Sciatica or Biomechanical Pain? How to Tell The Difference

Sciatica is one of the most misdiagnosed issues we see today. Anytime someone presents with pain that radiates or travels down their leg, they are told that it’s likely sciatica. GP’s often make this mistake without any imaging or testing to support their hypothesis.

While sciatica is of course a real issue, biomechanical pain is something that can also cause symptoms that may be mistook for something involving this nerve. For this reason, labeling every pain down the leg as “sciatica” can be damaging as people’s perception of this term can often lead them to believe the issue they have is more serious than it is.

What is Sciatica?

Sciatica is in inflammation of the sciatic nerve. This nerve comes from our lumbar spine and travels down the back of our leg with its tributaries reaching the foot. Like any true nerve issue, it can present as severe pain that has elements of numbness, throbbing, and burning associated with it. Often relentless, it can persist even at rest or while sleeping.

What Causes Sciatica?

For the sciatic nerve to become inflamed, it must be compressed somewhere along its path. Either at its root in the spine by a bulging disc, or as it travels through the musculature of the leg. The issue with trying to clinically diagnose this issue is that it often just presents as pain down the leg, absent of any symptoms that would deem it truly nerve like.

Regardless of it’s presentation, this nerve does not just spontaneously start acting up. Excessive compression in the body as it moves is what causes discs in the spine to bulge, or restriction of the muscle and fascia around the nerve as it descends. Usually this compression is caused by instability in the hips and pelvis as we walk or do other activities.

Biomechanical Pain

This is a very broad term, but what we mean by this is pain that is generally associated with poor biomechanics. The instability mentioned above qualifies as something that would cause the body to be compromised, and as a result start to compensate by creating dehydrated adhesions in between the layers of muscle and fascia.

Why is Fascia Relevant?

Fascia is a dense, fibrous connective tissue that creates a network connecting all of the soft tissue around the body. The fascia houses the muscles, but not only that, all of the neural and blood networks that are present in the body. It has the ability to transmit force in order to maintain balance and structural integrity during movement and can  transmit sensations of pain too.

As the fascia and nerves are so closely related it is difficult at times to tell which structure is giving us pain symptoms. Unless an MRI confirms that there is nerve compression a the spine there is a high likely hood that structures other than the nerve itself like the muscles and fascia are also contributing.

The Solution

Regardless of whether someone’s pain is being caused by true sciatica or something else, there is always an underlying biomechanical issue that has caused it. It’s crucial to assess someone’s gait and posture to understand what part’s of the structure are unstable and getting excessively compressed. Once this has been done, we can train in a way that improves those tendencies in order to not only recover from the current issue but also future proof against any issues that may come down the line.