Sciatica

Sciatica is a relatively common condition and an estimated 10 to 40% of the population will experience it through their lifetime. Patients often present to us having been told by their GP or having self-diagnosed with sciatica but sciatica is not a diagnosis in itself.

I often say to patients the term "sciatica" is a general and non-specific diagnosis used by people (including health practitioners!) when people describe pain down the leg.

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Therefore we need to be more specific in terms of location and potential causes when it comes to patients presenting with sciatica so here are some hopefully useful points to help you understand sciatica better.

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What is sciatica?

As mentioned above sciatica is not a diagnosis but merely a term used to describe a symptom (pain often) or a collection of symptoms caused by an irritation (mechanical and / or chemical) of the sciatic nerve along its course.

The sciatic nerve is the longest and largest (can be as big as your thumb in the buttocks!) nerve in the body. Several nerve roots come off the low back (lumbar spine) and join together in the pelvis to form the sciatic nerve. As it comes off the pelvis, through the buttocks, the sciatic nerve runs at the back of the thigh to the back of the knee where it splits into 2 nerves going to the front and the back of the leg and foot.

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A common area where the sciatic nerve can be irritated is the buttock area (glutes muscles) and it is often referred as “Piriformis syndrome”. The piriformis muscle is a deep muscle in the buttocks and as the sciatic nerve runs near the piriformis muscle, the diagnosis of "piriformis syndrome" is often made. However, we are not sure if the piriformis is always responsible for the irritation of the sciatic nerve in this area so the term "deep gluteal pain" may be more appropriate to describe the condition.

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Another common area which can be a source of sciatic pain is the low-back. As the nerve roots (5 of them on each side) come off the spine, they can be irritated by the disc between the vertebrae (the bones -building blocks of the spine) which can be “pressing” on the nerve root. The good news is that discs don’t slip so if you have heard or been told you “slipped a disc”, this is not the case (more about the facts and myths of back pain soon).

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There are several other structures in the low back which can be causing nerve root irritation but these will be discussed in a later post.

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How can an osteopath help?

As mentioned above, sciatica is not a diagnosis but merely the description of symptoms involving the sciatic nerve. Therefore, your osteopath should start by taking a detailed case history of your presentation followed by a physical examination. The key aspect here is to identify the location(s) and potential structure(s) causing the sciatic nerve irritation. This is essential as this will affect the treatment approach, management and prognosis.

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Once the location(s) and cause(s) of the sciatic nerve irritation have been identified, your osteopath should discuss with you the most appropriate course of treatment and management approach based on your lifestyle and activities. In some cases, when the sciatic nerve symptoms affect the patient’s daily activities or sleep, your osteopath may suggest consulting your GP to see if medications can help with your symptoms.

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Early accurate diagnosis and intervention are key in the treatment and management of sciatic pain, so if your symptoms do not improve within 5-7 days, consult a qualified healthcare professional.