You Don't Have Sciatica.
It's a symptom, not a sentence.
Sciatica is such a common condition. Like really common. So many people experience it at some point in their lives.
So, naturally, there is a wealth of information available to educate people about the condition and provide helpful advice and treatments.
Sounds great, right...?
WRONG!
Unfortunately, these commonly praised "sciatica treatments" are often useless at best. Trying to understand and treat "sciatica" often just leads to more confusion.
Let me explain.
One of the big issues in understanding and effectively treating back pain is that it is such a non-homogeneous diagnosis.
While we tend to broadly refer to it as "back pain" and say things like "I've got a bad back", what that means can vary greatly.
There is a variety of conditions and injuries that can cause back pain. They can occur in different locations in the spine, cause pain through different mechanisms and overall have different effects on your life and function. In some cases, back pain may not be caused by an issue in the back or spine at all!
As a result, the best way to treat your back pain may be completely different to the best way to treat someone else's. This often makes it horribly confusing for someone who has developed back pain and is trying to figure out what the hell is going on and what they should do about it.
Sciatica suffers from these same problems.
Sciatica is not a diagnosis; it's a symptom.
We need stop diagnosing people with sciatica. Sciatica is not a diagnosis; it's a symptom. We need to diagnose the cause of this symptom, not the symptom itself.
This is like your Doctor diagnosing you with a fever.
Imagine going to see your Doctor because you are feeling unwell, and they diagnose you with a fever. You would be thinking, "NO SH*T SHERLOCK... What's causing it!? What should I do about it!?"
Is it an infection? Do I need antibiotics, or is it viral? Should I medicate the fever, or let it run its course?
And so on...
Beginning to see how insane this is? It's no wonder people with sciatica struggle to get relief.
We need to identify the cause of the sciatica.
Sciatica is a symptom, not the full explanation.
The SpineScribe assessment looks at what makes your symptoms better or worse, where they travel, and what pattern they fit.
I continue to be shocked and disheartened as I repeatedly encounter concerned people that are told they have sciatica and are terrified about what this may mean. There is so much baggage associated with the term now that it has become such a confusing mess, particularly for people who may have just developed this pain for the first time.
I regularly read and hear things like:
"Will this go away? I cannot imagine living the rest of my life like this."
The equation in their heads seems to go something like: sciatica = permanent, incurable nerve damage and pain.
Sciatica does not mean any of these things. The only thing it refers to is radiating pain felt in the sciatic nerve.
While this pain is commonly caused by a lower back injury (such as a disc bulge), it isn't always. And the overwhelming majority of sciatica causes are very treatable without major intervention or lifelong pain and disability.
There is a big difference between telling someone:
You have sciatica... caused by severe spine cord compression that could lead to permanent loss of function if we don't operate immediately, and,
you have sciatica... caused by mild disc bulge, take it easy and it will probably resolve itself in 8 weeks or so.
This is just a ridiculous situation to be putting clients and patients in, and I believe it initially stems from diagnosing people with something that isn't a diagnosis.
If you have been told you have sciatica but still do not understand what is causing it, your symptom pattern is the place to start. The SpineScribe assessment helps organise those clues into a clearer explanation.
Frequently Asked Questions
What is sciatica, exactly?
Sciatica means pain travelling along the sciatic nerve pathway, usually from the lower back or buttock down the back of the leg, and sometimes into the foot. It describes where the pain goes. It does not explain why the nerve is irritated. That is why treating “sciatica” as the diagnosis often leads people in circles.
What are the most common causes of sciatica?
The most common cause is irritation of one of the lumbar nerve roots that forms the sciatic nerve. A disc bulge or herniation at L4-L5 or L5-S1 is a common example. Other possibilities include spinal stenosis, facet-related irritation, and less commonly, piriformis syndrome. The right treatment depends on which structure is involved and what is aggravating it.
Does sciatica go away on its own?
Often, yes, especially when the cause is a disc irritation that is given time to settle. Load management, movement modification, and avoiding repeated aggravation can make a big difference. If symptoms are worsening, spreading, or associated with weakness, numbness in the saddle area, or bladder or bowel changes, get medical advice promptly.
Is sciatica the same as a pinched nerve?
They overlap, but they are not quite the same. “Pinched nerve” is a broad term for a nerve being compressed or irritated. Sciatica refers specifically to symptoms along the sciatic nerve pathway, or the lumbar nerve roots that feed into it. It is a more useful description than a diagnosis, but it still leaves the main question unanswered: what is irritating the nerve?