5 facts about Sciatica

In my last blog post we learnt more about osteoarthritis and how to manage it. If you haven’t had the chance to read it yet click here. Often I will have a patient come into my clinic and say that they have been diagnosed with sciatica. People’s experience with sciatica can greatly vary, so it can be confusing to know whether you have sciatica. This guide will help you understand what signs and symptoms to look out for.

1. Sciatica is a symptom, not a diagnosis

Sciatica is basically a fancy word for saying you have pain along the path of your sciatic nerve. You should not be ‘diagnosed’ with sciatica by a medical professional, because there are many causes of sciatica. If this happens to you ask the medical professional “why do I have sciatica”? See point 4 for some of the causes.

2. Sciatica symptoms can be present in any part of the nerve pathway

This nerve branches out from your spinal column in the lowest part of your back (L4-S3). The sciatic nerve goes down your bottom and the back of your thigh. At around the back of the knee the sciatic nerve splits into two:

1. The tibial nerve which goes down the back of your calf and into your foot 

2. The common peroneal nerve, which goes down the outside of your calve.

With sciatica you can have symptoms in one part, multiple parts (in any combination) or along the course of the whole nerve. These symptoms can be in your:

  • Lower back
  • Buttock
  • Back of your thigh
  • Back or side of the calf
  • Foot
  • Toes (most commonly the big toe)
Sciatica can make your lower back painful, but not always.

3. Sciatica pain can present differently in different people

With sciatica you may feel one or more of the following sensations: pain, numbness, tingling or weakness.  You may feel a different sensation in each area e.g. pain in the back and buttock, but occasional tingling in the calf. 

The type of pain can also vary from mild to severe. For some it may only be a mild, dull ache, for others it could be an intense burning or electric shock-like pain. Normally the symptoms will be on one side only, however it can occasionally affect both sides. 

4. There are many causes of sciatica, and most are not harmful long-term.

Sciatica is very common symptom in my osteopathic practice, and the good news is majority of the time the symptoms are temporary. Here are some of the more common causes I have seen:

  • Piriformis syndrome: The piriformis is a deep muscle in the buttock region. In most people the sciatic nerve runs just underneath this muscle, and occassionally goes through the muscle. When this muscle becomes tight, strained or spasmed it can irritate the sciatic nerve. 
  • Disc herniation – We will explain disc herniations in more detail in a future post, but sometimes a disc can bulge slightly and irritate one or more of the sciatic nerve roots. It sounds scary, but I want to reassure you in most circumstances the discs will improve, and surgery is rarely needed.
  • Degenerative disc disease –  Again another name that sounds scarier than it really is. This more often occurs in the older population. Degenerative changes can occur in the spinal joints and the discs. The joint spaces and discs start to shrink slightly, which means there is less space for the sciatic nerve root, which can sometimes irritate the nerve. You tend to find stooping forward slightly relieves it (such as using a shopping trolley).
  • Facet joint and sacroiliac joint irritation- These are the joints of the spine and pelvis, and have small spaces for the nerve roots. If the joints get irritated they can become inflamed which temporarily aggravates the sciatic nerve.
In most circumstances osteopathy is an effective method in managing sciatica symptoms.

5. Rarely are sciatic symptoms a medical emergency – but be aware of the ‘red flags’

Most of the time most causes of sciatica can be managed with a mixture of self care, manual therapy and advice. Serious health conditions are rare, but is is useful to be aware of some of the warning signs, also known as ‘red flags’:

  • Persistently having sciatica symptoms on both sides at the same time
  • Weakness or numbness in both legs that is severe or worsening
  • Numbness in the saddle region (inner thighs, genitalia and anal regions)
  • Difficulty urinating
  • Urgency or lack of control of your bowel movements
  • Major trauma
  • Pain significantly worse in the night

If you have any of these symptoms, even if it is just one of the symptoms, it is important to rule out a serious health condition ASAP. Therefore you must seek immediate medical treatment. If it is serious, the quicker you are treated the more likely you will make a full recovery. 

In my clinical experience I have only had to refer one person with sciatica signs to A&E. This was because they had numbness from the waist down on both sides, with difficulty urinating. They did not have any back pain. As they received hospital treatment quickly they made a full recovery.

If in doubt contact me for advice 

If you think you have sciatica and are uncertain what to do next, then you can contact me for advice, in most circumstances I can help you. I recommend booking an initial consultation to help find the cause of your sciatica symptoms. The benefit of booking an appointment with me is that you get 60 minutes for your first appointment. This gives me the time to listen to you and assess appropriately, so you can get a proper working diagnosis and a suitable treatment plan. In the rare event I feel further investigation is needed, I will also write a referral letter to your GP/specialist to help support you through this process.

Published 21/12/2022