Myths

Common Misconceptions about Sciatica

In this section, we'll discuss what people commonly think when they hear the word "sciatica" and use up-to-date research to help clear the air and set the record straight. If you haven't already, we strongly encourage you to take a look at the other sections of this website and come back if your questions still are not answered, or you are just curious.

The myths being covered have been separated into several sections below for easier navigation: Definition, Onset, Treatment, and Outlook

Myths: Categories

Definition

Myths pertaining to how sciatica is understood

"Sciatica is a condition in and of itself."

Sciatica is primarily described as a symptom in which there is an irritation to the sciatic nerve or its roots from the spinal cord. The cause of the irritation, however, can be variable (Ropper & Zafonte, 2015).

"Sciatica is the result of leg issues."

Disturbances anywhere along the sciatic nerve can cause sciatica but the most common areas are at the sites of disk rupture and osteoarthritic change in the spine, typically L4-L5 and L5-S1 (Ropper & Zafonte, 2015).

"All shooting leg pain is sciatica."

Sciatica is, by definition, radiating pain along the sciatic nerve pathway. However, the sciatic nerve is not the only nerve found in the leg. Therefore, shooting leg pain that does not follow the pathway of the sciatic nerve is not sciatica. This means that shooting pain along the front of the leg and along the inside of the leg is not sciatica and would likely be due to irritation along the femoral nerve pathway (Vazquez et al., 2007).

"All patients with sciatica have the exact same symptoms."

Sciatica may begin suddenly or slowly over a long period of time. Sciatica is usually only felt on one side but could be felt on both. Pain can be located directly in the middle of the back of the thigh, along the side in the back of the thigh, or along the side toward the front, all depending on which level of spinal nerve is affected (Ropper & Zafonte, 2015). The sciatic nerve sends branches below the knee, so symptoms could be felt in the lower leg or foot as well.

Sciatica may be caused by a number of issues related to the spine, surrounding musculature, infection, or trauma - these causes may be accompanied by additional and variable symptoms (Ropper & Zafonte, 2015).

"Pain is the only problem associated with sciatica."

Sciatica is defined as pain along the sciatic nerve pathway. However, it is important to understand that this pain can be caused by a number of issues related to the spine, surrounding musculature, infection, or trauma (Ropper & Zafonte, 2015).

It may be more beneficial to first consider what is causing the pain and then consider the problems that pain brings with it.

"Sciatica symptoms are constant."

Sciatic pain has aching and sharp components which may occur under varying circumstances (Ropper & Zafonte, 2015).

There are often positions in which the pain is more or less intense and these positions are used to confirm sciatic pain (Valat et al., 2010).

Myths: Infographics

Onset

Myths pertaining to the causes of sciatica

"Sciatica cannot be prevented."

Preventable and modifiable risk factors associated with the onset of sciatica have been identified. These risk factors include smoking, obesity, and existing low back pain (Cook et al., 2013). Low back pain is a common occupational hazard and has been associated with twisted work postures, exposure to whole-body vibration, load lifting, and cumulative loading involving rotation (Miranda et al., 2002).

"A specific event brings on sciatica."

Sciatica due to disk rupture and degenerative spine disease is more common than all non-spinal causes combined. Additionally, the sciatic nerve may become entrapped due to muscular tightness or anatomical structure (Ropper & Zafonte, 2015). All of these causes typically occur over time and sciatica is very rarely the result of a single event.

"Getting sciatica properly diagnosed is difficult and/or expensive."

Sciatica is mainly diagnosed through history taking, pain diagram/description, and physical examination via tests attempting to reproduce reported pain. Imaging is often not necessary or useful unless red flags are present (Koes et al., 2007).

However, keep in mind that sciatica is not as much of a diagnosis as it is a confirmation of reported symptoms.

"Sciatica only affects inactive people."

Personal and occupational risk factors have been identified, including age, height, weight, mental stress, smoking, and exposure to vibration from vehicles. Evidence for an association between sciatica and sex or physical fitness is conflicting (Koes et al., 2007).

Several occupational hazards have been identified as risk factors for developing sciatica (Miranda et al., 2002; Tubach et al., 2003).

Myths: Infographics

Treatment

Myths pertaining to the do's and don'ts of sciatica

"Sciatica will go away on its own."

While this may be true for some, depending on the cause of the condition, there is no reason to believe that this condition will improve without at least taking conservative action in the first 6-8 weeks (Valat et al., 2010).

"Sciatica must be corrected by surgery."

More than 50% of patients reported symptoms of sciatica 2 years following surgery (Tubach et al., 2003).

Greater outcomes following surgery begin to diminish just 4 years following the operation when compared to physical therapy (Weber, 1983)

"Surgery is never a good option for sciatica."

Sciatic-like symptoms may be present in cases of infection, tumor, fracture, and cauda equina syndrome, in which case surgery is required (Valat et al., 2010).

Results of a foundational comparative study assessing short- and long-term effects of surgery versus conservative treatment argued that surgery resulted in better outcomes after 1 year but the differences diminished beyond 4 years (Weber, 1983)

"Medication is the best way to relieve symptoms of sciatica."

One study found no difference in overall improvement or amount of sick leave at short-term follow-up between the use of an NSAID (Piroxicam) or muscle relaxant (Tizanidine) compared to a placebo (Luijsterburg et al., 2007).

Epidural corticosteroid injections may be used as a means of reducing pain in the short-term but no long-term effects can be expected (Luijsterburg et al., 2007).

Transforaminal periradicular injections (TPIs) have been shown to be more effective than epidural injections, however, they are also associated with greater risk (Valat et al., 2010)

"Sciatica is best treated with bed rest."

Research has shown no differences in pain, disability, or overall improvement when comparing bed rest to no adjustment in daily living (Luijsterburg et al., 2007).

Rest and bed rest are not recommended and, in fact, have been shown to have a harmful effect in acute low-back pain and sciatica (Valat et al., 2010)

"Everyone will benefit from the same treatment method."

In a study comparing surgical and conservative outcomes, 25% of the participants receiving conservative care opted for surgery after 7.5 months of minimal improvement (Weber, 1983).

A similar but more recent study showed 40% of participants opting for surgery following dissatisfaction with physical therapy (Osterman et al., 2006)

However, long-term outcomes have been shown to be similar between both groups in both studies.

Myths: Infographics

Outlook

Myths pertaining to short- and long-term expectations

"Sciatica pain will never go away."

Regression of symptoms is reported to occur in almost 85% of cases and one study showed no symptoms at a 2-year follow-up in 45% of participants (Tubach et al., 2003).

"Sciatica pain will only get worse with exercise."

Physical therapy in addition to treatment from a general practitioner has been shown to be more beneficial than only treatment from a general practitioner in terms of pain reduction and overall improvement (Luijsterburg et al., 2008)

"Treatment of sciatica is temporary and the pain will return."

There are measures you can take to set yourself up for success, including minimizing some identified predictive factors for persistent/recurrent sciatica. These include: driving 2+ hours per day, high pain intensity, carrying heavy loads at work, and psychosocial factors (Tubach et al., 2003).

"Treatment of sciatica is permanent and the pain will never return."

55% of participants identified with sciatica reported still experiencing sciatica in a 2-year follow-up (Tubach et al., 2003).

More than 50% of patients reported symptoms of sciatica 2 years following surgery (Tubach at al., 2003).

Myths: Infographics

References

Cook, C. E., Taylor, J., Wright, A., Milosavljevic, S., Goode, A., & Whitford, M. (2014). Risk factors for first time incidence sciatica: a systematic review. Physiotherapy Research International, 19(2), 65-78.
Koes, B. W., Van Tulder, M. W., & Peul, W. C. (2007). Diagnosis and treatment of sciatica. Bmj, 334(7607), 1313-1317.
Luijsterburg, P. A., Verhagen, A. P., Ostelo, R. W., Van Den Hoogen, H. J., Peul, W. C., Avezaat, C. J., & Koes, B. W. (2008). Physical therapy plus general practitioners’ care versus general practitioners’ care alone for sciatica: a randomised clinical trial with a 12-month follow-up. European Spine Journal, 17(4), 509-517.
Luijsterburg, P. A., Verhagen, A. P., Ostelo, R. W., Van Os, T. A., Peul, W. C., & Koes, B. W. (2007). Effectiveness of conservative treatments for the lumbosacral radicular syndrome: a systematic review. European Spine Journal, 16(7), 881-899.
Österman, H., Seitsalo, S., Karppinen, J., & Malmivaara, A. (2006). Effectiveness of microdiscectomy for lumbar disc herniation: a randomized controlled trial with 2 years of follow-up. Spine, 31(21), 2409-2414.
Ropper, A. H., & Zafonte, R. D. (2015). Sciatica. New England Journal of Medicine, 372(13), 1240-1248.
Tubach, F., Beauté, J., & Leclerc, A. (2004). Natural history and prognostic indicators of sciatica. Journal of clinical epidemiology, 57(2), 174-179.
Valat, J. P., Genevay, S., Marty, M., Rozenberg, S., & Koes, B. (2010). Sciatica. Best Practice & Research Clinical Rheumatology, 24(2), 241-252.
Vazquez, M. T., Murillo, J., Maranillo, E., Parkin, I. G., & Sanudo, J. (2007). Femoral nerve entrapment: a new insight. Clinical Anatomy: The Official Journal of the American Association of Clinical Anatomists and the British Association of Clinical Anatomists, 20(2), 175-179.
Weber, H. (1983). Lumbar disc herniation: a controlled, prospective study with 10 years of observation.

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