Everything you wanted to know about Sciatica.


Sciatica!!!This common problem gets a lot of peoples’ attention!  The difficulty is that there isn’t just one problem, and often people (clinician’s and  patients) use the term to mean differing things.

You will get different advice from medical doctors, physiotherapists, acupuncturists, sports therapists, chiropractors, osteopaths and massage therapists.  Each one has their own perspective but it’s not always clear what’s the best option to take. It can be really confusing!

The trouble is that sciatica is a symptom and not really a ”diagnosis” at all.  Most of the time people refer to pain down the back of the thigh as ”sciatica” as though there was something in the leg that had actually had been damaged. This isn’t always the case.

There are 4 main things that can produce pain down the back of the leg –

First there is the ”classic sciatica” which is thought to be a compression injury to the sciatic nerve in the buttock by the piriformis muscle.

Secondly pain down the thigh can be produced by tissues in the back which may or may not involve nerve entrapment.

Nerve entrapment can be produced by a disc compression type injury, stenosis (narrowing of the holes in the back centrally or on one side due to joint degeneration, disc herniation or wear) or by a combination of these factors.

Thirdly, you can also have pain down the leg simply by having a disc being irritated, so that it causes pain to be referred along the course of the nerve sheath, without actually having any damage to the nerve at all.

Finally, you could also have pain referred, or occurring locally, in the back of the leg due to injuries to the hip joint, sacro-illiac joint or hamstring muscles.

Really it can seem like a maze trying to figure out what is wrong or what to do about the symptoms that you have.

Diagnostic imaging can show damage that may never cause symptoms.  The use of MRI and x-ray can confuse the issue, because of the inconsistency of the relationship between how much damage people have and what complaints they have.  Sometimes there is nothing to be seen on a scan or x-ray, yet people suffer greatly.

There are many opinions as to what the best tests are, but a thorough history and examination performed by an experienced clinician can go a long way towards clarifying

  • what a person is suffering from
  • what to expect
  • what sort of treatment, if any, is necessary.

There are no magical new examination methods that have been shown to work any better than this.