Patients often arrive having already been told they have sciatica — or having concluded it themselves. It is a reasonable starting point, but it is worth understanding what the word does and does not mean.
Sciatica is a description, not a diagnosis
Sciatica means pain travelling along the path of the sciatic nerve: from the lower back or buttock, down the back of the thigh, sometimes past the knee into the calf or foot. It tells you where the pain is and roughly which nerve is involved. It does not tell you why.
The distinction matters because the underlying causes are treated differently.
Things that produce similar pain
- Lumbar radiculopathy. A nerve root in the lower back is compressed or inflamed — often by a disc protrusion or by degenerative narrowing. This is the classic cause.
- Spinal stenosis. Narrowing of the spinal canal, more common with age. Characteristically the pain worsens with walking or standing upright and eases when leaning forward or sitting.
- Facet joint pain. Pain from the small joints of the spine, which can refer into the buttock and thigh but usually stops above the knee.
- Hip pathology. Hip joint problems refer pain into the groin and thigh and are regularly mistaken for spinal pain.
- Peripheral neuropathy. Nerve damage that produces burning or numbness in both feet, rather than pain following one nerve down one leg.
How the cause is worked out
The examination is doing something specific: mapping the pain against known anatomy. Which movements provoke it, where sensation is altered, which muscles are weak and how the reflexes behave together indicate which nerve root — if any — is involved. That map is then compared against imaging, if imaging is needed.
This is also why scan findings are interpreted cautiously. Disc bulges are common in people with no pain at all. A finding on an MRI is only meaningful if it matches what the examination shows.
Where the picture remains unclear, nerve conduction studies or EMG can help distinguish a nerve root problem from a peripheral nerve problem.
Why the distinction changes treatment
If an inflamed nerve root is the cause, reducing inflammation around that root — sometimes with an epidural steroid injection — may be appropriate. If the facet joints are the source, a medial branch block can confirm it and point toward longer-lasting options. If the hip is responsible, no amount of spinal treatment will help.
Getting this right is the difference between treatment that works and treatment that merely passes the time.
What you can do before an appointment
Note where the pain actually travels and how far down it goes; what positions or activities make it better or worse; whether there is numbness, tingling or weakness, and exactly where; and how long it has been going on. Bring reports and images from any previous scans. This detail meaningfully shortens the route to an answer.
When not to wait
Seek emergency care if you develop weakness that is rapidly worsening, numbness around the groin or inner thighs, or any new difficulty controlling your bladder or bowels. These are uncommon, but they need immediate assessment.