What exactly is sciatica?

The sciatic nerve is the largest nerve in the body. It originates from nerve roots in the lower lumbar and sacral spine (L4 to S3), passes through the pelvis and buttock, and travels down the back of each leg.

It supplies sensation to parts of the leg and foot and provides motor function to several muscles in the lower limb.

When people talk about sciatica, they're usually describing pain that travels from the lower back or buttock down one leg, sometimes extending as far as the foot.

Symptoms can include:

• Sharp, shooting or burning pain.
• Pain travelling down the back or side of the leg.
• Tingling or pins and needles.
• Numbness in parts of the leg or foot.
• Muscle weakness in more significant cases.

Symptoms can vary considerably. Some people experience predominantly leg pain with very little back pain, while others have a combination of both.

But here's where things get interesting: sciatica is a description of symptoms rather than a precise explanation of what's causing them.

Is it actually sciatica? Understanding the different types of pain

Pain travelling down the leg can arise from different structures and mechanisms. Three terms are particularly useful when trying to understand what's happening.

1. Referred pain

Referred pain occurs when pain originating in one area of the body is felt somewhere else.

For example, structures in the lower back, including the intervertebral discs, facet joints and surrounding tissues, can contribute to pain felt in the buttock or thigh.

This pain doesn't necessarily follow the pathway of a particular nerve and doesn't usually cause the neurological symptoms associated with nerve-root dysfunction.

Referred pain can sometimes feel deep, aching or difficult to pinpoint.

2. Radicular pain

Radicular pain occurs when a spinal nerve root becomes irritated or inflamed.

This can produce pain that travels along the pathway of the nerve, often extending from the lower back into the buttock and down the leg.

People may describe it as:

• Electric-shock-like pain.
• Burning or shooting sensations.
• Sharp pain travelling below the knee.
• Tingling or pins and needles.

Radicular pain is often associated with irritation of a nerve root in the lumbar spine, rather than a problem with the sciatic nerve further down the leg.

3. Radiculopathy

Radiculopathy describes dysfunction of a spinal nerve root.

Unlike radicular pain, which describes pain arising from nerve-root irritation, radiculopathy can involve changes in nerve function.

Depending on the nerve root affected, this may include:

• Reduced sensation or numbness.
• Muscle weakness.
• Changes in tendon reflexes.

Radiculopathy can occur alongside radicular pain, but the two terms aren't interchangeable.

Understanding this distinction is important because it helps clinicians assess whether someone is experiencing pain alone or whether there is evidence of neurological involvement.

What causes pain travelling down the leg?

There are several possible explanations.

Disc bulges and herniated discs

Between the vertebrae in your spine are intervertebral discs, which help distribute load and allow movement.

Sometimes the outer layers of a disc weaken, allowing some of the inner material to protrude. This is commonly referred to as a disc bulge or herniation.

If a disc herniation irritates or compresses an adjacent nerve root, it can cause pain travelling into the buttock and leg.

However, it's worth remembering that disc bulges are also frequently found in people who have no pain or symptoms at all. Their presence on an MRI scan doesn't automatically mean they are responsible for your symptoms.

Age-related changes in the spine

As we get older, the structures of the spine naturally change.

This can include disc degeneration, changes to the facet joints and thickening of some of the surrounding spinal ligaments.

In some people, these changes can contribute to narrowing of the spinal canal or the spaces through which the nerves exit the spine. This is known as spinal stenosis or foraminal narrowing.

Depending on the location and severity, this can irritate or compress nerve roots.

Other sources of referred pain

Not all pain travelling into the buttock or thigh originates from a spinal nerve root.

The hip joint, surrounding muscles and other structures in the pelvis can also contribute to pain in this region.

This is why a thorough assessment is important rather than assuming that every episode of leg pain is sciatica.

How do we work out what's causing your symptoms?

This is where a proper clinical assessment becomes important.

At Osteopathy West London, we don't simply assume that pain travelling down the leg is sciatica. We want to understand the nature of your symptoms, how they started and what might be contributing to them.

An assessment may include:

• Your medical history: We'll ask about when your symptoms started, where you feel the pain, whether it travels down the leg and what makes it better or worse.
• Movement and physical assessment: We'll assess your lower back, pelvis and hips, looking at movement, mobility and how different positions affect your symptoms.
• Neurological assessment: Where appropriate, we'll assess muscle strength, sensation and reflexes to look for signs of nerve-root involvement.
• Further investigation: Imaging such as an MRI isn't routinely required for everyone with back and leg pain. However, where symptoms are severe, persistent or suggest a more significant neurological problem, further medical investigation may be appropriate.

The aim is to build a clearer picture of what's happening and identify the most appropriate next steps.

Can osteopathy help with sciatica?

The answer depends on what's causing your symptoms.

Osteopathy can be helpful for some people experiencing lower back pain and associated leg pain, particularly where symptoms are related to musculoskeletal problems.

Treatment is individualised and may include:

• Gentle hands-on techniques to help improve comfort and movement.
• Advice on modifying activities that aggravate symptoms.
• Guidance on maintaining appropriate movement and activity.
• Exercise and rehabilitation advice to support recovery.
• Advice on when further medical assessment may be needed.

Where there is evidence of significant nerve-root involvement, treatment needs to be carefully adapted.

It's important to understand that hands-on treatment cannot simply remove a disc herniation or reverse structural changes in the spine. The focus is on managing symptoms, supporting function and helping you return to normal activities where possible.

Many episodes of sciatica-type pain improve over time, although recovery varies depending on the underlying cause.

When should you seek medical attention?

Most lower back and leg pain isn't caused by a serious underlying condition. However, certain symptoms need urgent assessment.

Seek emergency medical attention if you develop:

• New difficulty starting to urinate, inability to pass urine or loss of bladder control.
• Loss of bowel control.
• Numbness around your genitals, anus or the area you would sit on (saddle numbness).
• New or rapidly worsening weakness in both legs.

These can be warning signs of cauda equina syndrome, a rare but serious condition involving compression of nerves at the bottom of the spinal canal.

New or progressive muscle weakness, significant changes in sensation or other concerning symptoms should also be assessed promptly.

If you're unsure, seek medical advice rather than waiting for symptoms to settle.

So, is it sciatica?

Possibly. But pain travelling down your leg doesn't automatically mean your sciatic nerve is the problem.

It could be referred pain from the lower back, irritation of a spinal nerve root or another musculoskeletal issue.

The important thing is not simply to label the pain, but to understand what's contributing to it.

If you're experiencing persistent lower back pain, buttock pain or symptoms travelling down your leg, a thorough assessment can help establish what may be happening and what options are available to support your recovery.

Experiencing back or leg pain?

At Osteopathy West London in Ealing, we offer individualised osteopathic assessments and treatment for back pain, leg pain and other musculoskeletal problems.

If you're unsure whether osteopathy is right for you, you can book a free 15-minute video consultation to have a chat with one of our osteopaths.

Find out more about osteopathy at Osteopathy West London