When “sciatic” type of symptoms won’t go away, what else can be considered as causes? Travell and Simons emphatically state that “Sciatica is a symptom, not a diagnosis; it’s cause should be identified.” (Vol II, p. 173) Here’s a list of things you can check.

Structural asymmetries: Anything that makes one hip higher will cause or perpetuate symptoms.
Old accidents, injuries and surgeries: Even early ones can cause scar tissue and distorted movement patterns. More than one auto accident compounds the effects.
Spinal misalignment: Spondylolesthesis, scoliosis, genetic spinal deformities like missing transverse processes and partial fusion at sacrum can cause compression of the nerves at those segments, facet joint irritation, and/or myofascial TrPs that refer pain.
Spinal disease: Spinal stenosis, ankylosing spondylitis or any other degenerative disease that affects the spinal cord irritates the muscles.
Herniated disc: Well known and easily diagnosed, but not always pain-causing, a herniated disc can compress or irritate the nerve root. Herniated discs heal over and should not continue to cause a problem. Bulging discs rarely cause pain.
Degenerative joint disease: Bone spurs and osteoarthritis in the spine or SI joint are common as we age. They are also easily diaganosed and not always pain-causing. Space between the vertebrae becomes narrower and can irritate the joint and nerves.
Radiculopathy: General term describing any condition that affects a nerve root along the spine. What affects the nerves, affects the muscles.
Facet joint hypertrophy or disease: Swelling and inflammation fires the nerves in this little spinal joint on both sides of the vertabral body which sends pain to other areas corresponding to low back, gluteal, piriformis and obturator muscle TrPs. This can be treated medically with a nerve block and cortisone.

The next post is Part 2 of this checklist of causes.