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Low Back Pain

Why I Never Diagnose My Patients with Sciatica

I want to write an article about sciatica, because there is a lot, I mean, A LOT of confusion around what this word means in the minds of patients and health practitioners alike.

It’s a word that is often thrown around and is often mistakenly seen as synonymous with low back pain, or buttock pain; so much so that very often patients come to my clinic thinking that they have sciatica. And 100% of the time I diagnose them with something else.

How is that possible? Is it ever sciatica? For me, no. It never is, simply because the word sciatica does not actually describe a specific medical condition…

So what does sciatica actually mean? Historically the term is defined as a lower limb pain with or without neurological symptoms, which stems from the nerve roots of the lumbar and sacral spine.

To understand this, let’s do a bit of anatomy.

Here is a drawing of a portion of the lumbar vertebrae, which form the bottom third of the spine. The yellow lines coming out from the vertebrae represent what we call the nerve roots, which originate from the spinal cord (encased inside the vertebrae). The nerve roots split and combine to form various nerves which travel all the way down our legs, allowing us to a) control our muscles and b) feel sensations in our legs. When a nerve root is irritated, it results in pain felt in the area of the leg served by the nerves which originate from it. In a certain scenarios, it can also alter sensation in those areas of the leg (like numbness or pins and needles), and alter strength and reflexes: These are neurological symptoms.

So sciatica refers to either of these scenarios in the lower limbs. Medically, these symptoms are referred to as radicular pain (when it’s just pain cause by nerve root irritation) and radiculopathy (when there are neurological symptoms as a result of nerve root irritation). So, technically, sciatica means either of those things, which isn’t very helpful. So much so that it is debated in the medical world whether or not the word sciatica should simply be eliminated from medical dictionaries, as the frequent use of the term both in some medical practices and in some research articles cause more confusion than needed. Personally, I’m all for it.

But more importantly, there are many things which can cause these symptoms of which we call “sciatica”, and THAT is what is important to diagnose in order to help it. So if a patient comes to the clinic with sciatica, as defined, the aim is to diagnose the underlying condition. This may be a disk budge, or a disk prolapse (commonly called ‘slipped disk’), vertebral degeneration (like osteoarthritis), or simple pain referral from an irritated joint… the list goes on. Hence the un-usefulness of the term ‘sciatica’.

On top of that, in my experience, 90% of people who believe they have sciatica use this word because they don’t know how else to describe their pain, and in those cases, their low back and leg pain is caused by something OTHER than nerve root irritation, so not sciatica to begin with. This again, will result in a wide variety of more specific diagnoses.

I hope this article has been helpful if you have been given the diagnosis of sciatica, or if you are experiencing low back and leg symptoms. Please share your stories, thoughts, questions and opinions in the comment section below.