Sciatica

Sciatica is often a misused term for any pain radiating down the leg. True sciatica is defined as pain radiating down the pathway of the Sciatic nerve (1). This article will define what Sciatica is and what other conditions will cause pain radiating down the back of the leg

Sciatic nerve

The sciatic nerve is the largest nerve in the body starting in the lower back at L4-S3, then the nerve courses down the back of the thigh and at the knee it splits and goes down to the feet (as Tibial and Common Fibular Nerve) (2).
As mentioned earlier, true sciatica is any condition that will cause pain on the sciatic nerve, for example, a herniated disc that compresses the nerve root of the sciatic nerve. Typically, the pain is sharp shooting in nature. Usually, the pain is unilateral (one-sided). (3)
Surgery is not always indicated. Typically, with manual therapy, the pain can be managed. In severe cases, significant leg weakness or bowel or bladder changes, surgery can be warranted. (4)

Piriformis syndrome

The pain typically refers down the back of the thigh, up to the knee, where it stops. A closer inspection of the anatomy, the Sciatic nerve runs inferior to the piriformis muscle. Any injury to the muscle can cause pressure on the nerve, this will, in turn, refer pain down the leg. Similarly, the piriformis muscle’s referral pain is down the back of the thigh and stops just above the knee. (3)
By simply managing the inflammation and getting the piriformis muscle to relax, a significant reduction of pain can be expected. Frequent exercise, stretching and an active lifestyle can prevent this pseudo-sciatica.

Muscle referred pain

Referred pain is defined as a phenomenon that occurs when pain is perceived in a neurological distribution but originates from an injured or irritated muscle (5). There are a couple of muscles that refer pain down the leg that mimics Sciatica. The two most common muscles are the Gluteus minimus and piriformis
The gluteus minimus refers to pain down the back of the leg, more towards the lateral side. The pain runs from the gluteus (bum) down past the knee to the ankle. The other muscle is the Piriformis muscle and, it refers to pain down the middle and backside of the thigh up to the knee. Both muscles are located in the gluteal (bum) region and they respond very well to manual therapy.

Final thoughts

Many conditions can cause Sciatic pain and most of them respond well to manual therapies; however, please do not self-diagnose. When in doubt visit a professionally trained health worker such a Chiropractor so that the condition can be investigated and managed accordingly.

“Knowledge is Power”

Albert Einstein

References:
  1. www.dictionary.com. (n.d.). Definition of sciatica | Dictionary.com. [online] Available at: https://www.dictionary.com/browse/sciatica.
  2. Teachmeanatomy.info. (2019). The Sciatic Nerve – Course – Motor – Sensory – TeachMeAnatomy. [online] Available at: https://teachmeanatomy.info/lower-limb/nerves/sciatic-nerve/.
  3. MD, L.P. (n.d.). Is My Pain Sciatica or Something Else? [online] Spine-health. Available at: https://www.spine-health.com/blog/my-pain-sciatica-or-something-else [Accessed 30 Nov. 2020].
  4. Mayo Clinic. (n.d.). Sciatica – Symptoms and causes. [online] Available at: https://www.mayoclinic.org/diseases-conditions/sciatica/symptoms-causes/syc-20377435#:~:text=Sciatica%20refers%20to%20pain%20that.
  5. www.sciencedirect.com. (n.d.). Referred Pain – an overview | ScienceDirect Topics. [online] Available at: https://www.sciencedirect.com/topics/medicine-and-dentistry/referred-pain#:~:text=Referred%20pain%20is%20a%20phenomenon [Accessed 1 Dec. 2020].