Ask the Osteopath: Sciatica

By Chart Clinic Osteopath, Pavlos Pavlidis MOst.Med.

Hello everyone,

My name is Pavlos and I am a new member of the Chart clinic. I am a qualified Osteopath and have received a Masters degree in Osteopathic Medicine with First class honours.

In this article I will attempt to provide some insight for “Sciatica”, a term commonly used between clinicians as well as patients. However, it is also being commonly misused, especially by the latter.

In this article I will describe the meaning of this term in order to promote a better understanding. I decided to write this after many cases of patients that presented to our clinic thinking that they have “Sciatica” while in fact they did not.

To begin with the origin of the word “sciatica”, it derives from the Greek Ischialgia, with Ischio: Hip and Algos: Pain, and literally translates as Hip pain. In clinical practice it is commonly used to describe pain that radiates along the Sciatic nerve, usually as a result of compression at the lower back.

Now let’s get a closer look at the anatomy. The roots of the sciatic nerve exit from the space between the last two bones in the lower back vertebrae and the first three of the “tailbone” or sacrum as it is known to us, clinically referred to as nerve roots of lumbosacral plexus L4-S3.

                                       

It then travels to the buttock and back of the thigh area and divides into two branches at the back of the knee that goes all the way to the leg and foot. The Sciatic is the longest nerve in the human body and along with its branches supplies the majority of muscles at the back of the thigh, leg and foot. Furthermore, its branches provide sensation to the skin at the back and outside portion of the leg, as well as the top and bottom aspect of the feet.

Therefore, when this goes wrong or you get a  dysfunction of this nerve can lead to weakness of the above-mentioned muscles as well as burning pain, pins and needles or numbness to the back of the leg and foot.

(Note that any symptoms at the groin, front of the thigh or leg ARE NOT associated with the sciatic nerve and Sciatica would be completely inappropriate to describe them)

The term “Sciatica” describes any of the symptoms caused as a result of injury or compression to the nerve and therefore it represents a group of symptoms and NOT a diagnosis.  There are numerous causes of impairment of this nerve and its brunches, anywhere from its roots exiting the lower back to the lower limb. Some of the common causes include severe arthritis of the lower back, a “slipped disc” – a protrusion of the discs in the spine that compresses its roots, or tight muscles at the buttock (such as the piriformis muscle) and back of the thigh, as the nerves passes through them. Nevertheless, there are also some rare but potentially life-threatening causes of sciatic nerve impingement. 

Therefore, it is extremely important for anyone presenting with such symptoms to be properly examined by a clinician so a specific and appropriate diagnosis can be made.

Due to the variety of symptoms caused by dysfunction of this nerve and the numerous causes of it, it is often misused by patients that tend to use it to describe any low back pain that radiates downwards. However, self labeling must be avoided before a proper examination and diagnosis by a qualified practitioner, as it can be associated with diagnostic errors, misdiagnosis and therefore mismanagement.

Nowadays, the term has been labeled as “Archaic”, as it is non-evidence based and inaccurate as it literally translates to hip pain. The literature suggests that it remains from an era of poor understanding of the physiology of back pain.

To conclude: “Sciatica” is a generalised and non-descriptive term, as various conditions might lead to irritation of the sciatic neural tissue, in multiple anatomical sites with different presentation of symptoms.

Patients must avoid using this term and self-labeling themselves, especially if appropriate examination and diagnosis has not been carried out. Patients that experience any of the symptoms described are highly advised to seek help from a clinician with experience working on the musculoskeletal system to exclude any dangerous causes for that and provide appropriate diagnosis and management plan. This includes Osteopaths, Physiotherapists, Rheumatologists, Orthopaedic surgeons etc.

Please do not hesitate to contact me or any of my colleagues for any further information or advice concerning “Sciatica” or any other condition. 

Pavlos Pavlidis MOst.Med

Pavlos qualified in 2017 and received a Masters Degree with First class honors from the University of Surrey. During his time as a student he demonstrated a great passion for the profession, both in academic and clinical settings and was awarded with the Rising Star Award from the Institute of Osteopathy. 

In practice, he follows a multidisciplinary and personalised treatment approach, tailor-made for the needs of the patient. Pavlos has undertaken additional qualifications in Kinesio taping and Medical Acupuncture. Those extra skills have been found to be extremely useful in practice, as they provide additional treatment options, especially useful for pain management and rehabilitation. 

 References:

• Beers, M., Porter, R., Jones, T., Kaplan, J. And Berkwits, M. (2006). The Merck manual of diagnosis and therapy. 18^TH ed. Whitehouse Station, N.J.: Merck Research Laboratories.
• Bogduk, N. (2009). On the definitions and physiology of back pain, referred pain, and radicular pain. Pain Journal, 2009 Dec 15;147(1-3):17-9.
• Fairbank, JC. (2007). Sciatic: An archaic term. British Medical Journal, 2007 Jul 21;335(7611):112.
• Helianthus Holistic Health Clinic. (2017). Acupuncture Balance Method for treating lower back pain and sciatica. Helianthus Holistic Health Clinic, IMAGE. Available at: http://helianthusclinic.com/wp-content/uploads/2016/12/sciatica.png
• Koes, B. W., van Tulder, M. W., and  Peul, W. C. (2007). Diagnosis and treatment of sciatica. British Medical Journal, 334(7607), 1313–1317.
• Matsumoto, Y., Matsunobu, T., Harimaya, K., Kawaguchi, K., Hayashida, M., Okada, S., Doi, T. and Iwamoto, Y. (2016). Bone and soft tissue tumors presenting as sciatic notch dumbbell masses: A critical differential diagnosis of sciatica. World Journal of Clinical Oncology, 7(5), p.414.
• Valat, J.P., Genevay, S., Marty, M., Rozenberg, S. and Koes, B. (2010). Sciatica. Best Practice & Research Clinical Rheumatology, Volume 24, Issue 2, April 2010, Pages 241–252.