Back and hip pain: it could be “false sciatica”

“The source of the pain radiating to your lower back and hip may be the sacroiliac joint,” said Prof. Dr. Alper Murat Ulaşlı, Medical Director of Romatem Ankara, warning that it is easily confused with sciatica or a herniated disc.

What sacroiliac joint pain is

At the lower end of the spine, the sacroiliac joint connects the sacrum with the pelvis and is surrounded by strong ligaments. Intense, persistent pain in the lower back and hip can originate there, and because it radiates it can be mistaken for the pain of a herniated disc.

Causes include falls, injuries, accidents and fractures; a difference in leg length; pregnancy and childbirth; long periods of sitting or standing; spinal curvature such as scoliosis; gait and posture problems that load the joint unevenly; contact sports, heavy lifting and physically demanding work; rheumatic diseases such as ankylosing spondylitis; osteoarthritis of the joint; rapid weight gain and obesity; and previous hip or spine surgery.

The signs

If pain increases after sitting or standing for a long time, climbing stairs, long journeys or sitting with the legs crossed, the sacroiliac joint may be the source. An estimated 15 to 30 percent of people with low back pain have pain related to this joint. If spasm of the piriformis muscle in the hip is added, pain can intensify along the sciatic nerve from the hip to the calf, which is why it is called false sciatica and why it resembles a herniated disc.

Diagnosis and treatment

A physical medicine and rehabilitation specialist finds the source of the pain with a full history, examination and imaging where needed. Pain that continues or increases at rest may point to a rheumatic or rarer cause, which makes specialist assessment important.

Where the cause is mechanical, treatment starts with posture and sitting habits and an individual exercise prescription. Physical therapy agents and manual methods relieve pain, and where necessary image-guided injections into the joint or the piriformis muscle are used.