Sciatica is often accompanied by low back pain, which can be more or less severe than the leg pain. The term “sciatica” indicates that the sciatic nerve, which travels from the lower back through the buttocks and into the leg, is thought to be the cause of the pain in this condition. True sciatica is a condition that occurs when a herniated lumbar disc compresses one of the contributing roots of the sciatic nerve. This type of low back pain is less common than other causes and conditions that produce back pain. For instance, sporting activities, recreational activities, and heavy labor can cause back and leg pain, which is commonly misdiagnosed as sciatica.

Symptoms

The most common symptom of true sciatica is posterior thigh, lower leg or foot pain that can be much worse than the accompanying lower back pain. Usually a patient will experience moderate to severe pain, which begins in the buttocks and runs down through the leg or foot. It is important to know that true sciatica will produce pain that radiates beyond the knee. Often a patient will have a previous history of lower back pain beginning a few days or weeks before the leg pain occurs, then the leg pain becomes worse than the back pain, and in some cases the back pain will completely disappear.

Often there is not a specific traumatic event or motion associated with the onset of sciatica. Standing, sitting, heavy lifting, sneezing, or having a bowel movement may aggravate the pain. Lying down is usually the most comfortable position. Occasionally paresthesias, weakness and diminished bowel or bladder function will accompany sciatica, but these are rare symptoms.

Diagnosis and Treatment

A thorough history and physical examination is an important part of the diagnosis of sciatica. Nerve root tension tests can be used to confirm the presence of sciatica by attempting to reproduce the discomfort with certain motions and body positions. These involve moving the legs in certain ways that slightly stretch the sciatic nerve. Along with chiropractic care, a home program of stretching and strengthening exercises are very useful in allowing a patient to return to full activity.