“Sciatica”. It’s a pretty common term. But getting an accurate sciatica diagnosis is not always easy, and true sciatica is not as common as you may think.
If what you’re experiencing truly is “sciatica”, we have to say- we feel for you, because a proper case can be truly agonising!
However, after having more people than we care to mention tell us that they’re experiencing “sciatica”, when it is quite obvious to us right from the outset that they’re suffering something else, we thought we’d set the record straight.
Sciatica seems to have become a word used by many people to encompass many forms and locations of pain, when in fact, it actually has quite a strict definition and location of pain.
When we’re taking a case history, and the patient states that they have sciatica, we always take great care to have them define exactly where they are feeling the pain, as well as the type and intensity of the discomfort.
There is a lot of confusion out there about the term ‘sciatica’, with many people assuming they have it if they have pain anywhere from their lower back to any part of their leg.
Read on to find out if what you’re experiencing can really can get a “sciatica” diagnosis, or whether it actually has another label instead.
What is sciatica?
Technically speaking, sciatica is defined as:
“neuralgia along the course of the sciatic nerve” (1).
But what exactly does that mean to the average Joe?
In order to accurately answer this question, we need to talk a bit of anatomy!
The sciatic nerve is the largest and broadest nerve in the body. It is made up of a few nerves joined together as they come out of the spine in your lower back. These nerves supply the skin of most of the back of the leg and foot, as well as the muscles at the back of the thigh, and all of the muscles of the lower leg and foot.
“Neuralgia” means pain in a specific area supplied by a particular nerve. So sciatic neuralgia means pain in the area supplied by the sciatic nerve, which is in essence, anywhere in the back of the leg or foot.
So true “sciatica” must involve the back of the leg or foot.
The key words here are back of the leg. Sciatica does not cause pain on the outside or front of the leg. Yes, it is totally possible to have pain in these areas, but the cause is always something other than ‘sciatica’.
Sciatica can occur alongside lower back pain, or it can exist as buttock and/or leg pain alone. Usually, the pain is only in one leg, although occasionally it may affect both.
When a nerve is irritated, pain is not the only possible symptom.
Other common leg symptoms include:
Who most commonly gets a sciatica diagnosis?
Here’s where it gets a bit tricky to pin down some solid numbers, as unfortunately, the confusion over what is actually meant by ‘sciatica’ means that it is difficult to find out how common it really is.
As we’ve seen, a lot of people would be prone to (accidental) false reporting.
All the literature we’ve read lists the incidence as somewhere between 2% and 40% of the population- that’s a big range!!!
What we do know, however, is that some people are more likely to develop it than others.
The following is a list of risk factors for acute sciatica:
There is a peak in the incidence of sciatica diagnosis between 45 and 64 years. No one really knows the exact reason for this.
The taller you are, the more likely it is that you will be diagnosed with sciatica. Again, the reasons for this are unknown. Our theory is that this may be about your body’s constant battle against gravity- the higher you’ve grown, the more toll this will take on your lower back and ‘core’ muscles to help stabilise you.
Smokers have a higher likelihood of receiving a sciatica diagnosis when compared to non-smokers. Yet another reason to quit!
Stress is a predisposing factor for many types of physical conditions, and it also makes you more prone to developing chronic pain.
If your job involves a lot of strenuous physical activity, such as:
- repetitive lifting, bending or twisting,
- a lot of driving or other power tool use that places a lot of vibration through your whole body,
Then your odds of developing sciatica are increased.
How is sciatica diagnosed?
In most cases, sciatica is diagnosed by case history and examination.
Patients presenting with sciatica will complain of pain in the back of the leg.
When they mention this, the Osteopath will know to conduct a series of specific tests during their examination, in order to determine the true cause of this pain.
Do you need an X Ray, MRI or CT scan to get a sciatica diagnosis?
Sometimes, but certainly not routinely.
The only time you will need any sort of imaging performed is if it will change the course of your treatment.
Some examples of when you may need imaging performed for sciatica include:
- if you have some other symptoms that may indicate a more serious problem, or
- if the pain persists for more than 6-8 weeks of what is considered “conservative care” (which is basically everything other than surgery).
X rays have limited use in these cases. This is because the structures involved in sciatica are considered to be “soft” tissues. X rays are best at showing bones, which are “hard”.
If your health care professional feels that you need imaging, they will most likely refer you for either a CT (“cat scan”) or MRI, which are better at showing up soft tissues.
There are a few reasons why we don’t refer for imaging more often than this.
- One of the main causes of sciatica is a problem with the disc(s) in the lower back. However, this problem has been found to occur in 20-36% of people who are not suffering any sciatica.
i.e. around a quarter to a third of the population will have this same disc ‘problem’, and not even know it.So just because you may see something on imaging, it doesn’t necessarily explain why your pain is there.
- The natural extension of this is that sometimes, when people see that there are these ‘problems’ occurring inside their bodies, they assume that they are ‘broken’ and there is something fundamentally wrong with their backs. As mentioned above, many ‘normal’ people often have these changes occurring in their bodies without them even knowing it. So, there is no real need to worry people unnecessarily by having imaging unless it is completely necessary. We also now know that holding the belief that something is ‘broken’ in your back, or thinking that you have a ‘bad back’, can be a predisposing factor for developing chronic pain. No one wants that. So, we need to be judicious about which cases are referred for imaging.
- CT and MRI scans are usually relatively expensive, costing anywhere from $100-400 or so. When you take the two reasons above into consideration, it’s often best to also avoid forking out for these unnecessarily.
Once I get a sciatica diagnosis, will it get better? How long will it take?
When we look at the statistics, we can see that the majority of people will get better, although it’s not likely to happen overnight.
In the short term, one study showed that about 50% of participants showed improvement in a little over a week, and a further 25% were improving within a month (3).
One trial showed that 60% of people were fully recovered within 3 months, and 70% of people were better within a year (4).
In reality, this unfortunately also means that around 30% of people will continue to have pain for more than 1 year.
Early diagnosis, intervention, and correct physical and psychological management will make it less likely that your pain will become persistent.
Who needs surgery for sciatica?
There are two groups of people who qualify for surgery for sciatica.
The first group are those who require it immediately, regardless of the intensity etc of their pain. This is because in this group, the cause of their pain is a problem that is also affecting the nerve supply to their bowel, bladder or genital region. This is a medical emergency, that needs to be rectified ASAP.
The second group of people are those who, after at least 6 to 8 weeks, are not getting any improvement by any other means.
Does surgery actually help?
The aim of surgical intervention is to decrease the leg pain associated with sciatica. Unfortunately, this surgery is not usually effective in relieving lower back pain that may also be occurring.
In these patients, surgery has been shown to provide better results than not having surgery in the short term.
However, when compared at one and two years later, there is not a significant difference between patients who have undergone surgery, and those who have not. i.e. although the leg pain may be quite severe initially, it may get better on its own without surgery. The decision to operate should be made on a case by case basis. Of course requires discussion with a surgeon regarding the specifics of each case.
So- what can you do after your sciatica diagnosis?
Unfortunately, nothing has been conclusively proven to help absolutely everyone.
Two things that may be beneficial are:
Years ago, bed rest was a recommended strategy for dealing with acute back pain or sciatica. We now know that this can quite quickly lead to muscle loss, which can in fact make the condition worse, as well as predisposing you to developing chronic pain or mental health problems such as depression.
Advice now is usually to stay as active as possible and go about your usual life as much as possible, taking short rests when needed.
This exercise works in the same way as flossing your teeth. Sounds strange, we know, but bear with us here.
Your sciatic nerve can be encouraged to move more freely through your lower back with a gentle “flossing” movement.
There is some evidence (5) to suggest that this manoeuvre may be beneficial in helping you to improve your sciatic nerve pain.
This technique aims to increase the flexibility and glide of the sciatic nerve. Compare it to jiggling or lubricating a drawer that gets stuck. Once you’ve moved it around a bit, the drawer will often open and close more easily, and as a result function better.
Many people have never heard of this technique before, so we’ve included a video of the best way to perform it:
It is important to note that this exercise may temporarily make your pain feel worse. It may irritate the nerve, which can in turn mean that the leg pain increases in the short term. If you can, persevere, as it does not take long for the nervous system to adapt to these changes.
If you have any specific questions about this technique, please feel free to send us an email, or consult your health care provider.
Where to now?
If you’d like to learn some other strategies that can help lower back pain and sciatica, you can read another of our posts here.
Tried these out, but still in pain?
Our Osteopaths are experts in managing lower back pain and sciatica.
Give us a call on (03) 9372 7714, or book online today for personalised management strategies.
If you’re also suffering from lower back pain, we’ve created a free download titled “Everything you need to know about lower back pain”.
This guide is filled with information about:
- why you’ve got pain,
- the type(s) of practitioners who can help you, and
- some practical tips you can implement from home.
You can grab yours by filling in your details here:
- Baldwin, Jere F. Lumbar (intervertebral) disc disorders. Medscape. Accessed 6/9/19.
- B W Koes et al. ‘Diagnosis and treatment of sciatica’. BMJ. 23 June 2007, Volume 334. Accessed 6/9/19.
- Weber H, Holme I, Amlie E. The natural course of acute sciatica with nerve root symptoms in a double blind placebo-controlled trial of evaluating the effect of piroxicam (NSAID). Spine 1993;18:1433-8.
- Vroomen PCAJ, Krom MCTFM de, Slofstra PD, Knottnerus JA. Conservative treatment of sciatica: a systematic review. J Spinal Dis 2000;13:463-9.
- Richard F Ellis et al. ‘Neural Mobilisation: A systematic review of Randomised Controlled Trials with an analysis of Therapeutic Efficacy’. Journal of Manual and Manipulative Therapy. 2008; 16(1): 8-22.