Myths and Misconceptions About Sciatica
Our longest nerve in the body, the sciatic nerve travels from the lower back and buttocks into the legs. It is very common for people to have problems with the sciatic nerve, including sciatica. However, many people are unaware and misinformed as to what sciatica actually is…
Myth #1: Sciatica is a Diagnosis
Contrary to what many patients believe, sciatica is actually a set of symptoms rather than a diagnosis for what is causing the pain.
The most common lower back problems that cause sciatica are disc herniation, lumbar degenerative disc disease, spondyloistehesis, spinal stenosis, lumbar spine and sacroiliac joint misalignment.
Especially for more severe cases, the cause of the lower back pain and leg pain needs to be correctly addressed in order to relieve discomfort.
Myth #2: Piriformis Syndrome is Also True Sciatica
Piriformis syndrome is a condition that is often confused with true sciatica. When the piriformis muscle becomes tight, it can irritate the sciatic nerve. This causes sciatica-like pain, tingling and numbness that often run from the lower back to the rear, down the leg and into the foot.
Although the discomfort from Piriformis syndrome feels similar to sciatica, the two have different causes. With Piriformis problems, the pain is not caused by a compressed nerve root where it exits the spine as occurs with true sciatica.
Myth #3: Arthritis Pain is Also Considered Sciatica
The pain from arthritis or other joint problems is actually more common than sciatica, and they are often confused. In reality, sciatica and arthritis are classified as different types of pain.
In contrast, referred leg pain from arthritis is dull, achy and often moves around and varies in intensity. Although the leg pain from arthritis may feel similar, it is not truly sciatica. Distinguishing the correct problem is important because the treatments for each type of pain often differ.
Myth #4: The Sciatica Experience is Similar For Each Patient
Sciatica symptoms can be different for each patient depending of the severity of the case and tissues involved. Patients feel different types of sciatic pain depending on the location of the nerve compression.
The pain can run from the low back, down the back of each leg and sometimes into the feet and toes. Tingling and/or a burning or prickly feeling, usually only on one side of the body can be present or not.
The severity and duration of pain from sciatica also vary among patients. Some find sciatica pain severe and debilitating, while others experience it as irritating and intermittent.
Myth #5: Everyone Suffering From Sciatica Needs an MRI
A John Hopkins study published in 2011, suggests that MRI’s are costly (they average around $2,600 in the United States) and unnecessary for many back patients. According to the study, if you were to look at 100 middle-aged people who have never had reported back pain, two thirds of them would still show spinal abnormalities on an MRI.
Some people who have complained about back and leg pain will have a positive MRI reading that is not the cause of the pain . Others will have a negative MRI reading indicating pain originating not from spine but somewhere else. Since the correlation between an MRI reading and sciatica pain is low, an MRI should not be routinely prescribed.
Myth #6: Injections are a Magic Cure for Sciatica
Many significant studies indicate that epidural steroid injections are not a magic cure for sciatica pain. According to Annals of Internal Medicine, with steroid shots, back pain relief is only temporary, at best. The researchers concluded this by analyzing data from 30 studies of steroid injections for back pain radiating to the legs caused by a herniated disc and 8 studies for sciatica pain caused by spinal stenosis.
Researchers found very few benefits for sciatica pain associated with disc herniation and no benefits for sciatica pain associated with spinal stenosis. So, most of the millions of steroid injections given each year to people with back pain are unnecessary!
The Truth: Physical Therapy is Crucial to Help the Problem Causing Sciatica
Some patients believe that staying in bed and avoiding physical activity is the best idea when sciatica occurs. For the initial flare up of sciatica, bed rest is usually fine for a day or two.
However, avoiding activity any longer can typically lead to a downward spiral where episodes of pain lead to inactivity, leading to more pain, and so on.
Without proper exercise, low back muscles become weak and deconditioned, leaving them less able to support the back and the spine. Keeping the hip flexors, paraspinal musculature and hamstrings flexible is particularly important for sciatica patients, because muscle tightness compresses lumbar spine adding stress to the low back, which can aggravate sciatica pain. Core and hip stabilization exercises help stabilize and unload the spine. Furthermore, exercise also helps exchange nutrients within the spinal discs, improving their ability to heal and regenerate.
Gentle aerobic exercises increase level of natural pain-killers (endorphins) and help with symptom control. Modalities, such as the 830 Cold Laser we use at Lilly PT, help with pain, inflammation and swelling control.
Patients should perform a gentle exercise program that includes stretching, strengthening and low-impact aerobic exercise. Even after sciatica is relieved and other back problems have been treated, the exercise routine should be maintained to keep the back healthy and to help avoid future problems.