Can hip impingement cause sciatica pain down the leg

In the complex human body, the interplay between different systems often leaves us confused about the complexity of our own physiology. One such intersection of discomfort and mystery is the conundrum of hip impingement and sciatica pain. One question you might have about your hip pain is if hip impingement be the clandestine culprit behind the sciatica pain that courses down our legs?

I'll go through the anatomy of the hip and try to unravel the potential connections between hip impingement and the notorious sciatic nerve discomfort. In this blog post, I will try to decipher the mechanics, understand the symptoms, and shed light on the crucial link that may be causing a cascade of discomfort from the hip to the toes. Read on to find out and demystify the intricacies of these two seemingly unrelated issues, seeking clarity of where bones, nerves, and pain combine.


What is a hip impingement?

The hip in a large and important joint where the upper body meets the lower, facilitating both stability and a complex range of motion. At its core, the hip joint is a ball-and-socket joint, consisting of the femoral head— the rounded end of the thigh bone (femur)—and the acetabulum, a concave socket within the pelvic bone. This dynamic duo is surrounded by a robust network of ligaments, tendons, and muscles, collectively forming the musculoskeletal framework that supports our body weight and orchestrates movements. The synovial membrane envelops the joint, secreting synovial fluid to lubricate and nourish the articular surfaces, reducing friction during motion. The pelvic bones, ilium, ischium, and pubis, fuse to create the acetabulum, providing a stable foundation for the femoral head. The joint's flexibility owes much to the surrounding muscles, notably the powerful hip flexors and extensors, abductors, and adductors, all working in harmonious synergy. This intricate balance, when disrupted by factors like injury, degeneration, or anatomical abnormalities, can lead to conditions such as hip impingement, highlighting the delicate equilibrium that defines the hip's anatomy.

Hip impingement, also known as femoroacetabular impingement (FAI), is a condition characterized by abnormal contact between the hip bones—specifically, the femoral head and the acetabulum. These crucial components of the hip joint are designed to glide seamlessly, facilitating smooth and unrestricted movement. However, in individuals with hip impingement, structural irregularities can disrupt this harmonious interplay. Typically, there are two primary types of impingement: cam impingement, marked by an abnormality in the femoral head, and pincer impingement, where the acetabulum extends further than usual. Both scenarios result in an interference during hip motion, causing friction and potential damage to the cartilage surrounding the joint. This condition often manifests as pain, stiffness, or a limited range of motion in the hip, particularly during activities that involve flexion or rotation. Left untreated, hip impingement may contribute to the development of osteoarthritis over time, underscoring the importance of timely diagnosis and intervention.


What is sciatica?

Sciatica, a term that often elicits a wince of discomfort, is a condition rooted in the intricate anatomy of the sciatic nerve. This nerve, the longest and widest in the human body, originates from the lower back and branches down each leg, governing sensation and motor function. Sciatica comes to the fore when this nerve is compressed or irritated, typically emanating from issues such as herniated discs, spinal stenosis, or, as we're exploring, potential connections with hip impingement. The hallmark of sciatica is a radiating pain that traverses the buttocks and courses down the back of the leg, sometimes reaching the foot. This discomfort is often accompanied by tingling, numbness, or weakness along the nerve's pathway. The pain's intensity can vary, from a persistent ache to sharp, electric jolts, impacting daily activities and mobility. Understanding sciatica entails navigating the complexities of the spine and nerve interactions, where any disruption to the sciatic nerve's smooth journey can set the stage for this challenging and often debilitating condition.


What else can cause sciatica?

Sciatica, a painful condition that often causes shooting pains down the leg, can arise from a multitude of underlying factors, each contributing to the compression or irritation of the sciatic nerve. The term "sciatica" is a general term used to describe pain caused by aggravation of the sciatic nerve. It is not usually an "injury" itself, but is more of a symptom of an underlying condition which is leading to pain as a consequence of a pinched nerve, often in the lumbar spine or hip region. One common culprit is a herniated or slipped disc, where the soft inner core of a spinal disc protrudes, applying pressure on the adjacent nerve roots. This often comes with low back pain too, where the soft tissues around the spine can tighten as a consequence. Lumbar spinal stenosis, a narrowing of the spinal canal, can also encroach upon the sciatic nerve, triggering symptoms. Additionally, spondylolisthesis, a condition where a vertebra slips forward over another, and piriformis syndrome, involving the piriformis muscle irritating the sciatic nerve, are recognised instigators. Beyond these, the enigma of sciatica can be unraveled through the lens of hip impingement, as structural irregularities in the hip joint may lead to nerve entrapment and subsequent leg pain. Trauma, tumors, and certain systemic conditions like diabetes can further complicate the sciatic narrative. In essence, the causes of sciatica are as diverse as the symptoms it presents, requiring a comprehensive understanding to tailor effective interventions.


Herniated Discs

Herniated discs, a common culprit in the sciatica saga, introduce a spine-centric narrative to the  discomfort. When the soft, gel-like centre of an intervertebral disc protrudes through its tough outer layer, it can exert pressure on the adjacent nerve roots, often those comprising the sciatic nerve. In the lumbar spine, where sciatica typically originates, a herniated disc can impinge upon the nerve, causing inflammation and irritation. This compression disrupts the normal flow of signals along the sciatic nerve, giving rise to the common symptoms of sciatica—pain, tingling, and numbness that radiate down the leg. The sciatic nerve's intimate relationship with the spinal structures makes it particularly vulnerable to the effects of herniated discs. Treatment approaches often involve a combination of rest, physical therapy, and medications to manage pain and inflammation. In severe cases, more invasive interventions, such as epidural steroid injections or surgical procedures, may be considered to address the underlying disc herniation and alleviate the associated sciatica. Understanding this intricate connection is paramount for navigating the landscape of sciatica and tailoring effective interventions for relief.


Hip Bone Spurs

Hip spurs can also be the underlying cause of your sciatica. The presence of hip bone spurs introduces another possible aggravator of the hip joint, impingement, and sciatica. Bone spurs, or osteophytes, are bony projections that can develop on the edges of bones. When they form within the hip joint, particularly along the femoral head or acetabulum, they can disrupt the smooth articulation between these structures. In the context of hip impingement, bone spurs may lead to abnormal contact and friction during hip movement, causing irritation and inflammation. As the femoral head and acetabulum grapple with these irregularities, the sciatic nerve, which courses through the hip area, may become entrapped or compressed. This scenario sets the stage for the emergence of sciatica symptoms—pain, tingling, or numbness radiating down the leg. The intricate choreography of bone spurs, hip impingement, and sciatica underscores the importance of addressing the underlying structural issues to alleviate discomfort and restore optimal hip function. Seeking professional medical evaluation and intervention becomes paramount for a comprehensive understanding of this complex interplay and the development of an effective treatment plan.


Piriformis Syndrome

Piriformis syndrome is another one of many conditions that can contribute to, and is often the most common cause of sciatica pain. This condition involves the piriformis muscle, a small but crucial hip muscle located deep within the buttocks. In piriformis syndrome, the muscle can become tight or go into spasm, potentially compressing or irritating the sciatic nerve that runs beneath or, in some cases, through it. This compression can lead to sciatica-like symptoms, including pain, tingling, and numbness that radiate down the back of the leg. The challenge lies in differentiating piriformis syndrome from other sources of sciatica, as the symptoms can be remarkably similar. However, understanding this specific muscle-nerve interplay is essential for accurate diagnosis and targeted treatment. Physical therapy, stretching exercises, and sometimes interventions like injections are among the approaches used to alleviate the discomfort caused by piriformis syndrome, underscoring the intricate dance between muscle and nerve that defines this aspect of sciatica.


What to do if you have sciatica symptoms

If you find yourself grappling with the discomfort of sciatica, a proactive approach to managing symptoms is crucial. Firstly, seeking professional medical advice is paramount. A healthcare provider can perform a thorough examination, possibly including imaging studies, to identify the underlying cause of your sciatica. Depending on the diagnosis, treatment options may range from conservative measures to more invasive interventions. In many cases, rest, coupled with targeted exercises and physical therapy, can help alleviate symptoms by improving flexibility and reducing nerve compression. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be recommended to manage pain and inflammation. Lifestyle adjustments, such as maintaining good posture, avoiding prolonged sitting, and incorporating low-impact exercises into your routine, can also contribute to long-term relief. If conservative methods prove insufficient, more advanced interventions like corticosteroid injections or, in severe cases, surgical procedures might be considered. It's crucial to communicate openly with your healthcare provider, adhere to their guidance, and actively participate in your recovery to navigate the challenges posed by sciatica effectively.


​When should you see a doctor about your sciatica

If the persistent discomfort of sciatica starts to encroach upon your daily life, it's a compelling signal to seek medical attention. However, specific red flags warrant more urgent action. If you experience sudden and severe pain, especially after a traumatic injury, or if you notice a loss of bowel or bladder control, it's imperative to seek immediate medical attention. These symptoms may indicate a more serious underlying condition, such as cauda equina syndrome, requiring prompt intervention. Additionally, if your sciatica is accompanied by weakness or numbness that progressively worsens, or if it persists despite conservative measures and self-care, it's time to schedule a consultation with a healthcare professional. Moreover, if you have a history of cancer, and the sciatica symptoms emerge, a prompt evaluation is prudent. In essence, when sciatica transcends the realm of occasional discomfort and begins to significantly impact your quality of life, prompt consultation with a healthcare provider becomes paramount for an accurate diagnosis and tailored treatment plan.


If you are concerned at all about your pain or would prefer some reassurance to rule out anything serious, it is always wise to visit a physical therapist for a thorough physical examination. Not only will they be able to assess your chronic pain and diagnose what is causing it, they may also be able to give you some instant pain relief through manual therapy and provide you with a structured and tailored exercise plan to address your symptoms to ensure you receive the proper treatment.

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Arun Gray sports therapist strength and conditioning coach skegness

The author

Arun Gray is a sports therapist and strength & conditioning coach with over 15 years experience in the industry. He also has a personal history with chronic shoulder and back pain along with a range of other sporting injuries.

Arun writes about common injuries and aims to help people understand and manage their pain to prevent having to rely on national healthcare.

Read more about Arun