Sciatica is leg pain from an irritated nerve, and the irritation usually comes from a disc or from a tight muscle in the hip. A physical therapy evaluation tells which: Dr. Ed watches how you stand, bend, twist, sit and walk, tests the hips and checks whether a nerve is involved, because the cause is often somewhere other than where it hurts.
What the word sciatica means
Sciatica describes where the pain travels, not what is causing it. MedlinePlus says sciatica "refers to pain, weakness, numbness, or tingling in the leg" and is caused by injury to or pressure on the sciatic nerve. It calls sciatica a symptom of a medical problem, not a medical condition by itself. The same page says the nerve starts in the lower back and runs down the back of each leg.
The American Academy of Orthopaedic Surgeons (AAOS) calls it "a very broad term describing nerve pain, not a specific diagnosis." It describes the pain as felt in the lower back or hip and spreading to the back of the thigh and into the leg.
Two places the nerve can be irritated
Dr. Ed's treatment aims at what is irritating the nerve, usually a disc or a tight muscle in the hip, and at the movements that keep irritating it. Which one it is shapes the plan.
On the disc side, the AAOS says sciatic pain occurs "when the nerve root in the lumbar spine is compressed (squeezed)," and names a herniated disc as one cause of that compression. StatPearls, a medical reference on the National Library of Medicine Bookshelf, calls a herniated or bulging lumbar disc the most common cause of sciatica.
On the hip side, the National Institute of Neurological Disorders and Stroke describes piriformis syndrome. It happens when the piriformis, a thin muscle in the buttocks that allows the hip to rotate, presses against the sciatic nerve. StatPearls says that, because the sciatic nerve is so close, any injury or inflammation of that muscle can cause sciatica symptoms. Sciatica that starts at a tight hip muscle is a specialty of Dr. Ed, and he sees it often.
These are not the only causes. MedlinePlus also lists spinal stenosis and pelvic injury or fracture among the common ones. So the word sciatica does not tell you which cause is behind it.
How the evaluation tells them apart
Dr. Ed does not start with the sore spot. This is the sequence, in order:
- He watches how you stand, bend, twist, sit and walk.
- He tests the hips, the mid-back and the muscles that are supposed to be holding the spine steady.
- He checks whether a nerve is involved.
- He explains what he found in plain terms and tells you what the plan is.
Two steps speak to the question in the title: he tests the hips, and he checks whether a nerve is involved. The cause is often somewhere other than where it hurts. The evaluation is where he finds it, at a disc, in a tight hip muscle or somewhere else.
For comparison, StatPearls calls sciatica a clinical diagnosis, so a thorough history and physical examination are necessary for a complete evaluation and diagnosis. The AAOS says a physical examination may help pinpoint the irritated nerve root. It adds that a doctor may ask you to squat and rise, walk on your heels and toes, or perform a straight-leg raising test or other tests. MedlinePlus adds that tests such as imaging and blood tests are often not needed unless pain is severe or long-lasting.
When to contact a doctor right away
MedlinePlus lists signs that mean you should contact your health care provider right away. They include:
- Weakness or numbness in your buttocks, thigh, leg, or pelvis
- Loss of control of urine or stool
- Back pain after a severe blow or fall
- Unexplained fever with back pain
- Severe pain and you cannot get comfortable
It also says to contact your provider if this episode of back pain has lasted longer than 4 weeks. The full list is on the MedlinePlus page.
What to do next
You do not need to arrive knowing whether it is the disc or the hip. That is what the evaluation is for. Read more about sciatica, see what patients say on the Reviews page, or book an evaluation below.