What Causes Sciatic Pain of the Low Back

Featuring Gordon Bohlmann, BSc (PT), CGIMS, OMT, BSc HMS Marpole Physiotherapy

Duration: 3 minutes and 32 seconds

Sciatic pain, or sciatica, is a typical complaint that people will come into the clinic with, and what they usually mean by that is that they have pain somewhere in their back or going down their leg. It's important to remember that sciatica, or sciatic pain is really not a diagnosis, but a set of symptoms by which people describe pain, so it's very important to be assessed by a physiotherapist to determine where the pain is coming from, because it could come from a number of different structures.

If we have a look at the lumbar lumber, pelvic spine, we have the vertebra, which are these bones over here, and the lumbar spine is comprised of the last five vertebral segments. This is our sacrum or tailbone, and these are the two hip or pelvic bones with the hip joints sitting on either side over here. And five of these nerve roots will join together to form the sciatic nerve. And we have one on each side, one on the left and one on the right. So because sciatica is a complaint which can affect any of the five nerve roots, comprising of the big sciatic nerve, it's very important for your physiotherapist to assess each one of these levels to determine what the cause might be. So depending on where that nerve is becoming either irritated or compressed, we could have symptoms which mimic or are described as sciatica. They can be things like numbness or tingling going down the leg or into the foot, difficulty in controlling the muscles supplied by those nerves, pain or incoordination.

And so there are four common causes of sciatica. One might be a disc, which, in layman's term, is called the slip disc. Really, it's a herniated disc in which the disc tissue gets torn and that can push on a nerve root. The second could be something called spinal stenosis, which is compression around the central part of the nerve inside the spinal column. The third most common cause is something called spondylolisthesis, which is a big word that means one vertebra has slipped forward on another. The last most common cause of sciatic pain is something called piriformis syndrome. The piriformis is a muscle which runs through the pelvis from the sacral bone onto the hip bone. So as the sciatic nerve traverses this part, the piriformis muscle can compress that sciatic nerve and that can give you pain further down, because we know that sciatica has a set of symptoms rather than an actual diagnosis, it's important to get an assessment by a physiotherapist experienced in dealing with sciatica to be able to accurately determine where the pain is coming from.

Typically, when you see your physiotherapist, he or she will do an assessment, which consists of a subject of evaluation, during which number of questions are asked to determine the history of your pain and probable causes, followed by an objective examination, where your physiotherapist will use a variety of physical tests to put stress or load on various structures that could be responsible for the pain. An example of this would be a straight leg raise test, or stress tests of the lumbar spine joints to determine if they're at fault.

If you, as a patient, are complaining of pain in your buttock, lower back or leg, especially if that pain travels from the lower back down the leg, or you're experiencing symptoms of tingling, numbness pins and needles, or you're having trouble controlling the muscles in your low back and leg. It's very important to see a physiotherapist today to determine the causes of this pain.

Presenter: Gordon Bohlmann, Physiotherapist, Vancouver, BC

Local Practitioners: Physiotherapist