Sciatica or Sacroiliac pains?

showing the different pain sites for sacroiliac and sciatica

Sciatica or Sacroiliac pains are something I deal with daily, but they are not the same thing. This is a regular subject matter where even GPs often misdiagnose the conditions. Most GPs opt for the word Sciatica meaning any leg pains. I’ve even had Morton’s Neuroma misdiagnosed as Sciatica; despite being almost 1metre away from each other.

Sciatic nerve impingement usually presents as pain in your buttock.  Numerous issues such as inflammation or a misalignment of either muscle, tendon, ligament or bone may cause this. This pain may then extend down the rear of your affected leg; along where stocking seams would run. The more severe the nerve is squeezed, the further down the leg it is felt.

I advise my clients that, if the pain extends below the knee, it is inadvisable to drive. This is in case leg movement is impeded when you want to apply the clutch or brake pedals.

Sacroiliac pain points in Blue, Sciatica in Red

So what are nerves for?

Nerves have 2 primary functions. Firstly they are there to sense the world in contact with us. Secondly, they are there to move us about. If you put your hand into a fire (not recommended) the hand’s nerve endings will sense the heat. The brain assesses that you’re in danger. Then, to remove that danger, your brain signals your nerves to activate your muscles. This happens so fast as a self preservation reaction that we don’t consider it. The energised muscles move the hand away from the source of that danger.

Nerve issues occur when your nerves are not capable of transmitting signals fully. These range from Pins & needles to a lack of muscle power and, in extreme cases, paralysis if they are severed. Indeed the location of these sensations, or lack thereof, give the qualified skeletal manipulator an indication of where your problem may be.

The sciatic nerve is the largest nerve in the human body. The Sciatic nerve originates in the lower spine.

These nerves issue from:

  • L4 & L5; being the two lowest Lumbar vertebrae,
  • S1, S2 & S3 in the Sacrum

It then passes deep in the buttock and down the back of the thigh all the way to the heel and sole of the foot.

Because the Sciatic nerve originates in this region, it is understandable that there is a confusion between the 2 conditions hence the question of Sciatica or Sacroiliac pain?

What is the Sacrum & Sacroiliac?

Anatomy of the Sacroiliac Joint

the components that affect the SI




The Sacrum is a triangular portion of your spine with 5 fused vertebrae. Each of segment has a nerve issuing from their portion of the Sacrum. This assembly of Vertebrae nestles between the two large bones of the pelvis; yes, the pelvis is 2 separate bones. The Sacrum is most easily visualised as the triangle formed between & above your buttock cheeks. This extends to just bellow your belt line (depending upon your sense of style).

The Sacroiliac name comes from combining Sacrum & Ilium. The large curved upper part of the two large Ilium bones are called the Iliac crest. The Sacrum sits, located by notches within the Iliac of the Pelvis; leading to Sacro-iliac.

Another component that is often giving pain is the Piriformis muscle which links the Sacrum to the head of the Femur bone at the Hip. If you encounter pain deep into the buttock on one side, it will probably relate to the piriformis. If, however, the pain radiates down the leg it is more likely to be true Sciatica.

There are also many other muscles, ligaments and tendons involved in the region, including the ITB & the Quads. The ITB is a long ligament running down the outside of your legs (not shown). The Quad muscles (at the front of your thighs) may be tight. this tightness can cause you to stand with a forward tilt of the pelvis.

The difficulty for the therapist is recognising which components are causing the client’s Back pain. Not only because of the number of local factors, but also having to consider things further afield such as flat feet. Add to that the medical history of the client and it can be a can of worms.


How to treat Sciatica or Sacroiliac pains

In order to correct any problem you first have to correctly identify what is causing that problem. It is often the less qualified and experienced therapists that blunder in. This is because, if you are only qualified to treat muscles, massage will be your Go To option. Being qualified to treat muscles, tendons, ligaments, nerve impingements and skeleton problems gives me the opportunity to discover the real causes and the appropriate action to correct it.

One of the self help tips I give is to sit on a tennis ball placed directly onto the pain point whilst sitting on a dining chair. Do this for 10 seconds, remove for a few seconds, then repeat 3 times. I am always loathe to recommend specific stretches remotely as I consider it prudent to identify the real problem first.

In all cases it is important to ensure that the pelvis alignment is central, level & correct. Any deviation will create an imbalance & inhibit correct movement. If you suffer regularly with lower back, Sciatica or SI joint issues I recommend keeping the abdomen muscles firm & maintain a healthy weight. If you are reasonably local to Leighton Buzzard why not check out my Back pain page or visit my Facebook page.