Understanding and Preventing Sciatica Related Pain

Matthew Silvaggio, MSPT, CFMT

Sciatica is a very popular term used by patients to label the pain or symptoms that they are experiencing in their buttock region and into their leg. Sciatica has been used to describe pain that runs down the front of the leg, back of the leg, and even a pain that wraps around the leg. Sometimes patients’ report an ache down the leg, other times it can be reported as a sharp pain and other times it can be deemed sciatica if it is tingling down the leg. There is some gray area here, but let’s take a minute to try to clarify these symptoms so that one can be using the term sciatica appropriately when describing whether they have or do not have it.
Generally speaking, pain can be separated into two terms, pain that is referred and pain that is radicular in nature. Sciatica is a type of radicular pain and it is caused specifically by nerve root irritation. Nerve root irritation is typically caused by disc compression or localized edema. . It is deep and sharp in nature and most importantly it travels down the leg in a width of roughly 1.5 to 2 inches and it follows a specific pattern relative to that nerve root that is being affected. These patterns are known as dermatome patterns. Now some dermatome patterns do indeed wrap around the leg from the outside of the thigh and down the front of the leg. Also in these specific dermatome patterns ‘pins and needles’ can occur. As the nerve root fibers become further injured, numbness can occur and the pins and needles with typically subside. Also, weakness of particular groups of muscles that correlate with the nerve being aggravated can be noted due to nerve root atrophy. So under these constructs, one could consider having sciatica. But if the pain seems to cross dermatome patterns or not in a dermatome pattern at all, then one is thinking more of pain that is referred.
Referred pain is pain that is dull, ache, diffuse in nature. It is found distant from its source but the key is that the location of its pain reference is not in a specific pattern down the leg. For example, one strains the ligaments that support your pelvis joint (sacroiliac joint) while bending and reaching and you end up with an strong ache pain down the back of your thigh and possibly even into your groin region. Chances are these are referred pains, referred from the strained ligaments. They are not in a specific pain pattern down the leg and they are dull, diffuse in nature. A medical professional will help you differentiate between your symptoms. Sometimes this differentiation process is not cut and dry.
Preventing sciatica includes working diligently at using correct body mechanics when lifting and bending. Maintaining one’s flexibility, including hamstrings, hip flexors, and buttock muscles, is an essential component of being able to demonstrate proper body mechanics. Improving one’s core and leg strength is necessary for being able to tolerate the load that is to be lifted and carried, including exercises on a mat, as well as a physioball.

Referenced: A System of Orthopaedic Medicine. Ombregt L. Elsevier Health Sciences. 2003.


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