Everything you need to know about sciatica

You’ve heard the word thrown around, maybe even assumed you yourself have experienced it. The word “sciatica” conjures up scary images of debilitating pain, limping, bed rest and painkillers. Maybe your friend or colleague has described the aching or pins and needles down one leg that won’t go away.

I’m going to let you in on a little secret: sciatica isn’t actually a disease. It’s not even a condition or a syndrome. It’s probably not even a big deal, even if it feels like it is.

I'm going to let you in on a little secret: sciatica isn't actually a disease.

That’s because sciatica is a symptom, which means that it is a sensation dictated by another condition. In other words, a diagnosis of sciatica is not a diagnosis. It doesn’t tell us what’s causing the discomfort in the first place.

Traditionally, we attributed symptoms like leg pain, bum pain, pins and needles or weakness of the leg entirely to a compression of the sciatic nerve (which is a Big Mumma of a nerve that runs from your back, into your bum and down the back of your leg).

Hence: sciatic nerve compression = sciatica.

Lots of things could potentially compress your sciatic nerve. For instance, tight muscles in your bum or sitting on a hard chair.

However, the most common source of sciatica is from a disc injury in the lower back.

The discs in our lower back are squishy, cushiony structures that sit between our vertebrae. They’re made up of a firm outer shell and a jelly-like centre. Kind of like a jam doughnut.

We have nerves that come from just below each vertebrae. The nerves that come from the lower back all join together in the bum to make up the sciatic nerve.

Sometimes, normal ageing processes or traumatic sporting injuries can result in a slight weakening of the harder outer part of the disc, resulting in a bulging out of the jelly substance.

The reason that disc injuries are so painful is only partially to do with this bulging. Yes, the nerve might become a little bit squished, meaning that it could send pain down the sciatic nerve and into the leg. We used to think that this was the be all and end all, that we could operate and cut off the bulging part of the disc and all pain would disappear.

The problem with this approach is that, while it worked sometimes, it didn’t work all the time. In fact, a few people actually got worse. You see, pain is never an accurate representation of tissue damage. Even referred pain like sciatica!

We know that the emotions and feelings that we hold about our bodies physically change the way that our brain interprets the messages it receives from our body. Our brain creates the pain that we feel and, sometimes, depending on our circumstances, beliefs and emotions, it gets it really wrong.

I’ve already written an entire blog on the neuroscience of how and why we feel pain, so please have a read if you’re not sure what I’m getting at.

The bottom line is that “sciatica” is a really dodgy word. It says a lot without saying anything really, because leg pain with pins and needles could be caused by many different things, some completely innocuous.

These different causative factors all need to be managed differently, so having a chat to your osteopath about what’s actually going on is the best bet to get on top of things quickly.

Our brain creates the pain that we feel and, sometimes, depending on our circumstances, beliefs and emotions, it gets it really wrong.

Symptoms like leg pain, tingling or pins and needles can usually be managed and alleviated easily, with a combination of sensible exercise and appropriate treatment. If your osteopath suspects that you may need another intervention alongside their treatment, such as a prescription for painkillers or a cortisone injection, they can provide you with a referral to an appropriate practitioner such as a sports doctor.

Osteopathic treatment may include massage to your lower back, glutes and legs. It may also include stretching of joints like the hips or lower back.

Your osteopath can also advise you on ergonomics at work or strengthening exercises for your back and legs. The reason for the symptoms needs to be ascertained, because the treatment will be dependent on where the problem is coming from!

Using a scary, medical sounding word that has no real meaning just breeds fear. Fear makes our pain worse. Ironic hey? Calling it “sciatica” probably makes that “sciatica” worse!

Let’s just stick with, “I’ve got pain in my back/bum/leg with some pins and needles/weakness.”

Your osteo will certainly get to the bottom of your symptoms and help you on the path to recovery.

Until next time,

Claire