Before we delve into the answer to this question, it’s first important to understand what sciatica is, how it is assessed, and what other conditions can be mistaken for sciatica. Keep reading to find out more!
The Sciatic Nerve
The sciatic nerve is the longest nerve in the body. It runs from the spinal cord in your lower back, through your hips and buttocks, and down each leg. It’s responsible for sending signals between your brain and the muscles in your legs and feet. This allows you to move your legs and feel sensations like pain, temperature, and touch in your lower body.
It’s made up of several smaller nerves that branch out from the lower part of your spinal cord in your lower back.
From your lower back, the sciatic nerve travels under your buttock muscles (including the piriformis muscle). It then runs down the back of each leg, under your hamstring, and into the back of the knee. Here, the sciatic nerve splits into smaller branches that continue down to your lower leg, ankle, and toes, controlling different muscles and providing sensation.
The sciatic nerve controls most of the muscles in the back of your thigh, lower leg, and foot. It’s also responsible for the feeling in these areas. If something irritates or compresses the sciatic nerve, it can cause pain, tingling, numbness, or weakness along its path.
What is Sciatica?
The term “sciatica” refers to pain down the leg caused by compression of the nerve roots as they leave the lower aspect of the bony spinal column. This compression can be due to a disc bulge, degenerative-related bony outgrowths, or sometimes a non-mechanical cause like a cyst.
Sometimes these joints next to the nerve roots can get sprained or injured and produce local inflammation that irritates the neighbouring nerve root. In these cases, there is no physical compression of the nerve, but the inflammatory chemicals irritate the nerve and can cause pain to radiate down the leg along the path of the sciatic nerve.
Sciatica can produce several symptoms, including:
Pain that starts in your lower back or buttock and shoots down your leg to the outer calf or even the outer foot or big toe. It can range from a mild ache to a sharp, burning sensation.
You might feel numbness or a "pins and needles" sensation in your leg or foot.
In some cases, the compression of the nerve can affect the nerve supply to the muscles, causing weakness in the leg and foot muscles, leading to symptoms such as drop foot.
How to check for Sciatica?
It is the job of our chiropractors here at Marlborough Chiropractic Clinic to fully investigate the cause of any leg pain. They will go through your pain history and conduct a neurological and physical examination to determine if this is true sciatica or another condition that mimics sciatic leg pain.
History
The most telling sign of sciatica is pain that starts in the lower back or buttock and radiates down the back of the thigh, calf, and sometimes into the foot, following the path of the sciatic nerve. Sciatica usually affects only one side of the body.
Patients may report that the pain worsens with specific movements, such as bending forward, sitting for long periods, or coughing and sneezing. These actions can increase pressure on the sciatic nerve.
Sciatica can be triggered by an injury, such as a fall, heavy lifting, or sudden movements that strain the back. If the patient reports a specific incident after which symptoms began, this can help identify the cause of the nerve irritation. However, repetitive movements or prolonged sitting (such as driving) can also contribute to sciatic nerve issues.
Patients with a history of chronic lower back pain, degenerative disc disease, or previous episodes of sciatica are at higher risk for developing sciatic nerve problems.
Examination
Neurology: First, your chiropractor will check your leg sensations, muscle strength, and reflexes. Changes in sensation (numbness, tingling) along the sciatic nerve’s path using light touch, pinprick, or vibration can indicate nerve involvement. They will also check the strength of the muscles innervated by the sciatic nerve, particularly in the legs and feet. Weakness in foot dorsiflexion (lifting the foot) or plantarflexion (pushing the foot down) can signal sciatic nerve compression. Reflexes in the foot and hamstrings are checked to help confirm nerve compression.
Specific orthopaedic tests can also be done to assess the sciatic nerve and rule out other potential causes of leg pain:
Straight Leg Raise (SLR) Test: The patient lies flat on their back while the examiner gently lifts the affected leg while keeping it straight. If lifting the leg causes pain that radiates down the leg (often at an angle between 30° and 70°), it may indicate sciatica.
Braggard's Test: This further stretches the sciatic nerve
Bonnets Test: This stresses the sciatic nerve under the piriformis muscle to see if there is compression happening under this muscle as well.
Spinous spring: Pressing on the vertebra of the lower back, can identify areas of tenderness or muscle spasms.
Sacroiliac checks: This tests for joint dysfunction.
Other Causes of Leg Pain
Piriformis Syndrome
The piriformis muscle, located in the buttock, can spasm and irritate the sciatic nerve as it passes underneath or through the muscle.
Sacroiliac Joint or Facet Dysfunction
Dysfunction or inflammation of the sacroiliac (SI) joint, where the spine connects to the pelvis, or of the joints in the spine itself, can cause pain that radiates to the buttock or back of the leg. Leg pain caused by the SI joints often does not extend past the knee.
Hip Pathologies (e.g., Hip Arthritis, Hip Labral Tear)
Hip joint problems, such as arthritis or a labral tear, can cause referred pain to the buttock and leg. Pain is often located in the groin or front of the thigh but can radiate to the buttock or knee. Hip rotation often aggravates symptoms, and pain may not follow the typical sciatica pattern.
Myofascial Pain Syndrome
Pain caused by trigger points in muscles, often resulting from repetitive strain or injury. The radiation pattern of the gluteus minimus is very similar to the sciatic nerve distribution.
Chiropractic Care of Sciatica
All of this information can help guide your chiropractor to recommend the best course of care for you. We use spinal manipulations and mobilisations when treating patients with sciatica, as well as soft tissue techniques to address muscle spasm and compensatory muscle tension. These treatments assist the natural healing process of a disc bulge.
Check out our blog about different adjustment techniques we use in the clinic.
Depending on the cause of the nerve compression, we will also provide advice for at-home care, including movement recommendations and exercises to supplement in-clinic care.
Sometimes, pain and function do not improve as expected. In these cases, we may refer you back to your GP for another medical opinion or for further investigations or imaging to help guide the best course of care for you.
Struggling with Sciatica? Give us a call today to see what we can do for you!
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