Sciatic nerve: deep gluteal space and ischial region
The sciatic nerve can be entrapped in the deep gluteal space and next to the ischial tuberosity, close to the hamstring origin. This page brings both sites together with their anatomical plate and references. The SLR, its hip adduction and internal rotation variant and the Slump are the neurodynamic tests that load it.
Deep gluteal space
The sciatic nerve is related to piriformis and the deep rotators of the hip. Deep gluteal syndrome covers extraspinal entrapments by different structures; attributing any sciatic pain to piriformis oversimplifies its diagnosis.
- Frequency
- Described site, less commonly seen.
- Type of evidence
- Systematic review and clinical anatomy
References
- Kizaki K, Uchida S, Shanmugaraj A, Aquino CC, Duong A, Simunovic N, Martin HD, Ayeni OR. Deep gluteal syndrome is defined as a non-discogenic sciatic nerve disorder with entrapment in the deep gluteal space: a systematic review. Knee Surg Sports Traumatol Arthrosc 2020. PubMed 32246173 · DOI
- Kay J, de Sa D, Morrison L, Fejtek E, Simunovic N, Martin HD, Ayeni OR. Surgical Management of Deep Gluteal Syndrome Causing Sciatic Nerve Entrapment: A Systematic Review. Arthroscopy 2017. PubMed 28866346 · DOI
Ischial region · hamstring origin
Next to the ischial tuberosity, the sciatic nerve passes close to the origin of the hamstrings. Tendon changes or fibrosis may limit its space and mobility. This site is described as the ischial tunnel or proximal hamstring syndrome within the differential diagnosis of gluteal pain.
- Frequency
- Described site, less commonly seen.
- Type of evidence
- Clinical review and systematic review
References
- Martin R, Martin HD, Kivlan BR. NERVE ENTRAPMENT IN THE HIP REGION: CURRENT CONCEPTS REVIEW. Int J Sports Phys Ther 2017. PubMed 29234567 · DOI
- Kay J, de Sa D, Morrison L, Fejtek E, Simunovic N, Martin HD, Ayeni OR. Surgical Management of Deep Gluteal Syndrome Causing Sciatic Nerve Entrapment: A Systematic Review. Arthroscopy 2017. PubMed 28866346 · DOI
Tests that load this nerve
Mobilisation techniques
Sciatic · sliding (slider)
The hip flexes (lengthening the posterior thigh bed) while the knee flexes (shortening the distal bed). On the way back, combined extension.
Sciatic · tension (tensioner)
The hip flexes while the knee extends: both ends lengthen the bed.
Joint parameters and animation in the techniques lab · Student plan €29.99/year
Evidence for the techniques
- Coppieters MW, Andersen LS, Johansen R, et al. J Orthop Sports Phys Ther. 2015;45(10):731-7. PubMed 26304637 · DOI