Technically, the term “sciatica” refers to pain along the path of the sciatic nerve caused by irritation to the nerve or the nerve’s roots. In most instances, people use the term sciatica to describe pain down the leg, though the pain could be from one of a variety of causes. In reality, what most people have when they say they have sciatica is referred pain from tight or injured muscles. While true sciatica is relatively rare, referred muscle pain is very common. In this article, we will clearly delineate between what people commonly refer to as sciatica and the rarer “true” sciatica.
What Causes Sciatic Pain?
By far the most common cause of “sciatica” is not irritation of the sciatic nerve but muscle pain. When muscles are tight or strained, they produce pain that is often perceived not at the source, but in another area. The originating point of pain is often called a “trigger point” and the place where the pain is felt is called “referred” pain. Pain in certain muscles follows very predictable paths of referral—paths that have been carefully studied and mapped out by doctors. The most typical generators of referred “sciatic” pain are muscles in the buttocks, specifically the gluteus maximus, gluteus medius, gluteus minimus and piriformis. These muscles can become strained or tight by prolonged sitting, bad posture, traumatic injury (e.g., a fall on the buttocks) or repetitive use (bending, twisting). Just as there are common trigger points in these muscles, there are common and predictable referral patterns. The pictures below show where the trigger points usually occur and where the pain is generally felt.
Gluteus Maximus
Gluteus Medius
Gluteus Minimus
Piriformis
What Causes “True” Sciatic Pain? An Overview of the Spine
The spine, or vertebral column, is made up of individual bone segments called vertebrae that are stacked one on top of the other and spaced apart by small, shock-absorbing, sponge-like structures called intervertebral discs. The purpose of the spine is to protect the spinal cord, hold up the body’s weight, and provide support for standing, sitting, walking—all the activities of daily life. A total of 33 vertebrae form the spine. The spinal cord runs the length of the spine down to the upper portion of the low back and is encased within the hollow sections of these vertebrae. Spinal nerves branch off of the spinal cord at each level and exit the spinal column through holes between each pair of vertebrae called “foramen”. Some of the nerve roots occurring between the L4 to S3 vertebrae join together to form the sciatic nerve. The sciatic nerve is very important—it supplies sensory function (feeling) and motor control (the ability to contract muscles) to large parts of the leg and foot. “True” sciatica occurs when either the roots of the sciatic nerve or the nerve itself is compressed. This compression is also commonly called a “pinched nerve” and can be caused by a disc herniation, spinal stenosis, or a bone spur. Compression of the sciatic nerve can happen anywhere along the nerve path but is most common at or near the roots. In select instances, the compression is caused by a shortened piriformis muscle. You may have heard of “piriformis syndrome”—it is very rare yet over-diagnosed. It is very uncommon for the sciatic nerve to grow through the piriformis muscle.
Sciatica Symptoms–Know What’s “True”
Typically, “true” sciatica manifests itself as sharp, “shooting”, “electrical” pain down the hip, leg or foot. The pain is usually very severe and easy to pinpoint. It often lasts until a medical intervention is performed, often without variation in intensity and with no perceived relationship to movement or activity. Even in the short term, stretching and massage do not help relieve “true” sciatica. Referred muscle pain is typically described as “achy like a toothache”, diffuse, and hard to pinpoint. It comes and goes depending on activity or the position of your body, and typically varies in intensity. Short-term relief may be achieved by stretching or massage.
Effective Sciatica Treatment with an Accurate Diagnosis
Effective treatment of sciatica depends on an accurate diagnosis—whether the cause of discomfort is from referred muscular pain or “true” sciatica. A doctor should be consulted any time pain, numbness, tingling or loss of function is experienced in the hip, leg or foot. A doctor can perform tests to determine whether the sciatic nerve is definitely being affected (“true” sciatica). As previously mentioned, muscular pain down the leg is far more common than “true” sciatica. Treatment for “true” sciatica depends on the cause. Please refer to the sections on disc herniation, spinal stenosis, or bone spur for detailed info. Treatment for referred muscle pain should include a strengthening program to build tone in the affected muscles and learning to move in ways that avoid increased muscle stress.
Written by Dr. Jeremy James. Dr. 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.