Patients often present to our office saying, “My Sciatica is acting up.” This likely stems from the fact that patients turn to the Internet seeking answers regarding their symptoms. Sources on the Internet, such as Dr. Oz, WebMD, and Mayo Clinic, frequently offer some commonly accepted guidelines for diagnosing and treating a condition, and at times can be quite accurate. However, it is important to remind health care consumers that these sources provide information that is not based on a thorough health history or clinical examination.
Health care professionals understand that no patient is the same and that signs and symptoms do not often follow a “textbook” definition of a condition. As a result, it is vital that a professional examine the patient and screen carefully for any red flags or signs of serious pathology. For those patients coming to physical therapy, the cause of pain or dysfunction is almost always musculoskeletal, and rarely stems from serious pathology. However, in those rare cases, a physical examination is crucial.
Regarding musculoskeletal conditions, movement assessment is critical for a proper diagnosis, and online sources are unable to do this. It is also important to note that sciatica is a cluster of symptoms rather than a specific diagnosis. Individuals often assume this to be the root of their pain because they have heard of the sciatic nerve, it is located in the leg, and they may know someone who was had this diagnosis. The symptom of pain radiating into the leg is not exclusive to sciatica.
Numerous structures in the body and various pathologies can cause symptoms down the back and side of the leg, including any tissues in the low back, such as muscle, fascia, and joints between the vertebrae. These structures may be examined on an x-ray or MRI, and often times, findings will point to arthritis/degenerative joint disease or a situation where there is “bone on bone.” The majority of back pain however cannot be linked to one diagnosis and is of unknown cause. Orthopedic surgeon Gordon Waddell writes that a true pathology can be identified in only 15% of those with back pain. This means that the findings on images are often a normal part of the aging process, are incidental, and do not often explain the dysfunction a patient is experiencing. Regardless of what kind of back or leg pain you are experiencing, clinical signs and symptoms give practitioners a more definitive diagnosis than imaging alone. Physical therapists are qualified to screen for serious pathology, make an accurate assessment, and treat appropriately.
Key points to remember are that a thorough physical examination and patient history is needed to definitively diagnose a musculoskeletal condition, and online sources of health information should be used with caution. A variety of structures can cause lower extremity pain, and sciatica is often an inaccurate diagnosis. Finally, movement screening is a crucial tool physical therapist use to help identify and treat the underlying cause of pain or dysfunction