Good to know
Sciatica means aggravation of the sciatic nerve which is the main motor and sensory nerve to the leg. If you have sciatica and sudden weakness in both legs, tingling or numbness around your genitals or inner thighs, or difficulty going for a wee then this might be a medical emergency and you should call 999 or go to A&E. It could be that serious, the doctors will explain when you get there! Fortunately this type of problem is quite rare but it’s good to know that every competent health professional has a responsibility to look out for it. If you ever see somebody for help with sciatica and they don’t ask about your recent toilet habits walk out the door because this person is incompetent.
A full diagnosis is crucial for the most successful treatment. There are 2 important points to consider: Mechanics and Sensitivity.
Mechanics: What is actually aggravating the nerve? Is it a disc herniation compressing a nerve root or is it a tight muscle like the piriformis. Contrary to popular belief we do not need an X-ray or MRI scan in most cases because mechanical aggravation patterns are easy to asses with manual testing.
Sensitivity: Could the nerve be unusually sensitive? Contrary to what many people think the sciatic nerve in an incredibly robust structure. As it passes through your buttocks it is as thick as your thumb, it’s not the scrawny piece of thread most people imagine. I’ve seen MRI scans with, almost complete obliteration of the space where the sciatic nerve roots are supposed to run but the person has had no pain or dysfunction. It is important to recognise that the sciatic nerve can function perfectly well under tremendous mechanical pressure but if the nerve is sensitised for example by stress hormones or inflammatory mediators it can be aggravated much more easily.
A full diagnosis in most cases will encompass mechanical and neural sensitivity factors and successful treatment will require both to be addressed.