Are You Suffering From Sciatica?

“Hey Doc, I think I have sciatica”. This is a very commonly heard comment in our office yet few people really understand exactly what it means. Most people assume that if they are experiencing any hip or leg pain that seems to be associated with back pain that they must be experiencing “sciatica”. This may or may not be true.

The problem is that the term sciatica is treated like a diagnosis when in actuality it really isn’t a diagnosis but a description of symptoms. Sciatica is a condition in which the sciatic nerve, one of the main large nerves of the lower limb, is being irritated resulting in leg pain. True classic sciatica results in severe pain down the back of the leg all the way to the foot. It is commonly described as an “electric shock” like pain and most unfortunate suffers usually express that it is the worst pain that they have ever experienced. Keep in mind that this is the classic textbook description and many variations are possible.

Now that we are clear about what sciatica really is, let’s discuss where the confusion lies.  As stated, the term sciatica really is a description rather than a true diagnosis. For it to become a true diagnosis one must uncover the cause of the sciatica. Sciatica is thought to be commonly caused by a disc injury such as a herniation but sciatica can also be caused due to inflammation of the joints in the lower back, advancing spondylosis (the term to describe arthritis in the spine), nerve root adhesions or even a tumour. There are even conditions referred to as pseudo-sciatica which appear like regular sciatica but are caused by compression of the sciatic nerve by tight muscles.

The challenge for the heath care practitioner is to determine the exact cause of the sciatica because until that can be determined there is no way to know what the best course of treatment will be. This is where a thorough history and physical examination come in. Studies indicate that 80 percent of a diagnosis can come from a good thorough history. The physical examination and other tests are then used to confirm the diagnosis and rule out the differential diagnoses.

Again, in a classic textbook case, the patient will present in moderate to severe pain.  The pain typically involves the lower back and one leg. Many times the leg pain is described as being much more severe than the back pain. The patient will stand and walk slightly stooped forward and perhaps leaning slightly to one side. The affected leg may also be slightly bent at the knee and the patient may have difficulty putting weight on the leg. The patient may relay a history indicating a specific precipitating event such as lifting or perhaps an occupation that requires long hours of sitting.

Most importantly when sciatic symptoms that seem consistent with a disc herniation are present the patient must be educated to help them understand their condition. It is important for the patient to understand that if they experience problems with bowel or bladder control that they should be advised to go to the emergency room as this might indicate a neurological emergency called cauda equina syndrome.

Finally, many treatment options exist depending on the cause of the sciatica. It is important to seek out the advice and help of a qualified health practitioner such as a chiropractor or physiotherapist as these people specialize in the treatment of these types of conditions.