Sciatica is commonly self diagnosed- although not all leg pain is caused by the sciatic nerve. The term is reserved specifically for a collection of symptoms caused by irritation to the sciatic nerve.
Symptoms of Sciatica
Whenever a nerve is irritated like this, common symptoms can include sharp or shooting pain, pins and needles, numbness, or weakness. Usually only some are present at one time. The symptoms often follow the course of the nerve closely, and patients find that they would be able to draw a defined line of pain on their leg. More diffuse pain, even if the symptoms are otherwise similar, may be caused by something else.
The illustration above shows the course the nerve takes in fig B. Symptoms may affect all or some of the nerve. Where it splits around the knee, you may feel symptoms in both the anterior part (into the shin) and the posterior part (into the calf and foot), or just one, or neither.
Potential Causes
The image above shows a few examples of potential causes for sciatica. Fig C shows a bulging disc compressing one of the nerves that combines to make the sciatic nerve. Similarly, fig D shows a spondylolisthesis, where the nerve is compressed by the shifted bone. Spondylolistheses are rare, and may follow trauma or come on for no apparent reason if there is no fracture involved.
Not all cases of sciatica originate so close to the spine. Piriformis syndrome is another form of sciatica, in which the nerve is irritated by a muscle deep in the buttock. Tightness in the piriformis muscle could be caused by new demands on the glutes, such as more intense exercise than normal or sitting in an awkward position for a long period. You can read more about piriformis syndrome here.
Other Causes of Similar Symptoms
- referred pain from the spine
- referred pain from the SIJ
- hamstring or calf injuries
Managing Sciatica
Your osteopath will endeavour to work out where the nerve irritation is coming from, although this is not always possible. However, this is not necessarily an issue, as long as your osteopath is confident that the irritant is unlikely to be a cause for concern in itself.
NHS guidelines do not prioritise imaging such as X-Ray or MRI for standard cases of sciatica. One reason for this is that there are often things going on within the back that could be blamed for the symptoms, despite being totally unrelated. By the age of 40, most people have at least one bulging disc, but less than 50% of people have back pain or sciatica.
Osteopathic treatment may involve work to the lower back or gluteal muscles, as well as desensitising work to the course of the nerve. Exercises often make up a large portion of your management plan, with a combination of stretching and strengthening typically addressing the symptoms and root causes. As you begin to feel better, we can adapt your exercises to best reflect the current situation, and provide a long term management plan.
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