"Sciatica": The most common incorrectly self-diagnosed condition ever?

If we were playing Family Fortunes and the question was: "Name a condition seen by a physiotherapist?" The top answer would be: Low back pain.

Back pain affects so many people. With this comes so many worries, fears, concerns and myths. I read so many articles that try to lay some of these myths to bed but yet people still have this almighty fear. If I am honest, I still cringe to this day when I see referrals from clinicians that diagnose as sciatica. Hopefully the information below will go some way to undo this mis-diagnosed conditions.

So, let's go over a few things that could be going on in your back

Disc herniation

The term slipped disc is banded about all too often. This implies that the disc has moved. It hasn't! Disc herniation or disc prolapse or disc bulge are more accurate. Even though disc bulge sounds a bit scary! However, whatever we call it, it is very uncommon! All too often, clinicians will say "Something is pushing on your nerve". This only leads to increased worry and fear. In reality, your spine is extremely strong, it has to be, to withstand what we do on a daily basis. As I have blogged before, if we were to MRI scan the adult population, approximately 1/2 will show having some sort of disc herniation as part of a normal aging process and is not the source of your pain. Disc herniation is actually the least likely of reasons for low back pain.

Sacro-iliac joint dysfunction (SIJ) This is another area of the body that is often mis-diagnosed as the root of the problem. It is usually diagnosed by an over keen clinician who has been on an SIJ course and wants to find that one patient who has one. Ironically, it was only 24 hours ago that I did diagnose my first SIJ dysfunction! But I still had a 2nd opinion of my reasoning before I gave the diagnosis because it is so rare!

To be told that the reason for your low back pain is because something is out of alignment is extremely unlikely and extremely difficult to diagnose. And, like disc herniation, even if you do have mis-alignment, it is unlikely to be the course of your pain. For SIJ dysfunction to occur, you need to have had an almighty fall. A classic is being thrown from a horse. So unless there is no significant mechanism of injury, it probably isn't SIJ

Nerve impingement Nerves are a scary thing. People associate nerve pain with burning or pins and needles or numbness. Because we associate these pain types with nerve pain, our brain gets confused and thinks this is what we are feeling, when in fact what we are probably feeling is a heavy leg as opposed to numbness for example. The sharp shooting pain is unlikely to be a trapped nerve. Again, a true nerve impingement or trapped nerve is extremely uncommon. There is one simple test that you can perform on yourselves to rule out nerve impingement. Your clinician will check your dermatomes (ability to feel touch) and myotomes (the ability to withstand resistance) on you, yet if you were to scratch the area of your leg that feels "numb" with a pin and you truly cannot feel it, then you may have nerve impingement. If you feel it, then the pain you are probably feeling is more to be a heavy leg then altered sensations.

Piriformis Syndrome

I have to admit. When I was a student learning, my MSK lecturer advised us of this condition and explained that it is predominant in a significant population. However, further research has shown that this is untrue. Piriformis syndrome is again, very uncommon. The theory that the sciatic plexus (group of nerves) is running through your piriformis or that your piriformis is over-acting and pushing on your sciatic plexus is extremely unlikely. Now, I do have to say that piriformis syndrome does exist, but again is very unlikely to be the cause of your low back pain.

Muscle Tension

So here we are. The most likely reason for your low back pain. Your muscles over-working in your lower back. Be it due to trauma, muscle imbalance, poor posture or for whatever reason, this is the most likely reason for your low back pain. As a clinician, I get my clients to lay on their front and I immediately press into their low back and their bottom and say "Does that bring your pain on?" At least 99% of the time they jump, twinge, yelp or calmly say yes! Irrespective of the diagnosis, the advice is always the same: There is no harm going on inside your back. Your nerves are not getting damaged (or even trapped). You need to loosen those tight muscles, address the reason for the muscle over-activity and maintain normal movement of your low back. By thinking and acting in way that your back is under harm and damage, you are inadvertently making the problem worse.

More recent studies have been performed that identify people's belief and understanding of what is going on in their back has an impact of their recovery. If you have fear and worry, you will not get better as quickly as you have the potential to. Please, do not worry, if your clinician tells you not to worry, then try not to. Your clinician is duty bound to not lie to you. Your good clinician will find better ways to explain to you so not seeming to disregard your concerns but to put your mind at ease.

So please, don't worry, your back isn't going to snap. Your nerves are not getting trapped or damaged and your spine is certainly not crumbling through wear and tear! One thing our MSK lecturer said to us was: Move it or lose it!