What is the difference between sciatica and a hamstring strain?

What is sciatica? 

The biggest nerve in the body is your sciatic nerve and it runs from the lower lumbar region (low back) all the way down your leg to your toes. It is one of the biggest nerves in the body at its root and therefore requires a lot of room to move around, a room that it doesn’t always get due to its close proximity to the spinal cord. 

It can get trapped by a disc prolapse, muscle contraction or inflammation in the back and this can be severely debilitating. It is the most common condition we see in the clinic and it is life changing as the pain is very severe and there is little position that you can get comfortable in. 

But on the flip of this, it is also life changing when we can help someone with sciatica and get them back to doing what they love. 

What is hamstring pain? 

Pain in the back of the leg is often diagnosed as sciatica and is characterised by a sharp, shooting pain down the leg or pins and needles further down towards the calf.

Often this can be confused with a hamstring strain or tear. This can happen when we have not warmed up properly before doing activity. Gardening, walking, or running are common activities where our clients pull their hamstrings.

It is different to sciatica in that it will not be as painful after the actual injury. It will improve rather than get worse and usually there will not be shooting pain afterwards. Sciatica is often more painful when sitting or standing for long periods of time.

Also Sciatica tends to get worse as the duration goes on and can go all the way down the leg to the toes as numbness, whereas a hamstring strain will be located just in the back of the thigh.

When you injure your hamstring you will feel it immediately as a tight pull in the back of the leg whereas the sciatic nerve pain tends to come on gradually over time. 

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How can I tell the difference between sciatica and hamstring pain?

It is often tricky as there can be some overlap between the two, you should look out for thee symptoms:

-Severity- sciatica is generally more severe and is more painful than a hamstring strain 

-Location- a hamstring strain usually occurs from the base of the buttock anywhere down to the middle of the thigh and doesn’t radiate. Whereas sciatica can go from the base of the back all the way to the toes

-Type of pain-sciatica can be shooting pain, pins and needles or a hot/cold pain whereas a hamstring pain is more of a tightness in one area

-Pain on movement-it is tricky to find a comfortable position with sciatic pain as it is always there when it is bad, whereas with a hamstring you can usually prop the leg up and find a comfortable position. 

How does a hamstring injury happen?

These often happen on cold winter days after not warming up correctly. Particularly with increased running, playing football, rugby and hockey, where changing direction is very common. Often, you will see the athlete pull up, as they would have felt a ping, and often in more severe hamstring injuries; you hear a crack or pop similar to a gunshot as the pressure builds.

Immediately afterward, there may be some bruising and swelling around the site of the strain. It’s very important to stop activity and rest as quickly as possible. Putting ice on the area to reduce the inflammation is key, and try to avoid heat where possible.

Hamstring strains can take anywhere from two to four weeks to heal if they’re grade one, sometimes longer. If you are unable to bring your leg up to your buttocks then please seek help from a professional as that may be a more serious tear.

So it is important to be careful when getting back into activity. You must make sure that you stretch it after the first week to ensure that the fibres can reorganise through the hamstring. Very gently to make sure that the hamstring comes back to its original length and you don’t let the scar tissue build-up.

Often, the hamstring will strain because it’s not in the right position. It attaches onto the base of the pelvis, and if that is rotated, it will put undue tension through the muscle, and that can cause it to occur again. So it’s important to get the pelvis, and the stability of the hips checked to ensure that it doesn’t.

If you are a runner, walker or doing more team sports then it’s vital your pelvis is located in the optimum position to keep the hamstrings under the correct tension so that they don’t keep straining. Often we see clients who have strained their hamstrings 2,3 or even 6 times.

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How to get hamstring strains fixed?

A skilled sports physiotherapist is one of the best people to see for this. I used to work at Bournemouth football club, the physiotherapists and sports therapists would see hamstring strains every single day, they could tell you within 5 minutes what grade it was, how long it would take and what they needed to do to rehabilitate it. 

We don’t all have the same luxuries as a premiership football player so you can find a great sports therapist locally, again I’m biased but we have a team here who help with hamstring strains. Find someone local who specialises in these types of injuries. 

They will carry out a full examination to understand why it has happened to prevent it from coming back and get you back to activity as soon as possible. 

They do:

-Soft tissue release to help the blood flow back to the muscle to heal it

-Deep tissue massage

-Active release technique to help the muscle fibres re organise

-Dry needling to get deep in the muscle and create a local inflammatory response for healing 

-PIR stretching to help lengthen and reorganise the fibres

Things you can do yourself:

1. Rest, ice, compression and elevate the leg to take pressure off it and let your body do the work. Sounds simple but sometimes it is just that.
2. Compression thigh sleeve to aid circulation
3. Stretch gently after the first few days to help the muscle re-organise. Try this one here to get more length in the hamstrings Watch here

How do you tell if the hamstring is pulled or torn?

Neither of them are good, but if you were to choose one of them then having a pulled hamstring is better as the recovery is quicker and there is less damage caused. A pulled hamstring means that the muscle has become overstretched and the fibres have broken, usually this is a grade one or two tear and the recovery is usually 2-4 weeks following rest. It happens when the muscle is placed under excess stress or sudden load and cannot withstand the force. 

I have done it several times when running for a football after setting off from a standing position. I probably haven’t warmed up properly, it has always been cold and I went to sprint and felt my hamstring just ‘go’. This is a pulled hamstring, very often it feels like it needs to be stretched, the more you stretch it and walk it off, the more you realise that stretching won’t help and it is a pulled muscle. 

A torn hamstring is different and I cannot speak from experience, the premise behind what happens is similar but the muscle fully tears and the number of fibres that tear is greater and this is usually a bad grade 2 or grade 3 injury. This can take a number of months to recover from. 

What are the grades of a hamstring injury?

The grade describes the severity of your hamstring injury:

• Grade 1: A mild muscle strain.
• Grade 2: A partial muscle tear.
• Grade 3: A complete muscle tear.

How long does a pulled hamstring take to heal?

If it is a minor grade 1 strain then this means that it could take anywhere from 2-4 weeks to heal and you can be back running and playing sport. Grade 2 strain can take anywhere from 4-8 weeks whereas a grade 3 could be up to 3-4 months. You need to be careful when returning to activity as they are prone to reoccurring. 

The best way to diagnose a pulled or torn hamstring is with MRI, this is not always possible as they do cost £200 plus and not always necessary. You can do an ultrasound scan and get a grade diagnosis, but very often a skilled physiotherapist can do tests to determine which grade it is and the level of the tear. 

They will assess:

-How you walk and push up off the ground, if you are struggling to push up when you walk and flex your toe then this can be a sign of a more serious injury. 

-The texture of the muscle, if it feels smooth then it is more likely a grade 1, if it is tough, knotted and feels bunched then more likely a grade 2 or 3. 

-If it is inflamed and swollen and bruised then more likely a grade 2 and 3

-If they do muscle testing and there is no power in the hamstring or if they stretch the muscle and it is a severe pain then the injury will be more serious. 

This is a common injury for most sports therapists and physiotherapists to be able to diagnose as they will have seen many of these, so make sure you find someone that specialises in sports injuries. You don’t necessarily need to spend money on having an MRI (the NHS are unlikely to provide an MRI for a hamstring strain) unless you are a professional athlete. 

What are the signs of a hamstring injury?

You will notice that something is wrong when you injure your hamstring, when I have injured mine in the past (fortunately only a grade 1) you can feel a ‘pull’ in the back of the leg. It is difficult to keep running and it becomes stiff and sore after around 10 minutes. 

As you have stopped running or exercising it seizes up and can be difficult to move around. With a grade one you usually don’t feel any palpable lump or tightness in the muscle; it is just stiff and sore for a few days and then after 1-2 weeks it settles down. 

With a grade 2 or 3 it is much more painful, with a grade 3 there may be a popping sound as well and bruising and swelling can occur. 

You need to be more careful with these and make sure you rest the leg and don’t put too much weight through it. 

Can you walk on a torn hamstring?

You can walk on a grade 1 or a mild strain. I wouldn’t go on a 5 mile walk, but walking at work or back to the shops should be fine and then after the first week get back to walking further distances. 

With a grade 3 I would not walk on this, you want to be wearing a compression sleeve on the thigh to improve the circulation and blood flow to promote healing and keeping it rested and not stretched to allow the fibres to reorganise.

I might have sciatica; what do I do?

What does sciatica feel like?

It is usually characterised by pain in the buttock and leg, that can run down the leg all the way to the toes. This list will give you an idea of how it typically presents:

• Severe shooting pain down the leg or both legs 
• Pins and needles in the legs
• Numbness in the legs
• Hot or cold feeling in the legs
• Weakness in the legs
• Foot drop, you will feel your big toe catching on the floor (this is a serious sign)
• Bowel or bladder incontinence (serious sign) 
• Severe back pain 

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How does sciatica happen?

It happens when something traps the sciatic nerve, as mentioned above it is the biggest nerve in the body so we need to ensure it has room to function. 

The main ways it happens are:

1. Disc prolapse-the inner part of the disc (nucleus pulposus) can seep out and press onto the nerve impinging it. This can happen from an accident for example a fall on the buttocks or bse of the spine, it could be from prolonged poor posture like sitting poorly for years as this puts a lot of pressure on the base of the back. 
2. Muscle tightness-the piriformis muscle is close to the sciatica nerve and many anatomy researchers believe the sciatic nerve goes through the piriformis so a tight piriformis can compress the nerve.Other schools of thought are that the piriformis becomes slack and then flops on to the nerve causing it become trapped. 
3. Bone misalignment-if the vertebra becomes dislodged this can cause inflammation or pressure on the nerve 

How can I find a solution to my sciatica pain?

It is important not to jump on the first thing that comes along promising the best results, remember sciatica is different for everyone therefore the treatment will be different. You need to find a professional who will be able to diagnose, examine and provide a long term solution for your problem. We don’t treat on the first visit as we want to take our time to put together a report and present this to our client in order to get the prognosis as close as possible and then begin the treatment plan. 

Sciatica treatment is not limited to Chiropractors, remember I’m biased being a Chiropractor. 

You can get treatment from: 

1. Physiotherapists-they will work more on the muscles around the buttocks and spine in order to provide a solution. They are excellent at providing long term rehabilitation exercises to strengthen the area as well
2. Osteopath-they are very good with sciatica and can be more gentle than Chiropractors when they adjust the spine and tend to do more soft tissue work to help the muscles. 
3. Exercise-just doing an exercise programme can help, but in my opinion won’t correct it long term. You may need some more work done from a therapist to alleviate the compression on the nerve
4. Injection-an epidural injection mixed with a steroid can help to alleviate pain. Ultimately you are still left with the underlying problem, the injection just blocks the nerve. But it can be a good interim whilst you are on the journey to recovery. 
5. Surgery-this should be a last resort. If the sciatica is being caused by a disc prolapse then very often a microdiscectomy is used to get pressure off the nerve. 

What should I not do with sciatica pain?

If you are in extreme pain then you need to find a comfortable position to be able to sleep as this is what will wear you down, it is important to try and get your body relaxed. 

You should not:

-Sit down-sitting down will compress the disc at the base of the spine as it promotes flexion. Especially on a sofa, you do not want to sit. If you do have to sit make sure it is in a dining room chair

-Run or do any impact type activity, this can jar the back and put pressure on to the sciatica nerve 

-Use heat- this can inflame the area even more, you want to use ice to reduce the inflammation. 

How can I relieve sciatica pain?

You need to be careful with this as usually sciatic pain is coming from the lower back, so trying to stretch your leg and rotate your leg can often put more pressure on the lower back. 

The tips below can be done from your bed, as very often sciatica is debilitating and you need to take it slowly. The idea behind sciatic pain relief is to ‘floss’ the nerve. Like when you floss your teeth twice per day (don’t tell my dentist that I don’t do it everyday). The flossing movement allows the nerve to glide back and forth to give it more space. 

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These are my top tips for sciatic pain:

1. Cat/Camel exercise-on all fours with your shoulders stacked over your hands, slowly round the soldiers and bring the hips up, then rotate the opposite way with the hips dropping down and the neck extending back. Watch the video here. Repat this 10 times, you cannot do this enough but if it is causing pain please stop. 
2. Child’s pose-on all fours again, gently push your hips back towards your feet and let your chest drop down, you can wiggle your hips gently from side to side to stretch your back and glutes out, hold for 30 seconds, repeat 3 times. 
3. Figure 4 stretch-this is often called the crossover stretch and helps to stretch the glutes and piriformis to give the nerve more room. You can lie on your back, cross one leg over the knee and pull both legs towards you, you should feel the stretch in the leg that is crossed over. Watch here

What exercises can I do to help my sciatica pain?

We talked in the section above about the exercises to relieve sciatic pain, but we need to make sure it doesn’t come back. Very often sciatica is caused from a lack of strength or stability in the low back and core. This is why pregnant women can experience debilitating sciatica, as the pelvis becomes more unstable with the hormone Relaxin and the weight from the baby.

If you are not pregnant though you will still understand the debilitating nature of sciatic pain and how we need to prevent this from coming back. The ideas behind these exercises are to build stability and strength to hold the core and low back in place, so that if you sit for long periods, exercise or lift something then the body can withstand this. 

A warning for these exercises, if you are in severe pain this is not the time to start exercising to build strength, focus on the section above and then move on to this after the pain has started to go. If you do these with pain it can often be too much and cause it to worsen.

1. Dead Bug- this is a great movement to provide stability for the core, it is very slow and controlled. You start on your back on a hard floor (not the bed or sofa) and have the legs at 45 degrees and knees at 45 degrees, suck your belly button in and slowly drop one leg down to the floor, the back will want to arch here, don’t let it arch keep the tension on your tummy. Then return to the beginning and repeat with the other side. Do this 3-5 times on each side, it should take 5 seconds per leg, very slow. You can watch it here. 
2. Hip thruster-this is to build strength in the glutes and help them give stability to your back. On your back have the legs shoulder width apart and the knees at 30 degrees of flexion. Slowly squeeze your bum and lift your hips up, hold for 2 seconds and return. Repeat 12-15 times for 3 sets.  Watch here

If you do know someone who wants more advice, please send them our details. You can send them this blog and they can request a free copy of our book which has posture related exercises in it as well. Click here for FREE book.