If you are feeling a sharp shooting pain that runs from your lower back into your leg you may be wondering if you have Sciatica. Sciatica is common, affecting people at some point in their lives.
What is Sciatica?
It is more of a symptom of an underlying issue when something is compressing or irritating the Sciatic nerve. This nerve runs from the back through your hips, buttock and down the leg. There are other other conditions that can also cause referred leg pain so it is essential to distinguish if the pain is related to the sciatic nerve or other structures.
When the Sciatic nerve is affected you may feel:
- Pain that travels down the leg (often sharp, shooting or burning)
- Pins and needles or tingling: especially in the leg or foot
- Numbness in parts of the leg or foot
- Weakness: in the leg or foot
Scaitica usually affects one side of the body.
How is Sciatica diagnosed?
Diagnosing Sciatica involves your Physiotherapist or GP listening to the symptoms you are experiencing and doing a few simple tests.
- Questions about your symptoms would be:
- Where is your pain
- Does the pain go below the knee
- Is your leg pain worse than your back pain?
- Have you noticed any numbness, tingling or weakness?
2. Assessments may include:
- Straight leg raise test- looking if this brings on your leg pain
- Checking your reflexes – to see if the nerve is affected
- Sensation- to see if this has changed side to side
What else could it be?
There are other conditions that may mimic Sciatica but may be unrelated to the Sciatic nerve.
These could be:
1. Hip osteoarthritis
How to tell the difference:
- Pain often in groin or front of thigh
- Stiffness with movement especially in the morning
- Pain worsens with activity such as walking
2. Deep gluteal syndrome
This can occur if the Piriformis muscle, which is where the sitting bone is, compresses on the Sciatic nerve.
- How to tell the difference:
- Often no lower back pian
- Worse with sitting
Can be due to overuse of those muscles
3. Sacroiliac joint dysfunction
The sacroiliac joint connects the spine to the pelvis. If there is inflammation in this joint it may cause pain that feels like Scaitica.
- How to tell the difference:
- Pain is localised to the back of the pelvis or buttocks
- Worse when standing or climbing stairs
Does not usually radiate beyond knee
4. Facet joint dysfunction
The facet joints in the spine can also become painful and inflamed and can refer pain into the upper buttocks and thigh.
How to tell the difference:
- Pain is above the knee
- Worse with twisting or standing
- Can be related to spinal arthritis
5. Vascular conditions
Conditions such as deep vein thrombosis (DVT) or peripheral artery disease (PAD) can cause leg pain similar to Sciatica.
Things to look out for with these conditions could be:
- Leg redness, warmth or discoloration (DVT)· Pain or cramping in the leg that worsens with exercise and settles with rest (PVD)
Management of Sciatica
The prognosis of Sciatica is good for studies showing that 90% of patients are thought to improve in 4 months. Other studies do show that 1/3 can continue to have symptoms up to 1 year so it may take time.
It is important to have an assessment with a Physiotherapist or an Exercise Physiologist who can provide rehabilitation strategies and advice around how to self manage your condition. Exercise assists in reducing the inflammatory effects, it also targets weakness that may be occurring from the nerve compression as well as improving the function of the nerve. Mobility may be an issue due to reduced or restricted movement, so this is also included in rehabilitation as well as education on how pain works and how to cope with the pain. Due to the sometimes complex nature of pain it is useful to have a team involved in your care and this may be a GP, Physiotherapist, Exercise Physiologist, Massage therapist etc. They may be able to assist if further referrals are required or if imaging or injection therapy is recommended.
The term Sciatica is often misdiagnosed and the signs and symptoms can mimic other causes which is why it is important to have a thorough clinical assessment and management plan with one of our health professionals who understand it.
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