“I have sciatica” is a term often overused and misused when referring to pain down the back of the leg. Clinically, having true sciatica would mean you have leg pain that refers past the knee due to direct irritation/damage to the nerve roots associated with the sciatic nerve or the sciatic nerve itself.This can be from an L4/L5/S1 nerve root injury, a disease affecting the sciatic nerve, or an entrapment of the sciatic nerve. There other cases of “sciatica” but they are not directly associated to the sciatic nerve, rather they other injured structures sending pain signals down the leg, mimicking sciatica
*What are the true causes of sciatica?*
A true cause of sciatica would be damage to the L4/5/S1 nerve roots from a disc herniation or osteophyte pushing on/ irritating the sciatic nerve at its roots. This is the more serious form of sciatica. The sciatic nerve can also become “entrapped” when the piriformis muscle becomes tight and overused, resulting in compression and irritation of the sciatic nerve causing pain down the leg.
*What else can mimic sciatica?*
When pain down the leg is not from the above causes, it is called “Referred Pain” meaning that the injured structure is sending pain signals to different areas of the body. What can cause this? Tight/overused/damaged muscles can send these signals down the leg, such as the gluteus medius muscle, hamstrings and quadratus lumborum muscle. A dysfunctional sacroiliac joint can also send these pain referrals down the back of the leg, as well as the ligaments surrounding the sacroiliac joint.
*I have pain down my leg, what should I do?*
The best approach is to find a health care professional, such as a physiotherapist or chiropractor, that can identify what is causing the leg pain and whyit is happening. There is a vast difference in treatment approach and prognosis for a nerve root injury versus a tight muscle or joint causing referred pain. Once the structure/cause is identified, proper treatment techniques, behaviour modifications, and rehabilitation exercises can be implemented to improve the pain in the leg.
So, next time someone says to you that you have sciatica, ask them from what and why it is happening, and what you can do to fix it!
William Powls, Chiropractor