the outcome if he returns.