"I Think I Have Sciatica..." But What Does This Mean?

If you have ever come back from a long drive, overdone it in the garden or pushed too hard at the gym and found yourself saying, “my sciatica is playing up again,” this article is for you.

It is one of the most common phrases we hear in the clinic. People often use the word “sciatica” when they have sharp pain travelling from the lower back into the buttock, hip or leg. And it makes sense why people use the word. “Sciatica” has become the common phrase to describe nerve-like pain into the back and leg. But here is the important bit: not all back and leg pain is the same.

As therapists, we understand that when someone says “I have sciatica” it could mean I have one or more of these issues:

• pain into the buttock

• pain down the back or side of the leg

• pins and needles

• numbness

• burning, shooting or electric-type pain

• symptoms that feel nerve-like

The word “sciatica” gives us a starting point, but it does not tell us the whole story that we need to know to effectively guide treatment. One of the main things we are looking for is pain below the knee that is worse than lower back pain. Unfortunately, there are a few conditions that can refer pain into the leg in a similar pattern. 

Why the label “Sciatica” is not enough.

Firstly, with any issue involving nerves we need to be very specific with what the impairment is to know if it’s getting worse or better. Using the phrase sciatica doesn’t really capture an individual’s impairment. Clinically, we often think about three broad presentations:

1. Radicular pain: Nerve-related leg pain, often sharp, burning, shooting or electric, but without clear loss of strength, sensation or reflex change.

2. Radiculopathy: Signs that the nerve is not working normally, such as weakness, altered sensation or reduced reflexes.

3. Painful radiculopathy: Nerve-related pain alongside signs of nerve dysfunction.

You do not need to remember those labels. The key point is that pain alone is different from pain with weakness, numbness, or loss of function.  Two people can both say they have “sciatica” but need very different advice.

Is the nerve “trapped”?

Sometimes people describe sciatica as a “trapped nerve.” That can be a useful way to picture it, but it is not always quite that simple. Sometimes an intervertebral disc can irritate a nearby nerve. This may happen through pressure, inflammation, or increased sensitivity around the nerve. That irritation can then create symptoms such as shooting pain, pins and needles, numbness, or weakness into the leg.

Unfortunately, nerves cannot be released as most people imagine. The aim is to understand what is irritating it, calm symptoms down with gentle exercise, keep you moving where possible, and gradually rebuild confidence and tolerance.

Will it get better and How do I know? 

Most cases improve with time, but factors like number of previous episodes, health status, sleep and stress can drag it out further. A good sign of improvement is symptoms becoming less intense, less frequent, and most importantly travelling less far down the leg

When should you get checked?

You should seek advice if your symptoms are worsening, becoming less predictable, spreading further down the leg, or affecting walking, sleep or daily activity.

You should seek urgent medical advice if you develop new bladder or bowel changes, numbness around the groin or saddle area, weakness or numbness in both legs, severe or worsening leg weakness, foot drop, repeated tripping, fever, unexplained weight loss, or severe pain after a significant fall or injury.

The takeaway.

• Sciatica is a useful descriptor, but it is NOT the full diagnosis.

• To guide treatment, you need specific diagnosis

• The nerve does not get trapped or squashed, its sensitized

If you want to get to the bottom of your pain, send us a message and book your initial assessment today. We'll assess the issue and discuss the best plan to help you with that "sciatica" pain.