Sciatica. That’s a dreaded word for the patients who first come in to see me. Unfortunately, it’s a word that is misused by the medical and non-medical worlds, leading to confusion and lasting pain.
So what really is that terrible pain running down the back of your leg? Let’s get technical, shall we?
Oh the possibilities with a low back injury
An injury at the low back can present with various symptoms and in expected or unexpected locations.
Sometimes the pain can be centered in your low back. Other patients feel it as a thumbprint pressing painfully just above the buttock.
Many experience symptoms in their back and down their legs, possibly to the feet and toes. You might even have pain only down your leg, with no pain in your back, but the source can still be your low back.
How is this possible, and what does it have to do with that sciatic pain I promised to explain? We’re going to answer those questions by learning about somatic referred pain, and why I don’t like the term ‘sciatica.’
Somatic referred pain
Most back pain can be attributed to an injury to an intervertebral disc in your low back. An injury to the disc can cause pain anywhere, from your back to your big toe, as previously described.
There are two main mechanisms of pain referral from a disc injury, but we are just going to focus on one of these pathways.
Good news for everyone, our discs have free nerve endings within them that sense pain (1). Just like with any other injury, the body rushes in to help with the healing. An assortment of cells arrives onsite that we generally refer to as inflammation.
If we continue to trigger our disc injury and pain, like picking at a scab, the inflammation continues to hang around because the disc hasn’t healed. This can lead to inflammation and irritation at the nearby nerve exiting the spine.
This nerve then becomes mechanically sensitized to stretch and compression and becomes painful itself (1). The pain can evidence anywhere along its many paths down the buttock and lower extremity.
One of the more common symptoms: aching pain from the buttock and down the back of the leg…unfortunately referred to as sciatica.
Why not sciatica?
When most people hear sciatica they think they have an issue with their sciatic nerve being compressed at their glutes, specifically their piriformis muscle. They smash and massage and try to stretch their hamstrings and glutes into oblivion.
This is a huge mistake.
Remember how we just described that the source of this pain is the disc, and the nerve became sensitized? Nerves don’t like to be stretched or smashed.
If you try to stretch away your sciatic pain, you likely will get temporary relief called a stretch reflex. This may last 10–30 minutes, but the pain comes rushing back because you’ve only pushed the pain down the road a few minutes.
Not to say the piriformis can’t be an issue, but it most likely isn’t…and you still wouldn’t stretch and blast your piriformis by sitting on a small ball to get rid of the pain anyways.
Conclusion
Quick and easy take-home message today.
If you are having that aching, sometimes sharp or burning pain down your leg, remember that there’s a good chance it is somatic referred pain coming from your spine. Not sciatica or sciatic pain.
If you want to get rid of the pain, you need to take care of your back!