Back & sciatica  ·  Rick’s case

When sciatica isn’t about your back: 8 years of pain solved by fixing the hip

Al had a failed back surgery and eight years of sciatica. The real cause was hiding in a place no one thought to look: his hip joint.

Rick Olderman, MSPT
 ·  9 min read
 ·  Part 2 of the Solving the Pain Puzzle series

Licensed orthopedic physical therapist with 30 years of clinical experience, former owner of an
orthopedic PT clinic, and author of the Fixing You book series, including
Fixing You: Hip & Knee Pain and the award-winning Pain Patterns
(2025 NIEA Award winner). He created an APTA-approved continuing education course teaching other
clinicians his systems-thinking approach to chronic pain.

Eight years of sciatica changed Al’s life. Not because it healed, but because every healthcare practitioner got the diagnosis wrong.

The sciatica problem wasn’t in his back at all. It was hiding in a place no one thought to look: his hip joint. And when we finally addressed the real cause — gluteal weakness and anterior femoral glide syndrome — eight years of debilitating pain vanished in 60 seconds.

This is Al’s story, and it might be yours too.

Al’s 8-year journey with sciatica

The 67-year-old mechanical engineer sat across from me with arms folded, his voice monotone, like Eeyore from Winnie the Pooh saying, “If it is a good morning, which I doubt.”

Eight years of sciatic pain had turned him into this. Eight years of:

• Emergency room visits for stabbing leg pain
• Failed cortisone shots
• Back surgery that helped for only six weeks
• Being told “it will heal in two to three years”
• Abandoning walks with his wife of 42 years
• Giving up yard work, his favorite pastime
• Weighing the pros and cons of a simple grocery store trip

The numbness and stabbing pains in his right leg had forced him to whittle his life down to avoid triggering episodes. He’d stopped working as a mechanical engineer. He couldn’t lift, push, or pull anything.

The failed treatments: why back-focused care didn’t work

Every medical professional reached the same conclusion: Al’s sciatic nerve was the problem, and his lower back was the source. The logic seemed sound:

• Lasegue’s Test was positive (straight leg raising reproduced his pain)
• MRI showed a disc bulge
• The pain followed the sciatic nerve distribution

So they treated his spine:

• Cortisone injections to reduce disc inflammation — failed
• Surgery to remove bone and part of a spinal disc — helped 6 weeks, then pain returned
• Physical therapy, chiropractic and other treatments focused on the lumbar spine — no lasting relief
• More tests to check for pinched nerves — all negative

After eight years, one doctor finally admitted defeat: “Whatever it is will heal over the next two to three years.” Translation: “We don’t know what’s going on.”

The 60-second fix that changed everything

I needed to do something dramatic. Al had heard it all before from a long line of healthcare professionals.

First, I confirmed what everyone else had found. I had Al lie down and perform Lasegue’s Test, raising his straight leg off the table. He could barely lift it a few inches before searing pain tore through his leg. Sweat beaded on his brow.

“That’s exactly the pain I’ve been having all these years,” he confirmed through gritted teeth.

Then I did something different. “Get onto your elbows and knees,” I instructed. He gave me a weird look. Apparently, none of the other eight years’ worth of healthcare professionals had asked this of him.

I had him lift his right leg with the knee bent and perform two sets of small pulses to activate his gluteal muscles — his butt muscles. The whole thing took maybe 60 seconds.

“Now lie on your back and lift your right leg again,” I said. He looked at me doubtfully, took a deep breath…

And his leg shot up, almost perpendicular to the ground. No pain.

He tested it ten more times. Still no pain. His Eeyore expression transformed into complete bewilderment.

“Huh? What did you do?” he asked.

“I didn’t do a thing,” I said. “You did.”

“I don’t understand, how did that fix my back?”

The exercise Al did is the butt pump. See how to do it step by step.

What is anterior femoral glide syndrome?

Anterior femoral glide syndrome (AFGS) is a movement impairment where the thigh bone (femur) doesn’t glide properly in the hip socket during movement.¹

Normal hip mechanics

When you flex your hip, the rounded head of the femur should glide slightly backward (posteriorly) in the socket. This creates space and maintains proper alignment.

With AFGS

The femoral head glides forward (anteriorly) instead, causing pinching of tissues, overwork of structures in the back of the hip, irritation of the piriformis muscle, and compression of the sciatic nerve.

In Al’s case, the head of his thigh bone migrated forward when he moved his leg, causing:

1. The piriformis muscle in the back of the hip to spasm
2. Compression of his sciatic nerve
3. Stress on his lower back from poorly controlled pelvic movement
4. Eight years of debilitating pain

Watch the video versionRick Olderman on hip-related sciaticaI explain anterior femoral glide syndrome and how it leads to hip-related sciatica.

Why gluteal weakness creates sciatica

The gluteal muscles (particularly the gluteus maximus) are primarily responsible for helping the thigh bone pivot correctly in the hip socket.

I could tell just by watching Al walk that his gluteals weren’t firing properly. When your butt muscles don’t activate correctly, movements get sloppy, and the sciatic nerve pays the price.

Why standard MRIs miss this diagnosis

Almost everyone has some structural anomalies in the spine, especially the older we get. Disc lesions appear on MRI in many asymptomatic people — a positive finding doesn’t mean it’s causing pain.²

Spine specialists typically dismiss this possibility. According to their training, if anything is wrong with the hip, it must be coming from the spine, not the other way around. This is why Al suffered so many years.

When sciatica isn’t about your back: how to tell if yours is a hip problem

If you’ve been dealing with sciatic pain that won’t respond to back-focused treatments, ask yourself these questions:

The second layer: solving Al’s lower leg numbness

A week later, Al returned. The sciatic pain was still gone. But he had a lingering issue.

“I still have numbness in my lower leg when I use it in certain ways, like moving something with my foot,” he added. I had him slide a phone book with the side of his right foot. It produced numbness. He grimaced.

Since his problem was hip-based, not spine-based, I hypothesized the lower leg numbness wasn’t coming from his back either. I used a technique called Hanna Somatics — a method that uses controlled muscle contraction and release to reduce tension and reflexive spasming. The whole process took about five minutes. (Why this works when stretching doesn’t is its own story.)

“Test your numbness now,” I said. He moved the phone book. No numbness. He moved it more, scooting it across the floor. I watched this distinguished older gentleman express pure delight at sliding a phone book with his foot. Still no numbness.

Why medical professionals miss hip-related sciatica

It’s not that doctors are incompetent. The diagnostic pathway is simply set up to look in the wrong place — primarily because we are trained to identify structural components of a problem, rather than systemic causes.

Al’s issue likely resulted from a “slow burn” of years of sitting at work in poor posture, walking with poor technique, sleeping in a deteriorating bed, and accumulating old injuries that never fully resolved. All these tiny negatives accrued over time until pain precipitated.

From Eeyore to Tigger: Al’s transformation

To see eight years of frustration and pain melt away in that moment was one of the reasons I love what I do.

Al’s face showed a mixture of joy, relief, and understanding. Imagine hurting for eight years. And then, suddenly, you don’t. It can turn an Eeyore into a Tigger.

Most importantly, he understood how his body worked and why he had pain. That knowledge meant he would never slip back into old habits.

If you’re dealing with chronic sciatica or other pain that hasn’t responded to traditional treatments, the solution may not be where you’ve been looking. Like Al, your pain might have an unexpected cause that requires a different approach.

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