Sciatica is a challenging and puzzling condition. Most commonly it is felt that sciatica is an injury or irritation to the sciatic nerve. The sciatic nerve comes from nerves in the base of the lower back and the tailbone or sacrum. 

Most people who think they have sciatica actually do not and that is a good thing. Most pain that you might feel in your leg is actually not sciatica. That actually makes it much easier to deal with. 

What’s an easy way to find out if it might be your sciatica nerve causing leg pain?

Here are some things I ask of anyone experiencing pain into their leg:

• Does the pain run down the back or more the side of your thigh?
• If I asked you to paint where the pain is would you use a sharpie or a 2” brush?
• If you sit and straighten out the leg with pain does it increase the pain or send it into the leg?

The first thing you want to do if you are experiencing pain down your leg is actually determine if it is likely sciatica or pain from another cause. In my more than 35 yrs of practice the majority of pain radiating down into the leg is not sciatica. And, that’s a good thing. Some of the causes of sciatica can be a long process to overcome. 

So, what about those questions?

• Sciatica causes pain down the back of the thigh and possibly calf and into the foot.
• Pain down the side of the thigh is not sciatica.
• Pain into the leg on straightening the leg is a possible indication for sciatica. 

If it Isn’t Sciatica, What Is It?

Wow, do we love labels in our culture? Whether we label the leg pain sciatica or not we still have the most important hurdle ahead of us. What are we going to do to correct the problem?

Because of how the body is wired when you irritate any organ or tissue it is common for pain to be felt elsewhere. 

Did you know that one of the more common symptoms or pain from a heart attack in addition to chest pain is pain down the left arm. In the case of a heart attack we’d want to know that the heart attack was causing the left arm pain. 

There are a number of tissues that commonly cause pain into the leg. You always want to make sure it isn’t a significant internal organ issue like the heart attack example. 

Here are the more common causes of leg pain that are not sciatica:

• Sacroiliac Joint: a loss of motion or inflammation of the SI joint of the pelvis is a very common cause of pain radiating into the leg. 
• Spinal Joint in the lower lumbar spine: a loss of proper motion or an injury to these joints can cause leg pain.
• Trigger Points: tight areas in the muscles of the low back and pelvis caused by joint imbalances can also refer pain into the leg. 

Now that we’ve addressed the importance of determining whether it is likely sciatica or not, how do we proceed?

3 Critical Keys to Overcoming Sciatica

The key to solving any spinal or health challenge is correctly identifying what the problem is and even more importantly what is causing or aggravating the problem.

Critical Key #1: Is it a Space Occupying Lesion: we want to determine early on if there is something putting pressure on the sciatic nerve. Outside of the rare possibility of a tumor we want to consider the more likely causes. Here are the 2 most likely causes:

• Herniation of the L4 or L5 Disc: If the disc is injured it can put direct pressure on the sciatic nerve. An MRI is the best test to evaluate for the presence of a disc herniation causing sciatica.
• Bone Spur: long term wear and tear of the lumbar spine causes the growth of arthritic bone spurs that can put direct pressure on the sciatic nerve. 

If a disc herniation or bone spur is present, the severity will determine whether or not conservative care is appropriate. Many disc herniations heal fine without surgery. 

Critical Key #2: Is there Muscle Weakness: while pain is the most disturbing nerve pressure that causes significant muscle weakness is more troubling. Nerve pressure causing significant weakness can cause permanent loss of muscle function.

In the presence of significant muscle weakness, testing using EMG and Nerve Conduction Velocity is appropriate to assess the degree of damage.

Critical Key #3: Biomechanical Assessment: The vast majority of sciatic and non-sciatic leg pain are caused by altered movement patterns in the lower lumbar spine, pelvis, and hips. Not only is restoring this function critical to solving the puzzle of sciatica, but in the long term this dysfunction will cause joint degeneration and arthritis. 

Too many people that I encounter have a long history of repeated episodes of pain radiating into their legs. What most don’t understand is that just because the pain resolves doesn’t mean the problem has been corrected. 

While some episodes of sciatica follow an accident, injury, or trauma, the vast majority show up in the absence of any identifiable cause. What I almost always find is a longstanding pattern of imbalance that eventually surfaces as an irritation of the sciatic nerve causing sciatica. 

The sciatic nerve is not the problem! The problem is whatever is driving the imbalance that has resulted in pressure, irritation, and inflammation of the sciatic nerve. If you don’t address the cause, not only will it be more difficult in overcoming sciatica but…

…it will most likely return and

…it will cause a chain reaction of other problems.

I want to encourage you to pay attention to your body and “listen” to it. It’s not as simple as pain or no pain. Pain is always the last thing to show up and the first to go. Underneath the pain is always some imbalance and something not working correctly. 

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