Do I Have Sciatica, or Something Else?


What conditions can mimic sciatica?

Back pain accompanied by pain radiating down one or both legs is sciatica, right? While that's often the case, several other back problems can be confused for highly common sciatic-type pain, according to Kaliq Chang, MD, of Atlantic Spine Center.

First, what is sciatica? It's not a condition, but actually, a term used to describe symptoms caused by compression of the sciatic nerve, explains Dr. Chang, an interventional pain management specialist. All sciatica cases have one thing in common: The pain begins in nerve roots located on either side of the lower spine but radiates down the spine in a way that can be much worse than back pain alone.

So, sciatica is usually leg pain caused by an affected longest and widest sciatic nerve. This nerve provides movement, sensations, and strength to the lower part of the body. If this nerve is compressed, you can feel pain or weakness in the legs.

"This radiating pain can worsen while sitting, or it can show up as a sharp, constant pain on the back of the leg that hinders standing or walking," Dr. Chang says. "Some cases of sciatica result in numbness or tingling down one leg, and severe cases, which are rare, can include weakness or loss of motor function in the leg or foot."

Sciatica causes

When the sciatic nerve is compressed, the resulting pain is due to one of several underlying common conditions, Dr. Chang says. These include:

  • Bulging spinal disc
  • Herniated spinal disc
  • Spinal stenosis (a narrowing of the canal surrounding the spinal cord)
  • Scar tissue
  • Spinal bone spurs

"Essentially, any condition coming from the lower back close enough to the sciatic nerve can prompt sciatica, he says. "Symptom severity, however, is highly variable. For one patient, the pain is mild, while for another, it may stop them in their tracks."

Sciatica and sciatica-like conditions diagnosis

Several causes of leg pain certainly feel like sciatica but aren't because they're due to other conditions. These include:

  • Piriformis syndrome, which happens when the piriformis muscle in the buttocks irritates the sciatic nerve, causing radiating pain down the leg. "Although piriformis syndrome feels extremely similar to sciatica, it differs because the nerve irritation doesn't stem from the lower back," Dr. Chang explains.
  • Spinal joint problems such as arthritis. These joint problems can result in 'referred' pain from the affected joint into the leg that feels like sciatica but isn't, Dr. Chang says.
  • Sacroiliac joint dysfunction occurs when the sacroiliac joint that connects the bottom of the spine to the pelvis moves too little or too much. "The resulting pain can radiate down the legs like sciatica," Dr. Chang says.

While these variations may seem small, they can mean significant differences in how a back condition is treated. How can doctors correctly diagnose sciatica and differentiate it from similar situations? Fortunately, there's a test that accomplishes this known as the straight leg raise, Dr. Chang says.

For the test, patients are asked to lay flat on their backs with their legs extended straight in front of them. The physician slowly raises each leg, noting the elevation of the patient's pain begins. The test helps doctors determine where the sciatic nerve is being compressed and can also help determine the cause.

"X-rays or imaging scans such as CTs or MRIs may also be used to pinpoint sciatica's cause after the straight leg raise," Dr. Chang explains. "The key thing is to see a physician for a correct diagnosis. Depending on the true cause of your pain, prompt treatment may be crucial."

To prevent these conditions, you should maintain a healthy lifestyle and add some physical activity to your daily life. For example, you can perform special sciatica exercises that are beneficial for your back. Not only do they prevent back issues, but they also provide sciatic nerve pain relief. With these exercises, the pain can ease for quite a while. Other pain-relieving options are those you can do yourself, like putting ice or heat on the sore spot, and the ones your doctor can recommend. Prescribed and over-the-counter pain medications, epidural steroid injections, and physical therapy can be included in your pain management program.