Sciatica Pain Down the Leg in People with Tailbone Pain

Sometimes people with tailbone pain (coccyx pain, coccydynia) will ALSO have nerve pain that shoots down one or both legs.

Nerve pain shooting down into the legs is sometimes called “sciatica.”

About the sciatic nerve
  • The sciatic nerve is the largest nerve that travels down into the leg.
  • It starts in the lower back and buttocks region and travels down the back of the thigh and divides into the tibial nerve and peroneal nerve.
  • From there, the nerve fibers travel all the way down into the foot.
  • Nerve fibers from the sciatic nerve innervate various muscles, which can become weak if the nerve is compromised.
  • Nerve fibers from the sciatic nerve also innervate various sensory areas on the skin, which can become partially non-if the nerve is compromised.
  • There are multiple locations where the sciatic nerve can be compressed or irritated.
  • Irritation of the sciatic nerve can cause pain that shoots down into the legs. For example, irritation of the right sciatic nerve would cause pain down into the right leg, whereas involvement of the left sciatic nerve would cause pain down into the left leg.
  • Pain traveling down into the legs is commonly referred to as “sciatica.”
  • However, not ALL pain that travels down into the legs (“sciatica”) is actually caused by irritation of the sciatic nerve.
Causes of “sciatica” in people with tailbone pain:
  • Sciatic nerve irritation in the lower buttocks or upper thigh.
    • People with tailbone pain often sit leaning forwards to avoid putting pressure on to the tailbone. This can put additional pressure on to the sciatic nerve at the lower buttock or upper thigh.
    • People with tailbone pain often sit with their buttocks scooted forward on the chair, again to avoid putting pressure on the tailbone. This can mean that the front edge of the chair is pressing directly into the area where the upper thigh meets the lower buttocks. This can irritate the sciatica nerve.
  • Sciatica nerve irritation at the piriformis muscle.
    • The sciatica nerve passes directly underneath the piriformis muscle within each of the buttocks.
    • Sometimes the sciatica nerve actually passes *through* the piriformis muscle.
    • Muscle tightness or muscle “spasm” within the piriformis muscle can cause irritation of the sciatic nerve at that region.
  • Nerve root irritation in the lower back.
    • Where the spinal nerve leaves the spine in the lower back, nerve irritation is common. Medically, this is called “radiculopathy.”
    • Many patients and even some physicians still refer to this as “sciatica” even though in actuality the nerve irritation here is up at the nerve root rather than actually involving the sciatic nerve.
 Finding the cause of sciatica in people with tailbone pain:
  • History: The treating physician should listen carefully to the patient’s symptoms.
  • Physical exam: The treating physician should perform a careful, thorough, and thoughtful physical examination.
  • Usually, the patient’s symptoms and physical examination findings will reveal the cause of the sciatica symptoms.
  • Diagnostic tests: Sometimes, additional testing may be helpful.
    • MRI of the lumbosacral spine can help to evaluate whether the pain down the leg is being caused by nerve root irritation  at the lumbar spine (such as from a herniated disc your attending the exiting nerve root).
    • MRI of the piriformis muscle may be able to reveal an abnormality of the sciatica nerve as it passes under or through the piriformis muscle. Higher-quality MRI machines may be necessary to see the nerve clearly (such as using a  MRI machine with a stronger magnets, such as a 3-Tesla magnet strength, rather than the typical 1-Tesla magnet strength).
    • Electrodiagnostic testing: electromyography (EMG) and nerve conduction studies may help the physician to tell the difference between nerve irritation of the sciatic nerve versus nerve irritation up at the lumbar spine nerve roots.
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Patrick Foye, M.D.
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Patrick Foye, M.D.

Founder and Director at Tailbone Pain Center
Dr. Foye is an expert at treating tailbone pain (coccyx pain).

His personable, private-practice office is located on a modern, renowned, academic medical school campus, at Rutgers New Jersey Medical School.

For an appointment, call 973-972-2802.
Patrick Foye, M.D.
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