Sciatic Pain: It’s Not Always a Pinched Nerve

“My doctor recently told me that I have sciatica and the pain that I feel in my butt was actually coming from my back. But, I do not have any pain in my back.”
As a physical therapist, this comment is not uncommon to hear and causes confusion with patients. So, what is sciatica? “Sciatica” is more commonly referred to symptoms felt from the back, buttocks and down the leg. The symptoms can range from pain, numbness/tingling or weakness. The symptoms can be constant, varying in intensity or can come and go.

Nerve referral patterns

The pain can be dull, aching or sharp. Sciatica symptoms can often be described as muscle spasms or sharp electric jolting down the leg. Also, weakness can be felt in the legs or foot with sensations of the legs giving away. Sciatica can be confused with symptoms that mimic a hamstring strain, hip pain, ankle sprain, calf cramp, and heel pain. As you can see “Sciatica” is a broad term used to describe many symptoms.

So what causes sciatica symptoms? It is common for patients to visualize a nerve being “pinched” by a herniated disc. There are many other sources of pain in the spine that can cause sciatica and people should not always fear that the disc is injured. Spinal stenosis is another common diagnosis that can cause sciatica, where the nerve is compressed as it exits the spine. Bone overgrowth (osteophytes) and joint stiffness can also irritate the nerve as it exits the spine to cause “sciatica”

A thorough examination and assessment of low back pain is performed by the physical therapist with the patient’s history, symptoms location, symptoms behavior, and neurological examination (sensory, motor and reflexes). This is important for figuring out whether the pain is coming from the back or not.
When sciatica symptoms are caused by irritation to a specific nerve root, the symptoms can follow a dermatomal pattern (area of skin that is mainly supplied by a single spinal nerve). For example, the L5 and S1 nerve root referral pattern has a consistent dermatomal pattern to the foot.

If you are experiencing or think you are experiencing sciatica symptoms, it is recommended to seek proper medical attention and treatment. The doctor may order diagnostics such as an X-ray or MRI to figure out what is irritating the sciatic nerve. Physical therapy intervention is usually successful for patients with low back pain with or without sciatica symptoms. Physical therapist can treat sciatica using various interventions that can include but not limited to: manual therapy, exercises, modalities, traction, postural education, activity modifications, pain management and neuromobilization.

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