These two questions aren’t at all easy. But it’s good to ask them. Everyone knows that the hamstring muscles can cause pain at the back of the thigh, and a lot of people know that sciatica can too. So if you have pain in the ‘posterior’ thigh, how do you decide which one it is?
First, let’s define sciatica. For therapists and doctors, sciatica means a radiating pain down the leg that is NOT caused by the hip joint or anything below that. Strictly speaking, sciatica means pain or ache, not other symptoms such as numbness.
A sore nerve root exiting the spinal canal in the small of the back can cause radiating pain down the back, side or front of the leg. This may (but not always) also cause numbness, pins and needles, and weakness in the leg.
Although that’s the most common cause of sciatica, there are others. For example, muscles of the low back or buttock can radiate pain down the leg. Another example; the joint between the pelvis and the sacrum can be an occasional cause of sciatica.
Second, let’s define hamstring pain. The hamstrings are a muscle group that ‘flex’ (or bend) the knee. They attach, at the top end, to the pelvis, so they also act as a hip extensor (or back straightener), in much the same way as their powerful neighbour, gluteus maximus.
What do we mean by hamstring pain? Do we mean tears or defects in the muscle belly (see the diagram above)? Or do we mean a problem at the ends of the muscle where the muscle belly fibres ‘morph’ into tendons which themselves then strongly insert into their bony attachment points?
And what do we mean by ‘tight’ muscles anyway?
This article is not the right place to go into too much detail about how to tell sciatic and hamstring problems apart, but here are a few essential pointers.
First, hamstring problems don’t directly cause pain in the middle or upper buttock, or below the knee. So, if you’ve got that, it’s more likely to be sciatica.
Second, hamstring problems don’t cause nerve symptoms (like altered sensation, pins and needles or weakness). So, if you’ve got those, it’s much less likely to be hamstring.
And should you stretch sciatic or hamstring problems?
Well, I have a different view from most therapists on this in that I don’t think you should stretch either!
Say it’s a hamstring muscle belly injury. That kind of damage needs to repair itself, just like a cut on your skin does. Would you really want to stretch your skin while it was trying to do that?
And what if the problem is hamstring tendonitis? The vast majority of the time, tendonitis reflects overuse or abnormal mechanical loading of the tendon (either where it links with the muscle belly, or where it inserts into the bone). How is stretching going to help that?
What about so-called ‘tight hamstrings’? Well, take bending forward to touch your toes. The hamstrings need to lengthen to achieve this (and lengthen is a better term than stretch to describe what is actually happening). These types of muscles don’t lengthen well when the lumbar spine is not working correctly. Overstretching the hamstring in this situation is not going to help. Better to strengthen the muscle and get the lumbar spine treated so that it’s working better.
And stretching sciatica? That’s a definite no-no. There’s an argument for gentle stretching of nerve fibres under careful supervision, for a particular clinical reason. But unguided stretching of sciatica caused by a trapped nerve root in the lumbar spine is likely to generate a nasty reaction. Best to get it diagnosed properly.
So I’m afraid that two apparently simple questions at the beginning of this article turn out to be anything but. And I’ve only scratched the surface of the issues involved here.
Be cautious, and get it looked at!