Get to the bottom of sciatica condition

Before you race to update your Facebook status with your self diagnosed sciatica, perhaps hold your fire a little bit longer so you might consider a helpful phrase we call "differential diagnosis", or "what else could that be"?
Sciatica is not the most popular girls' name for 2017, but is a concept in human pain experience that evokes both fear and dread in many people, because most of us know someone who was reasonably stifled in their everyday life by it.
As lay people the temptation is to think of it as a slipped disc, but as erroneous as the term slipped disc, so is it wrong to believe sciatica is only a low back problem.
Bill Boissonault, Professor of physical therapy, explains in his regular radio show anything that puts pressure on the sciatic nerve can irritate it enough to bring on the nervous system production of sciatica.
The sciatic nerve starts its life at the spinal cord, where five branches coalesce into one big fat chunky nerve. They unite just in front of a muscle that in English you would call The Pear Shaped Muscle - the Piriformis.
It is located in the area of the body that also can become pear shaped - the buttock. This is the first of the other options for explaining sciatica.
Piriformis Impingement or Syndrome involves the sciatic nerve when the muscle becomes injured or strained, or when a person has landed heavily on just the right area of their buttock.
It can become chronically tight in runners or walkers.
In around 10-17 per cent of people, the nerve passes through the muscle. This is a variation that offers the recipient a higher likelihood of experiencing sciatica than the rest of us. Heartening statistics once again. The dysfunctional muscle interferes with the nerve and can thus refer pain in similar ways to the classic sciatica, where pain travels down the back of the thigh and sometimes further into the calf, ankle and foot. There can be numbness or sensory loss along the same track or even weakness in the foot.
How can you tell if your sciatica is coming from your Piriformis? Firstly, you might not have noticed low back pain. You may be uncomfortable in the area immediately behind the hip joint. Peter Brukner, doctor for the Baggy Greens (those beloved Aussie cricketers), described the presence of a sausage shaped spasm in the buttock.
If you find yourself on the physiotherapy table, the stretching of the hip with the knee bent will be tight and uncomfortable, and resistance applied to outward hip rotation may hurt. Any of these will unlikely be part of a lumbar spine sciatica.
In the area of the spine, if sciatica is actually coming from a spine injury, how can we tell what is the cause?
In many cases is is hard to differentiate structures, especially if more than one is involved, but generally the pain is more often central low back pain with disc injury, and more off to one side with the joints of the spine.
If a vertebral joint is too mobile or looser where it should be more stable, it is possible to test this, as is true for vertebrae that are excessively less mobile. This can lead you to more long standing helps such as posture and lifting behaviours.
One of the most alarming signs that must not be ignored and should lead the patient to the emergency department, is the development of loss of bladder, bowel or erectile function. If the disc can find its way to compress the delicate spinal cord or nerves it is a medical emergency that must be investigated.
Severe arthritis in the low back can interfere with the natural course of the sciatic nerve but this is not usually a sudden development, but will probably be a gradual development with long years of back trouble. Direct nerve trauma as experienced in falls, blows in rugby or other contact sports or motor vehicle accidents may all deliver crushing trauma to the sciatic nerve.
Pregnancy where large off-centre mass levers the pelvis, and softening hormones are flooding the bloodstream can cause sciatica as well. In this case it usually is remedied by gentle movement exercise, water exercise or delivery of the off-centre mass!
In general, a couple of visits to a physiotherapist will get people the education they need to know how to move, what things to avoid, and even more importantly how to think.
Because low back injury is threatening and scary, it is important to know that the majority of victims of sciatic injury emerge unscathed out the other side. Catastrophic thoughts are more than dark clouds floating across the mindscape. Without good education, negative thinking can worsen pain states and delay recovery.
Bad advice can cause what physiotherapist Peter O'Sullivan calls Iatrogenic injury, which is where health professionals can lead sufferers down the path of "you are broken", "you might need surgery", "your disc is obliterated" and so on, and people suffer physical pain because of bad health advice. We are learning more and more as physios to think outside the model of "you must have damage because you have pain" - sometimes your brain is running the programme for pain in the absence of damage. This is what differential diagnosis is about and why armchair expertise can lead you off on a fruitless journey.
So if it goes pear shaped in your pear shape, get it sorted by getting informed and equipped.