It’s probably not sciatica (and why that’s important)

by Rosi Sexton

A common question we get asked here at Olton Health and Performance is, “can you treat sciatica?” The short answer is “yes!” – but there’s also a longer answer. Before we get to that, let’s look more closely at what sciatica is.

What is Sciatica?

Sciatica is a term used to describe a collection of symptoms that can include pain, numbness, tingling, or weakness. True sciatica is caused by damage or irritation to the sciatic nerve which extends from your lower back down to your legs. The symptoms can extend from the lower back through the buttocks and down the leg. It’s often felt as an intense ache in the lower leg, sometimes with numbness and pins and needles around the foot and ankle. People often describe the leg pain as being worse than the back pain.  

While it’s often thought of as a condition, sciatica is not a standalone diagnosis – rather, it can be the result of a number of different underlying issues in the lower back or hip. One of the common causes of sciatic pain is damage to the discs in the lumbar spine, but there are plenty of other possible culprits. Commonly, though, people (including some health professionals) may use the word “sciatica” to refer to any kind of lower back pain radiating into the buttocks or legs, even when the sciatic nerve isn’t involved. 

Some of you are thinking “hold on – what do you mean the sciatic nerve isn’t involved? Where is the leg pain coming from then?” I’m glad you asked! The most common reason people with back pain may get pain in their buttocks or legs is NOT sciatica – it’s good old referred pain. 

About referred pain

When I explain referred pain to patients, I sometimes describe it as a “filing error” in the brain. In order to perceive pain, the brain has to work out where in the body the signals are coming from. For some kinds of pain this is quite straightforward – if you accidentally lie on a drawing pin, you’ll probably have a pretty good idea where in your body it is. However for other kinds of pain, and particularly pain coming from parts of your body where you don’t normally experience much sensation, this can be harder – this is the same reason that people may feel heart attack pain in the arm or the jaw. Similarly, pain originating in and around the lower back and hips, including muscle, joint or ligament pain, can often be experienced further down the leg. This idea may seem a bit weird when you first encounter it, but it’s no stranger than the concept of optical illusions. Your brain is not feeding you an accurate representation of the world, it’s just spitting out the results of processing the signals it’s getting. Sometimes this can give you some odd results.

Why does this matter? Because different conditions require different kinds of treatment. This broad use of the term “sciatica” to cover multiple kinds of pain can cause confusion – I once made a list of all the different conditions that I’d seen labelled as sciatica, and it filled most of a side of A4. Some will respond well to manual therapy and exercise, others may need some kind of medical intervention and the rare one or two may need urgent hospital treatment. Even if we know the sciatic nerve is involved (and in many cases, it isn’t) we still have to identify the cause of the nerve damage or irritation, and decide on the best way tomanage it.

Making the right diagnosis

A good, experienced practitioner will know which questions to ask and tests to do to distinguish between these different conditions, and then make sure you’re getting the right treatment to meet your individual needs. I’ve also heard of less experienced therapists simply massaging the sore bit and handing out a list of exercises for sciatica. Misdiagnosis or poorly chosen treatment by the therapist can lead to exacerbation of symptoms, delayed recovery or (occasionally) potentially serious conditions being missed. 

If you suspect you may be dealing with sciatica or experiencing any other kind of lower back pain then it’s best to seek advice from a knowledgeable and experienced healthcare professional who can ensure you have a treatment plan tailored specifically to you. 

So, yes, we can treat sciatica, but most importantly we will make sure you get the right care for the specific symptoms and conditions that you’re experiencing.