What is actually going on
A nerve can be compressed or irritated at spinal level (by a disc, or bony spurs from arthritis) or further down its path (for example by the piriformis muscle in the buttock). In Amy’s experience, though, the majority of "sciatica" is muscular pain referral.
That is when a muscle goes into spasm and causes so much pain that the brain assumes a larger area is hurting, a similar mechanism to the pain felt down the left arm in a heart attack. The most common culprit is the gluteal muscles (gluteus minimus). They usually spasm because the nearby sacroiliac (pelvic) joint is irritated or inflamed, from an acute sprain or repetitive strain, and the muscles tighten to protect it.
What we do about it
First, a full history and comprehensive examination to rule out a disc injury or nerve compression. Treatment is then usually myofascial release (deep tissue massage) and chiropractic manipulation to release the affected joint, always with home stretches and strengthening exercises to help prevent it coming back.
It is one of the most common problems chiropractors diagnose, and one we are rather good at treating.
When to get checked quickly
Persistent leg pain with numbness or weakness should be assessed. If your examination suggests a cause that needs medical investigation, you will be referred to your GP.
Common questions
Is sciatica always a trapped nerve?
No. In Amy’s experience most cases are pain referred from a spasming gluteal muscle, usually triggered by an irritated pelvic joint. An examination is the only way to tell which you have.
How long does sciatica treatment take?
It depends on what is causing it and how long you have had it. Most people need a course of treatment, typically twice a week at first, then spread out.