What Is Sciatica?
Sciatica describes pain radiating down one leg or both from the hip or low back. The term on its own is a vague one and is often used incorrectly. True sciatica often radiates past the glutes and into the thigh. At its worst sciatica may radiate all the way to the foot. Sciatica may involve any combination of dull/achy, sharp, electric, and even numbness in the lower extremities.
There are two main types of sciatica that we see in practice
1) Lumbar radiculopathy
2) Piriformis syndrome
Thanks to Google and our affinity for quick fixes this rare syndrome (mostly competitive athletes) is a daily topic of conversation at the clinic. Let me reiterate, piriformis syndrome in isolation is actually very rare. With that out of the way, piriformis syndrome is most accurately described as pain radiating along the posterior hamstrings and posterior calf down one leg or the other and almost never both. Contrary to popular belief, back pain is not a part of the syndrome. The pain is felt due to tightness/spasm of the piriformis muscle which runs from the sacrum to the femur and lies over the sciatic nerve. It is estimated that as much as 10% of the population has fibers of the sciatic nerve that actually run through the piriformis muscle making them more prone to experience the symptoms of the syndrome. The fix for piriformis syndrome is simple. STRETCH! Its that simple. As with any purely muscular ailment it will be fine after a week or two.
This represents the bulk of sciatica that we see in practice and it relates directly to the low back. The sciatica produced is most often the result of a disc bulge/herniation/prolapse. As a disc tends to do when injured, the material (annulus fibrosis) gets torn and material may become displaced. Both processes result in a high level of inflammation as your body tries to heal what it can of the injury. It is actually rare that the disc material itself actually pinches the nerve but rather the inflammation around the disc injury that makes the space the spinal nerves usually have both limited and biochemically nerve irritating (phospholipase A2 among other culprits). Plenty people end up having surgery after lumbar disc herniations but a growing body of evidence supports conservative care first with surgery and pain meds as a last resort.
It may be clear by now that the treatment of these two conditions is probably going to be very different and must be properly diagnosed for optimal outcomes