Lower back pain (LBP) is one of the most common complaints we see here at Physioflexx. Furthermore, there are the groups of people that come in complaining of “Sciatica”. Often, this presents you with LBP and referred symptoms into either leg (usually one). The term “Sciatica” can sometimes be loosely thrown around as a diagnosis; either you have described leg and LBP to your GP (commonly on the phone right now), you have enlisted the help of Dr Google, or have spoken to a friend who has had a similar issue and they know it to be Sciatica.
Your expectations play a major role in the treatment and rehab process. Therefore, this blog should hopefully provide you with much needed information and knowledge to better understand the situation you are experiencing and to ultimately better manage it. It goes without saying that if you are experiencing any sort of LBP or into the leg – make sure you get a thorough assessment from a medical health professional.
Unfortunately, the amount and reasons for leg and LBP are vast and multifactorial so it would be difficult to dive into every possible explanation. However, one thing that is possible would be to explain and highlight the ways in which you can be a little more certain that it is the sciatic-type you are experiencing.
LBP - The Sciatic Nerve
Firstly, a little background on the Sciatic nerve. Originating from the nerve roots L4, L5, S1, S2 and S3. It is the largest nerve in the body. It branches out deep within the buttock and runs down the back of the thigh all the way to the sole of the foot and is responsible for providing motor and sensory function to the lower body (primarily the back).
3 main types of lower back pain
Injury to the Sciatic nerve can cause 3 main types of pain:
Radicular pain - Radiates from the back and into your hip. Usually felt as sharp severe pain and is felt in a distinct linear path down the back of the leg. This can be caused inflammation or compression of the nerve root itself.
Radiculopathy - Refers to injury of the nerve root that stops it from conducting messages to and from the brain. This may lead to motor or sensory deficits such as pins and needles, numbness or muscle weakness.
Referred pain - Felt from structures like muscles and joints that usually presents as a diffused ache.
Sciatic Nerve
Lower back pain - Are you sure it’s Sciatica?
So how can you be certain it’s the Sciatic nerve that is irritated and not just muscular aches and pains from holding yourself in a weird position after an episode of LBP? It’s very hard to know yourself, again – seek a thorough assessment – but here are a few tell-tale signs:
Pain in the bum...
A large portion of the Sciatic nerve runs through the back of the hip and through the muscles that make up the buttock. Often times diffuse aches originating in the buttock can be misdiagnosed as muscular but could be from the nerve root itself.
It’s worse in the leg and below the knee
Typically, with things like muscular or joint related pain, the pain is worst the closest to the area that is affected. Research has shown that in true sciatic presentations, pain experienced is worse in the leg and below the knee.
More symptoms
Pain levels are high
Pain severity is very very subjective. Your 9/10 pain might be different to my 9/10 pain. However typically people describe sciatic nerve pain as sharp, excruciating, unbearable pain, and different to a dull achey-type pain. Again, this is not a definite way to tell the difference but it can help give a better understanding of the deeper issue.
Motor/Sensory deficits
As already mentioned, sciatic pain – whether a radiculopathy or radicular pain (often can occur simultaneously) – presents with other symptoms aside from pain: pins and needles, numbness, motor loss or muscle weakness, tingling, ants crawling, water running down the leg.
Worse with stretching of the nerve
Another point that isn’t a definite but can certainly enhance the understanding of what is going on, people with true sciatic irritation will likely hate putting the nerve on stretch. Things like the straight leg raise or slump test are regular outcome measures we will use in clinic. Sometimes people have sensitive nerves, but certainly if you have sciatic irritation these two tests will not feel comfortable at all.
