Groin Pain (non-traumatic)

Sciatic Nerve

Sciatica is a general term used to describe any symptoms of injury to the sciatic nerve anywhere along the nerve.  Sciatica can be due to mechanical compression of the nerve such as previous trauma to the low back, tobacco use, pregnancy, and repeated poor posture and body movements.  

Signs & Symptoms

  • Pain along sciatic nerve 
  • Numbness tingling in groin, rectum, leg
  • Diminshed or absent deep tendon reflexes
  • Weakness in L4, L5, S1, S2, S3 myotomes

Musculoskeletal Factors

  • Previous low back injury or trauma (direct fall on buttocks)
  • Total hip arthroplasty
  • Pregnancy
  • Work-related postures
  • Fibromyalgia
  • Leg length discrepancy
  • Congenital hip dysplasia and hip dislocation
  • Degenerative disc disease
  • Piriformis syndrome
  • Spinal stenosis

Systemically Induced Factors

  • Tobacco use
  • History of diabetes mellitus
  • Atherosclerosis
  • Previous history of cancer 
  • Presence of intra-abdominal or peritoneal inflammation—Chrohn’s, Pelvic Infl Disease, Diverticulitis
  • Endometriosis of sciatic nerve
  • Radiation therapy
  • Recent spinal surgery

Differential Diagnosis

When diagnosing sciatica, a quick test is the straight leg raise (SLR) which is a neurodynamic test, but it does not differentiate between the possible causes of the nerve compression.  In order to determine the underlying cause, imaging and laboratory studies are recommended.  Extreme motor weakness, numbness in the groin, and difficulty controlling the bowel and bladder are signs that require physician referral before physical therapy is begun.   Treatments should be aimed at the underlying cause of the sciatic neuropathy, if possible. 
For more information on the Sciatic nerve, click here. 

Piriformis Syndrome

One form of sciatica is Piriformis Syndrome which is a specific entrapment of the sciatic nerve as it passes through the piriformis muscle.  This can be due to an anomalous piriformis muscle such that the nerve passes through the muscle belly, overuse injury causing hypertrophy of the gluteal muscles, or acute trauma to the nerve. 

Signs & Symptoms of Piriformis Syndrome

  • Pain in groin or buttocks with radiation down posterior leg 
  • Pain after extended sitting periods
  • Muscle strength often normal
  • Tender to palpation of sciatic notch
  • Provocation of symptoms with resisted abduction and external rotation of hip
  • Pain with passive flexion, adduction, and internal rotation of hip
  • MRI may show compression or edema of nerve 

Treatment options

  • Activity modification
  • Stretching of piriformis and hip musculature
  • Ultrasound treatment
  • Oral anti-inflammatories
  • Surgical release of piriformis in cases longer than 6 months