What Is Sciatica?

Sciatica is a term that I commonly see misdiagnosed in my patients. Some have been self diagnosed by Dr. Google and some have even been to the Gp who has told them (without any tests) that is what they have. The misconception being that all leg pain is sciatica.

So to clear the confusion;

Sciatica is basically how we describe INFLAMMATION OF THE SCIATIC NERVE.

Sciatica is NOT a diagnosis, it’s NOT a condition but rather a SYMPTOM of a condition. In the same way inflammation and pain occur as a result of something happening to or in the body, sciatica occurs when something is aggravating or impinging the sciatic nerve.

Sciatica; The Anatomy

It’s the largest nerve in the body. The diagram shows the pathway of the Sciatic nerve in the body.

The sciatic nerve exits the lower back (Lumbar spine) at both sides at levels: L4-LS. It then travels past the piriformis muscle located deep in buttocks(in rare cases it can actually travel through this muscle!). It travels down the back of the thigh and at the back of the knee it splits into two: the tibial nerve and the peroneal nerve. The tibial nerve continues down the back of the leg, central calf into the heel, under the foot and ends at the big toe. The peroneal nerve runs down the side and front of the LOWER LEG/SHIN area and top of the foot. This is the area of pain distribution you would experience with sciatica.

What’s NOT sciatica?

If the pain you experience runs along the side of your thigh or the front of the thigh THIS IS NOT SCIATICA. In my clinical experience, if the pain doesn’t run any lower then the back of the knee, it’s more likely the pain is being referred from hamstrings, or the pelvis rather then the sciatic nerve. Nerve pain generally is sharp and shooting with either burning, tingling or numbness involved also. If you have ever banged your elbow/funny bone, that pain is nerve pain. True Sciatica is generally quite severe. So when a patient comes in and tells me they “think they have a bit of sciatica”…most likely it’s not sciatica. If you are getting a general ache in both your buttock areas and hips it’s unlikely it’s sciatica.

Other symptoms to look out for

Sharp shooting pain in the back of the leg all the way to the underneath of the big toe.
Its usually unilateral/only affects one leg.
Numbness or pins and needles along the nerve distribution.
Pain aggravated when sitting, bending, coughing or sneezing.
Weakness in the leg (it feels like your dragging your leg).
In severe cases ‘drop foot’ this is the inability to lift/flex your foot.
In severe case muscle wasting.

Possible causes:

Impingement and irritation of the sciatic nerve can happen as a result of many conditions such as:
Disc bulge or prolapse
Spondylolisthesis
Spinal stenosis (narrowing of the spinal canal)
Severe wear and tear/Osteoarthritis of the spine.
Piriformis syndrome (the piriformis muscle in the hip/buttock compresses the nerve).
This one is RARE so please do not panic, but tumours of the spine can also cause this.
Diagnosing sciatica:

Testing for sciatica

The orthopaedic test is: The straight leg raise test.

You may have noticed your Osteopath ask you to lie on your back and they have lifted your straightened leg and flexed your ankle. This test stretches the nerve and if inflamed or irritated it will cause pain. Your Osteopath will be able to tell if it’s just pain from tight hamstrings or from the nerve itself. We would also check muscle strength (I would usually check the strength of the big toe) and we may check sensation for numbness.

What to do if you are experiencing sciatica

As an Osteopath, I’m pretty shocked at the so called ‘stretches for sciatic pain’ available on the internet. If the pain is a result of a disc prolapse bending and twisting would be the absolute worst thing to do. If the symptoms sound familiar to you I would recommend booking to see an Osteopath who can diagnose WHY the sciatic nerve is inflamed or irritated and can recommend whether you should be resting or stretching and how you should be stretching.

One of my most memorable cases was a builder who came in complaining of back and leg pain. He had the pain for 3 years! He came in now only because he was feeling numbness in his leg. On examination I diagnosed a disc prolapse with sever compression on the sciatic nerve and I immediately referred him to the hospital. His reflexes were absent and he had severely reduced strength in his leg. The problem with nerve compression is that unlike the other structures in the body, the blood supply to the nerves is limited. Once a nerve is compromised and damaged you run a severe risk of permanent damage! If you have ignored the pains for a long while and are starting to feel numbness this is no time to be stretching or self treating! Get your butt to the Gp, hospital or if you hate those places then to your Osteopath who can test and advise you accordingly.

And Finally…

If you know what is causing your sciatica and it’s more then just some wear and tear or muscle related, it’s important to get expert advice about what exercises to do from a qualified person. Please resist using Dr. Google because its unregulated so quite frankly any unqualified person can post exercises saying it’s good for sciatica. Most of the information I’ve seen is for sciatica as a result of piriformis tightness and is NO GOOD if you have a disc prolapse. If you see an exercise you really want to start trying it please get a second opinion from an expert. At The Backbone we always more then happy to give free advice. We are just an email away.