Clinique TAGMED Montreal / Mount Royal and Terrebonne
Sciatica and buttock pain: when the pain starts in the buttock
Appointments at our two clinics
Repères cliniques, diagnostic différentiel et prochaines étapes pour mieux comprendre ce profil.
La fesse est une zone de convergence : une radiculopathie lombaire, l’articulation sacro-iliaque, la hanche, les muscles fessiers et la région profonde du nerf sciatique peuvent tous produire des symptômes dans ce secteur. Le trajet qui suit ensuite dans la jambe fournit des indices importants.
- See also our pages on sciatica in Montreal, the sciatica in Terrebonne and Spinal decompression therapy.
- Approche centrée sur le trajet des symptômes, la fonction et les signes neurologiques.
- L’objectif est de distinguer une radiculopathie d’autres causes capables d’imiter une sciatique.
Understanding
What this symptom pattern may mean
La fesse est une zone de convergence : une radiculopathie lombaire, l’articulation sacro-iliaque, la hanche, les muscles fessiers et la région profonde du nerf sciatique peuvent tous produire des symptômes dans ce secteur. Le trajet qui suit ensuite dans la jambe fournit des indices importants.
Key point 1
Une douleur fessière accompagnée de brûlures, décharges ou paresthésies dans la jambe est plus compatible avec une composante nerveuse.
Key point 2
Une douleur très localisée, sensible à la palpation ou à certains mouvements de hanche peut avoir une origine musculaire ou tendineuse.
Key point 3
La douleur sacro-iliaque et la douleur référée lombaire peuvent aussi rester principalement dans la fesse.
Clinical guidance
La fesse est un symptôme, pas un diagnostic
Le mot « sciatique » est parfois utilisé dès qu’une douleur apparaît dans la fesse. Or, l’évaluation doit déterminer si le nerf ou une racine nerveuse est réellement impliqué ou si une structure voisine produit une douleur référée.
An important point
La présence d’engourdissement, de faiblesse ou d’une douleur qui descend sous le genou change fortement l’interprétation du tableau.
Assessment
What can be assessed during a consultation
L’évaluation examine la colonne lombaire, le bassin, la hanche, les muscles fessiers et le système nerveux. La distribution des symptômes et leur comportement sont comparés aux mouvements et aux charges.
1
Route
Localisation exacte, irradiation, durée et comportement des symptômes.
2
Function
Marche, assise, sommeil, travail, sport et activités qui modifient la douleur.
3
Neurology
Force, sensibilité, réflexes et signes nécessitant une attention particulière.
4
Plan
Objectifs, précautions, stratégies conservatrices et critères de réévaluation.
Options and limitations
Adapt care to the likely cause
La prise en charge dépend de la cause dominante : activité adaptée, réadaptation, stratégies de charge et parfois approche manuelle. Une décompression n’est discutée que si une atteinte lombaire discale ou radiculaire est plausible.
Conservative approach
Activité adaptée, progression graduelle, réadaptation et autres mesures choisies selon le mécanisme clinique.
Spinal decompression therapy
Peut être discutée chez certains patients sélectionnés lorsqu’une composante discale ou radiculaire concordante est présente.
Further referral
Une investigation médicale, une infiltration ou un avis spécialisé peut devenir pertinent selon la sévérité, la durée et les signes neurologiques.
When should you seek prompt or emergency care?
- New, significant or rapidly progressive weakness.
- Recent foot drop or a leg that gives way increasingly often.
- New bladder or bowel problems.
- Numbness in the saddle area or perineum.
- Significant symptoms on both sides, major trauma, fever or a decline in general health.
These signs should not wait for a routine appointment. Urgent medical assessment may be necessary.
Follow-up
Mesurer l’évolution et la fonction
Le suivi compare la douleur, le trajet dans la jambe, la force, la sensibilité et la capacité à reprendre les activités. Une stagnation ou une détérioration doit conduire à revoir le diagnostic de travail et le plan.
Votre douleur commence dans la fesse et vous voulez savoir si elle est vraiment sciatique?
A consultation can help clarify the likely cause, the signs to watch for and whether conservative care or another referral is appropriate.
Frequently Asked Questions
FAQ — Sciatique et douleur fessière : quand la fesse est le point de départ
Toute douleur fessière est-elle une sciatique?
Non. Plusieurs structures peuvent produire une douleur dans la fesse.
Une douleur qui descend sous le genou est-elle plus évocatrice?
Oui, surtout avec engourdissement, picotements ou faiblesse.
La hanche peut-elle faire mal dans la fesse?
Oui. Certaines atteintes de hanche produisent une douleur postérieure ou latérale.
Le piriforme est-il toujours responsable?
Non. C’est une hypothèse parmi plusieurs.
La douleur sacro-iliaque ressemble-t-elle à une sciatique?
Elle peut référer dans la fesse et parfois la cuisse.
When should I seek a consultation?
Si la douleur persiste, limite la fonction ou devient neurologique.
Which signs require emergency care?
Bladder or bowel dysfunction, saddle anaesthesia or severe, rapidly progressive weakness.
Medical references
References and guidelines
Ces références servent de repères généraux pour l’évaluation de la lombalgie avec sciatique, la radiculopathie et l’imagerie. Elles ne remplacent pas une décision clinique individualisée.
- NICE NG59 — Low back pain and sciatica: assessment and management
- American College of Radiology — Appropriateness Criteria: Low Back Pain
- North American Spine Society — Lumbar disc herniation with radiculopathy guideline
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Vanti, Carla, Kevin Saccardo, Alice Panizzolo, Luca Turone, Andrew A. Guccione, and Paolo Pillastrini. 2023. “The Effects of the Addition of Mechanical Traction to Physical Therapy on Low Back Pain? A Systematic Review with Meta-Analysis.” Acta Orthopaedica et Traumatologica Turcica 57(1): 3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10151852/ (December 16, 2024).
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Have, What Belly Type Do You. “When and How Is Spinal Decompression Therapy Used?” https://www.hypervibe.com/au/blog/when-and-how-is-spinal-decompression-therapy-used/ (December 16, 2024).
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Jimenez, Alex. “Recovering from a Dislocated Hip: What You Need to Know.” https://sciatica.clinic/recovering-from-a-dislocated-hip-what-you-need-to-know/ (December 16, 2024).
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Demiryol, Deniz. 2022. “Case Study of Physiotherapeutic Treatment about a Patient with Disc Herniation with L5/S1 with Radiculopathy.” https://dspace.cuni.cz/handle/20.500.11956/175303 (December 16, 2024).
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Jimenez, Alex. “Body Flexibleness: Decompression.” https://personalinjurydoctorgroup.com/2022/04/28/body-flexibleness-decompression/ (December 16, 2024).
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Jimenez, Alex. “The Benefits of Spinal Decompression Therapy for Osteoarthritis.” https://sciatica.clinic/osteoarthritis-spinal-decompression-therapy/ (December 16, 2024).
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Jimenez, Alex. “How Chiropractic Restores Spinal Structure and Improves Health.” https://sciatica.clinic/spinal-structure-restoration-ep-sciatica-clinic/ (December 16, 2024).
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Gaowgzeh, Riziq Allah Mustafa, Mohamed Faisal Chevidikunnan, Ejlal Abdullah BinMulayh, and Fayaz Khan. 2020. “Effect of Spinal Decompression Therapy and Core Stabilization Exercises in Management of Lumbar Disc Prolapse: A Single Blind Randomized Controlled Trial.” Journal of back and musculoskeletal rehabilitation 33(2): 225–31. https://content.iospress.com/articles/journal-of-back-and-musculoskeletal-rehabilitation/bmr171099 (December 16, 2024).
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Jimenez, Alex. “Take Control Of Pain With Non-Surgical Spinal Decompression Trials.” https://sciatica.clinic/clinical-trials-nonsurgical-spinal-decompression-pain/ (December 16, 2024).
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Chronic, Nonsurgical Spinal Decompression To Treat, and Low Back Pain. “CLINICAL STUDIES ON THE EFFECTIVENESS OF SPINAL DECOMPRESSION.” https://sosherniateddisc.com/clinical-studies-on-the-effectiveness-of-spinal/ (December 16, 2024).
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Jimenez, Alex. “Non-Surgical Spinal Decompression For Chronic Low Back Pain.” https://personalinjurydoctorgroup.com/2022/04/08/nonsurgical-spinal-decompression-chronic-low-back-pain/ (December 16, 2024).
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Jimenez, Alex. “Alleviating Lumbar Pinched Nerves With Decompression.” https://personalinjurydoctorgroup.com/2022/05/11/alleviating-lumbar-pinched-nerves-decompression/ (December 16, 2024).
Important information
This page provides general information and does not establish a diagnosis. Results and recovery times vary according to the cause, duration, neurological signs, medical history and individual response to care.
Sylvain Desforges, docteur en ostéopathie
TAGMED Clinic — Spinal decompression, specific osteopathy and assessment of low back, disc-related and sciatic pain.
Professional profile · Contact · Sciatica in Montreal · Sciatica in Terrebonne
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