Just because your back is killing you doesn’t mean you have sciatica. In my experience, the term “sciatica” is used by doctors and patients too loosely.
This can lead to misdiagnosis and poor treatment choices when in fact, you most likely do not truly have sciatica.
Do any of these statements describe your pain?
1. Your back is killing you
Sciatica means leg pain. However, there are a variety of potential causes which may exist in isolation or simultaneously. For example, you might have pain from a pinched nerve, often from a herniated, slipped or bulging disc. If you’ve ever been given a diagnosis of lumbar herniated disc, degenerative disc disease, or isthmic or degenerative spondylolisthesis, or lumbar spinal stenosis, your risk for sciatica is higher.
Sciatica follows the path of the sciatic nerve, which is the largest single nerve in your body. Pain from sciatica usually begins in your butt and lower hip, goes down through your knee, and often radiates all the way down your leg to your toes.
The pain can be truly excruciating, so that alone is worth treatment – but you should be extra-concerned if your leg also feels numb or weak. The combination of pain and weakness in a single leg is a sign that you need to get treatment, pronto, to avoid permanent nerve damage. FYI, if you have pain in both legs including bowel and bladder issues this should not be mistaken for sciatica. You should be concerned and go to the emergency room or visit a spine surgeon ASAP. Serious stuff, you don’t want to mess around with this.
2. You love to run
Piriformis syndrome feels a lot like sciatica, but it’s actually a muscular problem and has nothing to do with discs in your back that are pressing on the sciatic nerve. Take a look at the picture below. The sciatic nerve actually runs THROUGH your piriformis muscle. Cramping, tightness or imbalance can cause the muscle to spasm around the nerve causing sciatica-like symptoms. This is usually not serious, can be corrected or at least managed successfully.
3. You can trigger your pain by pressing a muscle
If you can press on a back muscle, say, with your thumb, and trigger your pain, you’re probably experiencing pain caused by tight or strained muscles, or muscles in spasm. It’s probably not caused by a disc problem, so it probably isn’t sciatica. Whew, you’re lucky — we can help you fairly quickly!
4. Raising your leg kills you
OK, this time, you might have sciatica. If you lie on your back, raise your straight leg, and you feel pain radiating down your leg, through your knee and as far down as your toes, you’ve probably got sciatica. If you’ve got an inflamed sciatic nerve, trust me, stretching the entire nerve like this will not feel good.
Here’s how to try this at home:
5. You have joint problems in your spine, like osteoarthritis
While these can cause pain that feels like sciatica, the treatment is different.
6. You have a sacroiliac joint dysfunction (SI joint pain)
This means too much or too little motion in the sacroiliac joint in your lower back and pelvis. Again, it might feel like sciatica, but the cause and treatment of SI joint pain is different. A little tidbit; don’t confuse your SI joint with your lumbar spine and hip. I’ve seen patients enter the emergency room explaining that they have lower back or hip pain. However, they really should have said SI joint pain and pointed to the correct area, shown in the picture below. Unfortunately, if you don’t see a spine specialist they may just take your word for it and give you an injection or other form of treatment in the wrong area. Naturally, you and your doctor will all be confused as to why you’re not getting any pain relief.
7. Other, unlikely, causes
Pain that feels like sciatica can also be caused by other serious medical problems, like a benign or cancerous tumor on your spine. Most sciatica-like pain is caused by muscle, joint and nerve problems – not by these very serious conditions – but your doctor will rule these things out just to be on the safe side.
The Bottom Line
If it IS sciatica, we can generally identify the specific area in your lower back – like the L4 nerve root, or L5, or S1 — that’s irritating the nerve, so we can tailor treatment to the specific cause.
And if it ISN’T sciatica, we can treat the joint, muscle or nerve problem that is causing your pain, so you can get back to normal as fast as possible. If a referral makes sense, we’ll tell you that.
Either way, here’s a fact that will relieve any remaining anxiety you might have: non-surgical treatment of sciatica is just as effective as surgery for most people – and avoids the cost of surgery and the risk of complications.