Sciatica is one of the most infamous forms of chronic pain — everyone knows someone who suffers with it. You’ve probably heard it described as a “shooting pain” that starts in the lower back and travels down one leg. So when you experience anything close to that description, it’s normal to think oh no, it’s sciatica! But there are other conditions that mimic sciatica’s signature pain, and some people with sciatica experience entirely different symptoms.
If you’re reading this because you have shooting pain in your lower back, hips, or legs, it’s important not to self-diagnose and start doing sciatica stretches or workouts that could worsen your condition. Instead, get checked out by a physical therapist, as soon as you can. If you’re pregnant, it’s especially important not to assume sciatica — while roughly 50% of pregnant people feel some form of back pain, only about 1% of them turn out to have sciatica.
Once you’ve made a PT appointment, keep reading to find out about the lesser-known symptoms of sciatica and why sciatica is often mis-diagnosed, even by doctors.
What exactly is sciatica?
Sciatica refers to chronic pain that’s caused by an irritated or compressed sciatic nerve. The sciatic nerve is the largest and longest nerve in your body. At its widest, it’s roughly the size of a piece of string cheese. Starting in the lower spinal column, it branches left and right, dives under (or sometimes through) the piriformis muscle located within each glute, then heads down the back of the legs, all the way to your toes.
Besides controlling the muscles that bend your knees and bring your thighs together, your sciatic nerve provides sensation to the back of your thigh, the lower leg, and the sole of your foot.
While sciatica is well known for sending pain blazing down one leg, that’s not the only way it can manifest. Some people experience a dull, constant ache in one leg, or an uncomfortable numbness or tingling in one calf. In some cases, sciatica is associated with a loss of bladder control
What’s the most common cause of sciatica?
The most common cause of sciatica is a herniated disk. Intervertebral disks are like gel-filled cushions that provide padding between the individual vertebrae of your spine. When these cushions rupture, they leak fluid that irritates sciatic nerve roots on either side of your spine — which can radiate pain to the hips and legs.
There are other causes of sciatic pain, especially for women. Injuries to bones, muscles, tissue, and other nerves in pregnancy, labor, and postpartum can lead to sciatica, as can health conditions like fibroids and endometriosis.
Why is sciatica tricky to diagnose?
The lower back and pelvic region are packed with a complex network of muscles, nerves, and connective tissue — all of which can contribute to pain in this area and beyond. Unless your healthcare provider has specialized knowledge of back and pelvic pain, it can be difficult to pinpoint the root cause.
The following conditions, to name just a few, can all produce sciatica-like symptoms:
Sacroiliac joint dysfunction is pain in your low back or hip due to too much or too little movement in the pelvic joints. It can occur on one or both sides of the body. Typically, you’ll feel sharp, stabbing pain where the pelvis meets the sacrum in the low back. You may experience pain and difficulty bending over or standing up, or pain with prolonged sitting, standing, or walking.
Piriformis syndrome is (literally) a pain in the butt caused by an overly tight piriformis muscle, which is located deep in the glutes. This can lead to sciatica if the piriformis muscle irritates the sciatic nerve.
IT band syndrome is common in runners and cyclists and refers to a sharp or burning pain on the side of the hips and down the side of the leg. This pain is caused by overused connective tissue and/or weak lateral glutes (aka your abductors) and tends to increase with sitting and laying on your side.
Low back pain. The majority of Origin patients who are worried they might have sciatica are diagnosed with low back pain. Whether back pain is the culprit or your sciatic nerve really is being compressed, physical therapy is an effective way to manage the pain.
How can physical therapy help?
Physical therapists are experts at diagnosing and treating pain anywhere in the body. At Origin, our PTs specialize in the female body and can help you at any stage of life, including during pregnancy, postpartum, and menopause. They’ll start by listening to your symptoms and concerns and examining how you move and experience pain — so they can make an accurate diagnosis.
If you are found to have sciatica, treatment typically involves manual therapy techniques to the glutes and low back to loosen up the tissues. It also includes exercises to improve core, glute, pelvic girdle, and pelvic floor strength, as well as stretches and mobility exercises for the hips and sciatic nerve. Pregnant or postpartum? Your PT will help you adjust movements that contribute to pre or postnatal sciatic pain, including how to get up off the couch and roll in and out of bed.
When it comes to chronic nerve pain, you’ll need to be patient and pace yourself. Nerves take time to heal and progress can be quickly lost if you do too much too soon or move in a way that re-aggravates the sciatic nerve. Your PT will teach you how to increase activity incrementally, so that you continue to heal.