Experiencing hip pain with radiating pain down the leg is a common musculoskeletal presentation that can significantly impact quality of life. At INSIDE our clinic we deal with this presentation on a regular basis. Understanding the different possible causes will help you seek the right specialist and in a great number of cases fully relieve the symptoms (pain, tingling, pins and needles, etc.).
Most common causes of hip pain radiating down the leg
- Sciatic nerve compression at spinal level
Compression or irritation of the sciatic nerve at spinal level causing sciatica. Bear in mind sciatica is just a symptom characterised by pain, tingling, numbness or weakness that radiates along the path of the sciatic nerve, arising from the base of the spine through the hip and buttock and down each leg. Sciatica can be caused anywhere along the nerve’s path, the nerve can be compressed or irritated by other structures and have different causes other than compression at spinal level.
In our clinic, most of our clients experiencing sciatica symptoms present with nerve irritation/compression caused by soft tissue restrictions (we’ll elaborate on this further down).
Typically, sciatica affects only one side of the body and can range from mild discomfort to severe, debilitating pain. The pain associated with sciatica can vary in intensity and may feel like a sharp, intense burning sensation, electric like pain, pins and needles and/or muscle weakness. These symptoms are very similar to those caused by Myofascial Trigger Points in certain muscles (we’ll talk about it further down!) so we must not rush into a diagnosis.
Common causes of sciatic nerve compression at spinal level include:
- Herniated or bulging discs in the lower spine pressing on the nerve root
- Spinal stenosis – narrowing of the spinal canal that houses the nerves
- Degenerative disc disease causing inflammation and nerve irritation
- Spondylolisthesis – when one vertebra slips forward over another
- Pregnancy – as the growing uterus can put pressure on the sciatic nerve
- Hip Osteoarthritis
Advanced hip arthritis can cause pain that radiates into the thigh (very common for pain to radiate in front of the thigh) and knee as well as restricted range of motion.
The restricted range of motion in osteoarthritis is a good differentiating diagnostic factor with presentations with similar location of pain (like sciatica). These limitations in movement often develop gradually.
Reduced range of motion in clients presenting with osteoarthritis often include:
- Reduced internal and external hip rotation
- Limited hip flexion (difficulty lifting knee towards chest)
- Decreased hip extension (difficulty moving leg behind body)
- Restricted hip abduction (difficulty moving leg away from midline)
Conservative treatment options for hip osteoarthritis include:
- Strength training/functional training therapy to maintain joint mobility and strengthen supporting muscles
- Myofascial release therapy to release myofascial restrictions that might be directly or indirectly contributing to the symptoms (pain and reduced mobility).
- Healthy lifestyle, weight management.
In advanced cases where conservative treatments are not effective, hip replacement surgery may be recommended to restore function and relieve pain.
- Myofascial restrictions
Restrictions of the myofascial tissue are, in our experience in clinic, the most common cause for hip pain that radiates down the leg.
So…
What is the Myofascial Tissue?
The Myofascial tissue is one of the connective tissues in our body. The Myofascial tissue forms a continuous three-dimensional web throughout the entire body. Ignored in the dissection rooms we now know that this tissue plays a much more important role than we thought and holds the key to musculoskeletal pain and dysfunction, biomechanics and sports conditioning. We also know that the Myofascial tissue is deeply interrelated with the brain and mind, also playing a key role in general wellbeing and mental health.
The myofascial tissue:
- Provides structural support and maintains postural balance
- Allows smooth movement between muscles and other bodily structures (like organs, nerves or vessels)
- Transmits force and tension throughout the body
- Contains a huge amount of nerve endings and sensory receptors that provide feedback to the brain and vice-verse.
- Has piezoelectric properties – meaning it generates electrical charges in response to mechanical stress that can travel at the speed of light (much faster than nerve communication) which can influence cellular behaviour and tissue healing.
All these properties make the myofascial tissue an extremely sensitive and powerful system within our body with a role that goes beyond being exclusively structural. It is adamant therefore for our general health, both physical health and mental health, to keep the Myofascial tissue in good condition.
When healthy, myofascial tissue can glide smoothly. However, it can become restricted or develop “trigger points” due to different stressors (like for example injury, stress, inflammation, muscle weakness or poor diet) leading to pain and limited mobility between other symptoms.
Different ways in which Myofascial Restrictions can cause pain down the leg:
- Soft tissue restrictions can directly compress the sciatic nerve at various points along its path through the hip and leg
- Myofascial restrictions can cause mechanical tension leading to nerve irritation
- Restrictions in key muscles like the piriformis, hamstrings, and gluteal muscles can compress or irritate the sciatic nerve where it passes through or by these muscles
- Fascial adhesions can reduce the nerve’s ability to glide smoothly through tissues during movement, causing irritation
- Myofascial Trigger Points in key muscles can cause referred pain and other symptoms in a similar pattern than sciatica (we’ll cover these more in detail further down).
A common area where restrictions are built and commonly linked with radiating pain down the leg is the top of the hip bone, between hip and last rib. The Deep Front Myofascial Line requires releasing at this level in a great number of cases in clients experiencing this presentation.
Another very common presentation caused by Myofascial restrictions and linked with hip pain radiating down the leg is:
Piriformis syndrome:
In this presentation, the Piriformis muscle in the buttock compresses the sciatic nerve on its way down to the leg causing pain that radiates from the buttock down the back of the leg and calf, occasionally all the way down to the foot. Pain might also refer into the groin area.
The pain distribution can be similar to sciatica caused by spinal issues, which is why proper assessment by a specialised soft tissue therapist is important for accurate diagnosis.
Now going back to the last bullet point in the above list of “ways in which Myofascial Restrictions can cause pain down the leg”, let’s look into another major cause for hip pain radiating down the leg, Myofascial Trigger Points.
What are trigger points?
A Trigger Point is a hyper-irritable spot within a taut band of skeletal muscle that is painful when compressed. Also commonly referred to as “knots”, Trigger Points can be latent or active and cause both local pain and referred pain (pain felt in other areas) in predictable patterns (thanks to the amazing work of Dr Janet Travell)
Dr Janet Travell documented Myofascial Trigger Points and their referred pain pattern, which is the same or very similar in every person, leaving behind a legacy of Trigger Point “maps”.
Current Myofascial Release therapists and Myotherapists are able to use these maps to link the client’s symptoms to the Myofascial Trigger Point pain pattern “map”, locating this way the Trigger Point that is directly causing the symptoms. Once located, these Trigger Points can then be released together with the symptoms linked to them.
Trigger Points can develop due to a variety of factors including, overuse, strain, direct trauma, injury, emotional stress, pressure stresses within the Myofascial system, weakness, postural imbalances, etc.
Important to highlight that Trigger Points can cause symptoms that mimic other conditions, making proper assessment crucial in order to avoid misdiagnosis.
Some of the most common Trigger Point referred pain patterns linked with hip pain radiating down the leg are:
Gluteus Minimus
In our experience in clinic this muscle is very often responsible for radiating pain down the leg.
Referred pain from TPs in the gluteus minimus extend over the lower lateral buttock, down the lateral or posterior aspect of the thigh, knee and leg to the ankle.
Piriformis
Referred pain from TPs in the Piriformis muscle might radiate to the sacroiliac region, laterally across the buttock and over the hip region posteriorly and to the top two thirds of the posterior thigh.
Quadratus Lumborum (LQ)
Even thought this muscle refers pain mainly into the hip area I wanted to include it here due to the high frequency of times it’s involved in hip and leg pain presentations. Trigger Points in this muscle refer pain into the sacroiliac joint (SI) and lower buttock area, sometimes anteriorly along the crest of the ilium and groin and greater trochanter.
Gluteus Medius
This is another muscle with TPs referring pain mainly onto the hip and sacral area. I choose to include it here again due to the high frequency of times it’s involved in hip and leg pain presentations some way or another.
In summary
Hip pain that radiates down the leg can stem from various sources, with myofascial restrictions being one of the most common yet often overlooked. Whether the pain originates from sciatic nerve compression, hip osteoarthritis, or myofascial restrictions and trigger points, proper diagnosis is crucial for effective treatment.
Understanding the important role of the myofascial tissue system can help guide treatment choices.
While some cases (for example advanced hip osteoarthritis) may require surgical intervention, in the majority of cases of hip pain radiating down the leg, people experiencing this presentation find a solution through conservative specialist hands-on treatment, like myofascial release therapy.
The key is to seek professional assessment early to identify the root cause of the pain and develop an appropriate treatment plan.
