When patients walk into a physiotherapy clinic complaining of sharp, radiating pain down their leg, many assume they already know the diagnosis: sciatica. It’s common for patients to believe they have sciatica when, in fact, their symptoms don’t align with a typical sciatica presentation. While sciatica is a frequent diagnosis, its symptoms can mimic those of other conditions, such as somatic, referred spine-related leg pain, hip pathologies, peripheral artery disease, or peripheral neuropathies – so even us physios can get it wrong! How can we be sure it’s truly sciatica?

What is “sciatica”, really?

People tend to label most spine or nerve-related leg pain sciatica, but this may be a mistake. How likely is it that the sciatic nerve is the sole culprit responsible for that radiating leg pain? Let’s consider a disc herniation that irritates a nerve root, like S1. That nerve root branches off into multiple nerves – not just the sciatic nerve! So why call this sciatica?

Here’s a quote from Charlie’s presentation:

“Usually, leg pain that comes from the spine is often going to be very heterogeneous in terms of how it presents… Very, very rarely is it going to just be an isolated mononeuropathy solely affecting that sciatic nerve”.

So, instead of “sciatica”, we can refer to nerve root-related pain coming from the lumbar spine as “lumbar radicular pain” – just like we don’t habitually call a cervical nerve root pathology “radial nerve pain”! Alternatively, if you choose to continue using the term “sciatica”, just understand that this does not automatically mean we are dealing with an issue that solely impacts the sciatic nerve.

The patient presented with back pain, along with sharp, radiating leg pain, raising the suspicion of radicular pain. So, how can we confirm this suspicion?