Sciatica

Understanding Sciatica and Radiculopathy

Sciatica is a term most people have heard, but few truly understand. It’s often used as a catch-all diagnosis for any leg pain, but the reality is more complex. True sciatica has specific characteristics, and understanding the difference between sciatica and other forms of radiculopathy is crucial for effective treatment.

What Is Sciatica?

Sciatica refers to pain that radiates along the path of the sciatic nerve—the largest nerve in your body. The sciatic nerve forms from five nerve roots (L4, L5, S1, S2, S3) that exit your sacral region, combine outside the pelvis, and travel down the back of your thigh, continuing into the heel and sole of your foot.

When the sciatic nerve becomes compressed, inflamed, or irritated anywhere along its pathway, you may experience symptoms traveling down this specific route.

Sciatica vs. Radiculopathy: Understanding the Difference

This distinction is crucial because treatment approaches differ:

Radiculopathy

Radiculopathy refers to nerve root compression or irritation at the spinal level—where the nerve exits the spine. This can occur at any spinal level and affect different nerves:

• Cervical radiculopathy: Nerve root compression in the neck causing arm symptoms
• Lumbar radiculopathy: Nerve root compression in the lower back causing leg symptoms

Not all lumbar radiculopathy is sciatica. Depending on which nerve root is compressed, pain may travel:

• Down the back of the leg (sciatic nerve distribution)
• Down the front of the thigh (femoral nerve distribution from L2-L4)
• Into the groin or hip area
• Along the side of the leg

True Sciatica

True sciatica specifically involves the sciatic nerve and typically causes symptoms in the back and/or side of the leg, potentially extending to the foot. However, the sciatic nerve is formed from multiple nerve roots, so compression of L4, L5, or S1 roots can all produce sciatic symptoms—but with different patterns and locations.

Why This Distinction Matters for Treatment

Different causes require different approaches:

If your leg pain comes from:

• Disc herniation at L5-S1: Treatment focuses on reducing disc pressure and nerve inflammation
• Foraminal stenosis: Treatment emphasizes creating space for the nerve root
• Piriformis syndrome (muscle entrapment): Treatment targets the muscle compressing the nerve
• Femoral nerve irritation: Entirely different nerve pathway requiring different management

Treating “sciatica” generically without identifying the specific nerve, level, and cause of compression often leads to poor outcomes and prolonged suffering.

How Sciatica and Radiculopathy Feel

Symptoms vary but typically include:

Classic sciatica (sciatic nerve involvement):

• Sharp, shooting pain down the back of the thigh
• Pain extending into the calf, ankle, or foot
• Numbness or tingling following the nerve pathway
• Weakness in the affected leg
• Burning or electric shock sensations
• Pain often worse with sitting, standing from seated, or certain movements
• Pain may be constant or intermittent

Front of leg pain (femoral nerve or L2-L4):

• Pain traveling down the front of the thigh
• Numbness on the front of the thigh or inner leg
• Weakness in hip flexion or knee extension
• Pain often worse with standing or walking
• Different from classic sciatica but often confused with it

Upper lumbar radiculopathy:

• Pain in the hip or groin region
• Pain along the side of the thigh
• May not extend below the knee

Common Causes of Nerve Root Compression and Sciatica

Compression, inflammation, or irritation of nerve roots can occur from:

At the spine level:

• Disc herniation: Bulging or ruptured disc material pressing on nerve roots
• Foraminal stenosis: Narrowing of the opening where nerves exit the spine
• Bone spurs: Arthritic changes creating pressure on nerves
• Spondylolisthesis: Vertebral slippage affecting nerve space
• Degenerative changes: Age-related alterations reducing nerve space

Along the nerve pathway:

• Piriformis syndrome: Sciatic nerve compression under the piriformis muscle in the buttock
• Other muscle entrapments: Nerve compressed by tight muscles, ligaments, or tendons
• Scar tissue: From previous injuries or surgeries

Less common but serious causes:

• Tumors, cysts, infections, or abscesses (rare but require immediate medical attention)

Our Comprehensive Diagnostic Approach

When you visit our office with leg pain, we don’t assume “sciatica” and proceed with generic treatment. Instead, we conduct a thorough evaluation to determine:

Which nerve is involved?

• Sciatic nerve (L4-S3)
• Femoral nerve (L2-L4)
• Other lumbar nerve roots

Where is the compression occurring?

• At the spinal level (disc, stenosis, bone spurs)
• In the pelvis or buttock (muscle entrapment)
• Multiple sites (“double crush syndrome”)

What is causing the compression?

• Disc pathology
• Degenerative changes
• Muscle tightness
• Postural or biomechanical factors

Our examination includes:

1. Detailed Symptom History: Mapping exactly where pain travels provides crucial diagnostic information
2. Pain Pattern Analysis: Understanding what positions or activities worsen or improve symptoms
3. Neurological Examination: Testing sensation, strength, and reflexes in specific nerve distributions
4. Orthopedic Testing: Specific tests to identify disc problems, nerve tension, or other pathology
5. Spinal Assessment: Evaluating lumbar spine mobility, alignment, and tenderness
6. Muscle and Soft Tissue Evaluation: Checking for entrapment sites and trigger points
7. Functional Movement Analysis: Observing how you move and what provokes symptoms
8. Postural and Biomechanical Assessment: Identifying contributing factors
9. Red Flag Screening: Ruling out serious conditions requiring immediate medical intervention
10. Imaging Coordination: Ordering or reviewing MRI when necessary to visualize nerve compression

This comprehensive approach allows us to provide an accurate diagnosis: not just “sciatica,” but the specific nerve involved, the level and location of compression, and the underlying cause.

Our Targeted Treatment Approach

Once we’ve identified your specific condition, we create a personalized treatment plan. Treatment varies significantly based on diagnosis:

For Disc-Related Nerve Compression

• Non-invasive spinal traction/decompression therapy: Creating negative pressure to reduce disc bulging and relieve nerve pressure
• Directional preference exercises: Specific movements that centralize pain and reduce nerve irritation
• Spinal manipulation: When appropriate, to improve mechanics and reduce inflammation
• Core stabilization: Building support to protect the affected disc

For Foraminal Stenosis

• Joint mobilization: Creating space in the foramen where nerves exit
• Postural correction: Reducing compression through proper alignment
• Flexion-based exercises: Opening the foraminal spaces
• Traction therapy: Decompressing the affected levels

For Muscle Entrapment (like Piriformis Syndrome)

• Myofascial therapy: Releasing the compressing muscle
• Trigger point release: Addressing painful muscle knots
• Instrument-assisted soft tissue mobilization: Breaking down tissue restrictions
• Stretching protocols: Lengthening tight muscles
• Strengthening weak antagonists: Balancing muscle function

Universal Treatment Components

Regardless of the specific cause, treatment typically includes:

• Laser therapy: Reducing nerve inflammation and promoting healing
• Exercise therapy: Strengthening supporting muscles and improving flexibility
• Core exercises: Stabilizing the spine to prevent recurrence and reduce pressure on nerves
• Neural mobilization: Gentle techniques to improve nerve gliding
• Postural and ergonomic education: Addressing contributing factors
• Activity modification guidance: Learning what to avoid and what helps

The Importance of Movement

As with other spinal conditions, appropriate movement is crucial for recovery from sciatica and radiculopathy. Contrary to old beliefs about bed rest:

Appropriate movement:

• Reduces nerve inflammation
• Prevents muscle deconditioning
• Improves circulation to healing tissues
• Maintains neural mobility
• Prevents fear-avoidance behaviors
• Accelerates recovery

Prolonged rest causes:

• Muscle weakness
• Increased stiffness
• Nerve adhesions
• Prolonged disability
• Fear of movement
• Slower recovery

The key is learning which movements help versus hurt your specific condition—guidance we provide based on your diagnosis.

When to Seek Immediate Care

Most cases of sciatica and radiculopathy respond well to conservative care, but seek immediate medical attention if you experience:

• Progressive weakness in the leg
• Loss of bowel or bladder control
• Numbness in the groin or inner thighs (“saddle anesthesia”)
• Severe, unrelenting pain unresponsive to position changes
• Symptoms in both legs

These may indicate cauda equina syndrome, a medical emergency requiring immediate intervention.

Early Intervention Prevents Chronic Problems

The sooner nerve compression is addressed, the better your outcome. Prolonged nerve compression can lead to:

• Permanent nerve damage
• Chronic pain
• Persistent weakness
• Muscle atrophy
• Reduced quality of life
• Surgical necessity

Early treatment when symptoms first appear:

• Resolves symptoms more quickly
• Prevents nerve damage
• Addresses contributing factors before they worsen
• Reduces the risk of recurrence
• Helps you avoid surgery

Don’t Accept “It’s Just Sciatica”

If you’re experiencing leg pain, numbness, or weakness, don’t settle for a generic “sciatica” diagnosis without understanding:

• Which specific nerve is affected
• Where the compression is occurring
• What’s causing the problem
• Why it happened

Schedule a comprehensive evaluation so we can:

• Accurately diagnose your specific condition
• Differentiate between true sciatica, other radiculopathies, and referred pain
• Identify whether pain is from spinal compression or peripheral entrapment
• Explain why you have front-of-leg versus back-of-leg symptoms
• Create a targeted treatment plan based on your exact diagnosis
• Address contributing factors to prevent recurrence

Leg pain traveling down nerve pathways is your body’s signal that something needs attention. With accurate diagnosis and appropriate treatment, most people achieve complete resolution of their symptoms. The key is understanding exactly what’s happening—not just applying generic “sciatica treatment” and hoping for the best.

Don’t continue suffering with radiating leg pain. Get the thorough evaluation you need for an accurate diagnosis and effective, targeted treatment.