Sciatica – Lets talk about ‘faux sciatica’

Back pain, Sciatica

In Albury Wodonga, our Osteopaths regularly see clients complaining of sciatica.  As mentioned previously, sciatica is just a symptom, so if it’s not coming from the nerve roots at lumbar spine where can it come from? Let’s discuss this faux sciatica, which is much more common than you think.

Anatomy

The sciatic nerve is the longest nerve in the body and therefore has multiple places that the nerve can be impacted. Stemming from the lumbar spine the sciatic nerve then travels through the posterior pelvis (buttock region) lying in close proximity to the piriformis muscle after passing through the sciatic notch, from here it continues to travel in between the thigh muscles until it reaches the knee, from here it splits into peroneal and tibial nerves which innervate smaller sections of the calves and feet. 

There are some anatomical variants in small sections of the population that increase the likelihood of developing sciatic pain, some of these include:

  • The sciatic nerve splints around the piriformis muscle
  • A portion of the sciatic nerve actually passes through the belly of the piriformis
  • Portions of the nerve enter and exit different parts of the muscle
  • In a few people the sciatic nerve splits above the knee 

The likelihood is you’ll never know if you were born with any of these variants, but simply having tight or injured muscles/joints through the pelvis and thigh can impact the sciatic nerve and cause that familiar nerve pain down the legs. 

Radiating pain 

Pain can radiate from any nerves aggravated in the body, the sciatic nerve is just the most common. Because of the nerve distribution some calf pain can very well be coming from your back, pelvis or upper thigh. Why?

The brain simply receives input from the body and is unable to specify where the pain is coming from, so in response send the whole area of the aggravated nerve into pain. 

Other common examples are pain in the fingers and hands that can be coming from compression through the neck or brachial plexus (located in the shoulder). This is slightly different to what’s known as referred pain which is a specific site of injury then causes pain in other areas of the body, like shoulder and jaw pain coming from heart attacks. 


Back to sciatic pain…

What are some things that can cause this sciatic pain if it’s not coming from my spine?

  • Injuries to the pelvis – sacroiliac sprains are commonly occurring in contact sports as well as slips and falls
  • Glute tendinopathies – an overuse injury when the muscles/tendons aren’t conditioned to increased load. 
  • Corkies – A good old fashioned corky can produce enough muscle trauma and inflammation to cause sciatic pain as the extra tension compresses on the nerve
  • Piriformis syndrome – As seen with the anatomical variants above any injuries or even tightness to the piriformis muscle can cause sciatic pain. 

Please remember not to diagnose your own sciatic pain due to the potential for much more serious causes such as bony metastasis and cauda equina syndrome (please refer to first blog!)

Treatment 

Treatment will be based on the results of a thorough case history and examination as our osteopaths endeavor to find the tissue that is causing the pain through the sciatic nerve distribution.

Treatment will involve specific physical therapy which can include, but not limited to:

  • Soft tissue therapy 
  • Joint articulation 
  • Stretching and mobilisation
  • Exercises and home rehabilitation program 
  • Shockwave (if Glute tendinopathy may be involved)
  • Dry needling and Cupping

 

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