Many are familiar with the term sciatica but are not sure what exactly it means. True sciatica (radiculopathy) is an irritation of the sciatic nerve, a large nerve that provides the connection to the nervous system for nearly all the skin of the leg, the muscles of the back of the thigh, the leg, and the foot. Over time, the term sciatica in public use has come to encompass any pain in the buttock, thigh, leg, or foot. This can be easily misunderstood and has major implications for treatment.
When a person is experiencing pain that is dull and achy into the buttock or thigh without numbness or tingling, this is most commonly myofascial or muscular pain. Compared to most of the causes of true sciatica, this is a relatively benign cause. Muscular pain, sometimes referred to as “trigger point(s),” is usually caused by muscle overload/overuse or direct trauma. Muscle overload can be the result of sustained or repetitive low level contractions of a muscle or parts of a muscle. These can develop during daily activities or sports when muscle capacity is exceeded and recovery is inadequate. This is very common when starting a new activity or changing to a new job — anything that changes the way you move, stand, or sit. This type of “sciatica” can be treated very well by conservative care methods, usually consisting of manual therapy to release the trigger point and improve joint mobility followed by exercises to strengthen the muscle and return it to its normal state.
True sciatica caused by irritation of the sciatic nerve has causes that are more challenging to treat. The most common causes are herniated lumbar discs, spinal stenosis, and spondylolisthesis. Treatment of those conditions depends on many things, including severity of pain, loss of sensation, and loss of motor function. True sciatica, technically called radiculopathy, tends to be more painful and can commonly go down the leg and into the foot. It is frequently sharp and is often accompanied by numbness or tingling in the affected area. These conditions can require surgical intervention depending on the factors mentioned.
It is very important to get an evaluation by a skilled health care professional any time you experience symptoms into the buttock, thigh, leg, or foot. Understanding these basic concepts before you go for your appointment will help you ask the right questions and understand your best options for treatment.
Dr. Jeremy James founded and was director of the Aspen Club Back Institute in Aspen, Colorado, is the coauthor of the bestselling The Younger Next Year Back Book and earned his Doctor of Chiropractic from the University of Western States. Learn more about Dr. James here.