Is It Really "Sciatica"?

Patients often present to the clinic and report that their “sciatica is acting up”,  or they are experiencing back and buttock pain and refer to it as “sciatica”. Is it really “sciatica”?

I suppose it depends on how you define the term “sciatica”.  Many health practitioners throw the term around carelessly, which leads to clinical confusion.

It’s important to note that “sciatica” is a description of pain, not a diagnosis.  So, in this sense my patients are usually correct in the description of their pain.  This is a good place to start when assessing these complaints.

According to Mayoclinic.org, a top Google search result for “sciatica definition”, “Sciatica refers to pain that radiates along the path of the sciatic nerve — which branches from your lower back through your hips and buttocks and down each leg. Typically, sciatica affects only one side of your body”.

Therefore, in order to be experiencing a true sciatica you would expect that the cause of the pain is something that is affecting the sciatic nerve – such as a disc herniation, spinal stenosis, piriformis syndrome or advanced spondylolisthesis.  These conditions all have one thing in common – compression, irritation, or traction of the sciatic nerve or the nerve roots that eventually form the sciatic nerve.  This presentation is also known as “radicular pain” or a “radiculopathy”.  Pain can be intense, deep, and is often described as electric or burning.  The pain can often be traced with a pen along the path of the sciatic nerve, and it may be associated with other neurological signs and symptoms – such as numbness, tingling, muscle weakness, and loss of deep tendon reflexes.

Does that mean that all pain referring from the back to the leg is “sciatica”?  No!  There is what is known as “referred pain”, or pain caused by “sclerotogenous referral”.  What’s the difference?  The short answer is that tissues (bone, muscle, skin, connective tissue) that share the same embryonic cell lineage have the ability to share pain with one another because they all share one common nerve supply.  Therefore, “referred pain” from the back to a leg is NOT the result of compression, traction, or irritation of the sciatic nerve.  Referred pain is often described as dull, achy, and diffuse or hard to localize.  The pain does NOT follow the path of a nerve root (dermatome) and typically does not go beyond the knee.  For example, an inflamed lumbar facet joint may refer pain to your buttocks.  By definition this is not sciatica.  An irritated sacroiliac joint may refer pain to your lateral thigh.  By definition this is not sciatica.

So, is any of this important or is Dr. Bigness just hung-up on semantics?  Yes, it IS important!  There are many different causes of pain travelling into your leg.  It is paramount that you are given the correct diagnosis so that the correct management or treatment can be applied.  Treatment for a disc herniation causing “radicular pain” or “sciatica” will be different than the treatment for sacroiliac joint irritation causing “referred pain” to the leg.

The take away message here is to always have your complaints assessed properly to determine the cause of your symptoms.  If a health professional tells you that you “have sciatica” without a physical assessment there is a chance you are being mismanaged.  A thorough history and physical examination can determine if you are really experiencing a condition causing sciatica.

Keep well until next time!

Dr. Andrew R. Bigness, B.Sc., D.C.

Genesis Health Centre

Cabana Court Chiropractic

Windsor, Ontario