Troy B. and Shelley P. each reported a sore hamstring (the muscles in the back of the thigh) for several months, one from horseback riding, the other from road racing. Their pains often go down into the calf. Should they just keep taking ibuprofen?
As surely as “you can’t get there if you don’t know where you’re going,” your treatment won’t work unless you have the correct diagnosis. In this case, several conditions can mimic hamstring strains. The most prominent is sciatica, the severe ache that “shoots” from the buttock through the leg and even into the foot.
Sciatica is actually a syndrome (a group of symptoms that may have many underlying causes) rather than a specific diagnosis. It usually results from one of the disks that sit between the bones of the vertebral column bulging onto the roots of the sciatic nerve. In some cases, this long, thick nerve can be irritated instead by a tight muscle that crosses it deep in the buttock, or by sitting on a fat wallet or a lumpy car seat for long stretches.
Physicians differentiate between a hamstring injury and sciatica by history and exam. Something specific usually triggers hamstring pain, like a sudden, forceful stride. These patients have a tender spot on the back of the thigh where the damage occurred, but have more pain with walking than — as both Troy and Shelley report — with sitting. Sciatica, on the other hand, is often preceded by back pain and increases with sitting. It is also worsened by raising the straightened leg.
An MRI will reveal whether the sciatica is due to a damaged disk. If so, a specialist should be consulted about the best way to start treatment. This might be physical therapy, steroid injections around the disk or surgery. Regardless of the cause, sciatica usually can be successfully treated. Both Troy and Shelley should start with a trip to his and her physician.
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