Three Presentations of Sciatica
- Sharp pain in the buttock only: This is indicative of a piriformis muscle strain and/or spasm.
- Sciatica without low back pain: This suggests piriformis syndrome, in which the sciatic nerve is being squeezed by this muscle. However in this presentation, you still may have an “asymptomatic” bulging disc (one that isn’t painful) pressing a nerve root (L5, S1 – S4) or spinal stenosis from degenerative disc disease encroaching a nerve root. A lumbar X-ray or MRI is very useful in ruling out these two scenarios.
- Sciatica with lower back pain: This is more indicative of a bulging disc, especially if the onset was sudden. A lumbar MRI can confirm this diagnosis. This scenario is more likely if you:
- have a history of lower back pain with disc bulging;
- recently injured your low back from lifting something heavy or being in an accident;
- recently bent at the waist and felt a sharp pain in your buttock/leg;
- engaged in sports involving impact trauma to the spine
The third condition is more accurately called lumbar radiculopathy, which means “radiating pain down the leg(s) from lumbar nerve root compression.”
Note that sciatica from lumbar stenosis (#2), particularly narrowing of the canal due to bone spurring from degenerated disc disease is the most difficult to resolve, and may even require spinal decompression surgery.
If you find that the pain is persistent (lasting more than 2-3 weeks) despite massage, PT, chiropractic, stretching, yoga or pain medications and had an a lumbar MRI that did not show an obvious disc bulge or spinal stenosis, it would be wise to get a brain and pelvic MRI to rule out masses/tumors or other unusual anomalies capable of compressing the sciatic nerve.
NEXT: Addressing Piriformis Syndrome
