Sciatica

Updated: Feb 18


The sciatic nerve is a nerve that courses from the low back, down the back of the thigh and branches into smaller nerves behind the knee. It is the largest nerve in the body, averaging 2 cm wide, about the width of your index finger! Along its course, it goes near (or through) the piriformis muscle, gives nerve supply to your hamstring muscles, then divides at the knee to supply the muscles of the lower leg, shown in Figure 1.


Figure 1: Shown above is the path of the sciatic nerve through the muscles of the back of the hip and thigh (2)


A common misconception is that any pain that radiates into the leg is considered sciatica, while this is not the case. True sciatica is a condition where a patient experiences pain in the distribution of the sciatic nerve caused by direct compression of the sciatic nerve or associated nerve roots, commonly as a result of a herniated disc (4). Other causes of sciatic type pain include piriformis syndrome, triggered by a contraction issue with the piriformis muscle. Clinicians must be aware that pain radiating down the leg could also be caused by referred low back pain. The root cause of pain must be identified for proper care, requiring diagnosis and treatment by a health professional adept in the musculoskeletal system. Your health care provider, such as your orthopedic physician or physical therapist, will perform a physical examination to determine the primary issue and to rule out any red flags. Once the pain trigger is identified, conservative treatment should be the first line of defense.


Conservative treatments, such as physical therapy, have up to 97% success in sciatica caused by nerve compression (4). In the past, bed rest was the primary recommendation for patients suffering from sciatica. Research now shows that engaging in regular exercise is crucial for recovery (1). Physical therapy is important in determining what level and type of exercise is appropriate for a patient, along with providing education to avoid exacerbation of symptoms, manual therapy for pain relief, traction for nerve decompression, etc.


In the case of failed conservative treatment, other treatment options are available. A physician may recommend over the counter pain killers, local steroid injections, and in more severe cases, surgery to correct any abnormalities. Recovery of symptoms after surgery is quicker than conservative management, however both were 95% effective after one year (3).


Determining the origin of pain is crucial in proper treatment of a condition. This will avoid unnecessary medical expenses and limit the duration of disability. If you have pain, be sure to consult your local health care provider and advocate for conservative treatment.



References:

  1. Davis DH, Wilkinson JT, Teaford AK, Smigiel MR. Sciatica produced by a sacral perineurial cyst. Texas Medicine. 1987 Mar 1;83(3):55-6.Available from:https://www.statpearls.com/kb/viewarticle/28772/ (last accessed 12.9.2020)

  2. Muscolino, Joe. "Piriformis Syndrome." Learn Muscles, learnmuscles.com/blog/2017/09/24/piriformis-syndrome/.

  3. Peul, Wilco, et al. "Surgery versus Prolonged Conservative Treatment for Sciatica." The New England Journal of Medicine, 31 May 2007, pp. 2245-56, doi:10.1056/NEJMoa064039.

  4. Vroomen, Patrick C. A. J.; de Krom, Marc C. T. F. M.; Slofstra, Patty D.; Knottnerus, J. Andre* Conservative Treatment of Sciatica: A Systematic Review, Journal of Spinal Disorders: December 2000 - Volume 13 - Issue 6 - p 463-469


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