Do I have sciatica?
Updated: Dec 3, 2021
I've had a few clients now who come to me saying that they have sciatica. They come primarily looking for pain relief, which I am always happy to help with. But, more importantly, I always take the time to investigate a little more as to the source and symptoms of their pain. Why? Because the source of the problem may not actually be the sciatic nerve.
Sciatica is caused by the compression of the sciatic nerve by a slipped or herniated disc - this is where the middle of the disc bulges out. The sciatic nerve runs from your lower back to your feet, and when this is irritated or compressed, you get pain. Generally, if you have true sciatica, your:
back of your leg
foot and toes
painful – the pain may be stabbing, burning or shooting
tingling – like pins and needles
Your symptoms may be worse when moving, sneezing or coughing.
You may also have back pain, but it's not usually as bad as the pain in your bottom, leg or foot. Having true sciatica means that you will experience pain throughout your lower body from this condition, and as it is nerve pain, you should generally feel tingling, burning or numbness with it.
You probably don't have sciatica though if you only have back pain or if the pain starts radiating into your hip.
It usually gets better in 4 to 6 weeks but can last longer.
The normal advice is to take anti-inflammatory tablets and do a few home remedies to help ease the pain while the nerve is healing, and then go back to your GP if you're still in pain a few weeks later.
Pain that doesn't originate from the sciatic nerve, however, is called "pseudo-sciatic" pain. This is because it mimics the symptoms of sciatica but in reality it's coming from a completely different area.
There are a number of things that can cause pseudo-sciatic pain. One condition is called the piriformis syndrome. It has different causes from sciatica, but because it mimics the symptoms, it won’t be a surprise if you and your doctor believe that it’s true sciatica.
As we now know, sciatica is generally caused by a compression of the discs in the back, so when the priformis muscle is the culprit, it does cause some confusion. Despite the name, however, there is nothing imaginary about "pseudo-sciatica". The sciatica nerve is indeed being pinched and compressed in the same way, it's just from a different cause. The pain is just as real. "Pseudo" just means mimic or copycat here.
There are a couple of ways to spot which one it is (this won't work, however, if both are causing you a problem).
From a seated position, straighten the leg in which you are having pain, so that your leg is parallel with the floor. If the symptoms increase, there is a good chance that what you have is true sciatica.
Again, taking a sitting position, using the same leg, bring the knee up to the shoulder on the same side. ( It shouldn't be as painful as it sounds unless you truly have the most severe case.) Then with the knee still raised, move your knee over towards the opposite shoulder. If there is an increase in pain, there is a good chance that you are suffering with piriformis syndrome.
The symptoms of piriformis syndrome are therefore very similar to true sciatica. This is because, as you can see from the picture above, the piriformis muscle passes straight through the sciatic nerve. The major symptom is pain and burning down the length of the nerve, from the buttocks to the feet. It usually affects only one side of the body, and can be worse when you are sitting, or after sitting for long periods of time.
The main difference between true sciatica and piriformis syndrome is that piriformis syndrome often causes more intense pain in the hip, to the point where it can actually cause you to limp or have other difficulty walking. People with pseudo-sciatica generally don’t have pain in the thigh, so if you also have pain in your thigh, hip and potentially down to your calf, you may need to look at other muscle groups in your buttock and leg instead for the source of your pain, as these can also mimic this condition.
Muscles such as the gluteus minimus or potentially, the medius in your buttocks. These muscles together with your hamstrings are also very likely to be culprits, as a huge percentage of leg pain, including sciatica, has a connection with these muscles (particularly the gluteus minimus).
So what causes them? The causes of true sciatica are likely to be primarily from being overweight because this puts extra strain on the area. You can also develop sciatica from not being active enough. And as some women will testify, sciatica is often an unwanted side-effect of pregnancy.
Pseudo-sciatica, on the other hand, can be caused by any number of things, from poor posture, sitting cross-legged, prolonged driving, standing on one leg, unbalanced leg lengths, wearing high-heeled shoes, or having an excercise-related or other injury.
Do you sit too long at a computer screen with your head bent forward to look at the screen as you work? This is another cause that can trigger it. If you do a repetitive movement (such as repeatedly lifting a child into the rear seat of the car), this can be another trigger. Men also tend to develop this by sitting for too long on a hard seat with their wallet stuck in their back pocket.
So, this is why I always make a particular effort to check. Because what looks like true sciatica may not be the sciatic nerve at all, and a correct diagnosis can be the difference between being pain-free more quickly, as treatment can be specifically and correctly targeted, to being stuck waiting for 6 weeks only to find the pain still hasn't gone away*.
Stay safe, as always
* Please note that I will always make a referral back to your doctor (with a letter) if I feel there is anything that needs further medical investigation.