So many patients come in to clinic with the diagnosis of sciatica. This can come from their GP, physio, personal trainer, family member, or of course the infamous Dr Google.
While sciatica is a great word to help patients to understand the location of their pain, it does nothing but confuse people when it comes to determining the cause.
Sciatica is just a word to describe neurological pain, usually down the back of one leg that comes from the irritation or inflammation of the sciatic nerve. It doesn’t tell us anything about why the nerve has become irritated, and does even less to help us understand how to get the pain to go away!
For people with sciatic pain there is normally one of two causes;
- The nerve is being irritated at the site it exits the spinal column, known as the nerve root. This can be because of an intervertebral disc herniation, an inflamed facet joint, or a big muscle spasm.
- The nerve is being irritated somewhere along it’s length, sometimes by a muscle called piriformis, located deep in the glute complex.
All of these scenarios lead to the nerve sending inappropriate information to the brain about compression and inflammation, which results in pain. Remember, all of the pain we experience is interpreted and tempered by the brain. Without the brain, we wouldn’t experience any pain at all!
Sometimes the nerve can be so badly affected by compression or inflammation that the motor function falters, and the person develops a limp. That’s because the motor fibres of the nerve are located more centrally, and wrapped in sensory fibres. That means, if you squeeze and irritate it a little bit, you’ll get pain and possibly pins and needles. This can be reported by a patient in clinic, or tested for by your osteopath.
If you inflame the nerve even more, you might start to notice a loss of foot power, and a foot-drop limp. The muscles affected by the impingement of the nerve are known as the myotome, and can be tested for in clinic.
Only by doing proper clinical testing can we understand the cause of the sciatica, and only then can we work out an effective plan for how to treat it. Next time you hear of someone say they have sciatica – ask them why… If they can’t answer, then it might be time to link them up to this blog post! Happy educating! 😉