When patients come to see me with sciatica, they often don’t know what is happening. This uncertainty can add to their stress level. All they know is that they have pain running down one or both of their legs. Sometimes simply explaining to the patient what is causing their pain and reassuring them that, yes, it can be helped will go a long way to easing their stress. As their doctor, I do have to ask them some questions and perform some tests to better determine if the pain is indeed sciatica and how to best treat their condition.
Sciatica results from pain running down one or both legs due to a pinching of the sciatic nerve. The sciatic nerve, the largest nerve in the body, comes from the low back and runs down the back of both legs. The sciatic nerve can be pinched as it leaves either the lowest or the second lowest vertebra in the spine. These are the last two movable bones right at the waist. Generally, the more the nerve is pinched and irritated, the further down the leg the pain will radiate. As the patient gets better, the pain will not travel as far down the leg and eventually disappear.
It is important to rule out conditions that resemble sciatica but are actually coming from a different source. Sometimes a spasm of the iliotibial band, a muscle that runs down the side of the leg from the hip to the knee will resemble sciatica. Differentiating iliotibial band syndrome from sciatica usually can be accomplished fairly easily. First of all, the iliotibial band stops at the knee. If the pain extends down further than the knee that rules out iliotibial band syndrome. Also, pain from iliotibial band syndrome tends to run down the side of the leg versus down the back of the leg or a feeling of deep within the leg as is the case with sciatica. I can usually confirm if the pain is coming from the iliotibial band muscle by simply pressing down the length of the muscle. If the patient exclaims that is where their pain is running down, then that tends to confirm the diagnosis of iliotibial band syndrome.
Another imitator of sciatica is what is called, sclerotogenous pain. This refers to pain running down the tissues of the leg as supposed to the nerves. Typically this type of pain is more diffuse and tends be less likely to go below the knee.
Unlike the other conditions, sciatica is also characterized by tingling or numbness down the leg which can occur in addition to the pain. Muscle weakness and loss of the leg reflexes can also occur. It simply depends on what part of the sciatic nerve is being pinched: the part that controls the muscles or the part that transmits sensation or combination of the two.
Once I have diagnosed the true cause of the pain down the patient’s leg, whatever it might be, I can go to work to help them recover from that pain and get back to their daily activities.