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Sciatic Nerve Pain - What are the Symptoms and Causes?
Sciatica or sciatic nerve pain is a term often used to describe all sorts of back pain. In fact, less than 5% of people who suffer from lower back pain will have sciatica.
Sciatica is caused by a sciatic nerve irritation. This is most commonly caused by a disc bulge in the lower back.
What is the sciatic nerve?
To understand this you need to have a bit of an idea about human spine anatomy. The spine is made up of large bones called vertebra. These bones are separated from one another by spinal discs. Each vertebra overlaps the next at the back to form a joint called a facet joint.
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 Running down through the middle of the spine is a channel called the spinal canal, its here that the spinal cord sits. The spinal cord is the main structure that passes messages from our brains to our bodies.
At each vertebra the spinal cord braches out to form a nerve root, these nerve roots leave the spine via a gap between each vertebra and then bundle together to form much larger nerves.
In the legs there are two main, large nerves, the femoral nerve at the front and the sciatic nerve at the back. The sciatic nerve passes down through the buttock area into the back of the thigh and leg.
What causes sciatic nerve pain?
The most common cause of sciatica is a disc bulge. The disc is a very misunderstood structure; it has been blamed for back pain ever since it was discovered. Over the years we have started to believe that the disc is a really weak and vulnerable structure.
The term slipped disc makes it sound as if it can slip about inside. In truth the disc cant slip anywhere, it is firmly fixed at the top and at the bottom to the vertebrae above and below.
The disc can and does cause problems however. Sometimes the central area of the disc bulges, usually backwards and sideways. This can cause an irritation of the nerve root as it leaves the spine. Occasionally the bulge is severe enough to actually squash or trap the nerve but this is fairly rare.
When the nerve is irritated by the disc bulge it can become inflamed. Remember what it feels like to hit your finger with a hammer or catch it in a door for a moment. Following the nasty sharp pain you are left with a dull ache. The finger may become red and swollen; there may be some heat or warmth there. After a while, those symptoms settle and everything gets back to normal. Its very similar with the sciatic nerve. It becomes very sore and can give you a lot of pain, even though it is not actually trapped or squashed.
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An important thing to know is that many people have disc bulges and have no symptoms at all.
There are some other conditions that can cause sciatic nerve pain but they are much less common. These include degenerative disc disease, severe osteoarthritis, spinal stenosis or spondylolisthesis. Fractures, tumours and infection can also cause sciatica.
What are the symptoms of sciatica?
If someone has true sciatica then they often have pain in the legs, usually in the buttock, back of the thigh or calf. There may also be pins and needles and numbness in parts of the leg.
In severe cases the leg may feel weak and the strength may be reduced. Often, disc bulges cause no back pain at all; the symptoms are felt only in the legs.
Why are so many people given the diagnosis of sciatica?
Very often, as soon as anyone has any lower back or leg symptoms they are told that have sciatica. However, there are other things that can cause leg pain; a strained facet joint for example can cause pain in the buttock and thigh. But if the sciatic nerve is not irritated then it is not sciatica.
The best way to tell if it is sciatica is to undergo a series of test that your physiotherapist or doctor can perform. These simple clinical tests will be enough to identify if the problem is an irritated sciatic nerve. Paula Fitzpatrick is a British trained physiotherapist specialising in the treatment of back pain. Visit The Lower Back Pain Toolkit for up to date, reliable information about the causes and treatment of lower back pain. Learn more about sciatica and sciatic nerve pain.
David Lind
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