What Is Sciatica?

Sciatica describes pain that travels from the lower back into the buttock and down the leg. It may be caused by:

• Disc irritation

• Nerve root inflammation

• Lumbar disc bulge or herniation

• Spinal stenosis

• Acute flare of lower back pain

Symptoms can include:

• Sharp or burning leg pain

• Pins and needles

• Numbness

• Weakness in the leg

• Pain aggravated by sitting or bending

Importantly, imaging findings do not always correlate with symptoms. Many people have disc bulges without pain.

Why Sciatica Develops

Sciatica often occurs when the lumbar spine is exposed to load beyond its current capacity.

Contributing factors may include:

• Sudden increase in lifting or training

• Prolonged sitting

• Reduced trunk strength

• Poor load management

• Previous back pain episodes

• Stress and sleep disruption

Research shows that most disc-related nerve pain improves within weeks to months with conservative management.

Is It Really Sciatica?

'Sciatica' is one of the most over-applied terms in musculoskeletal health. Many people self-diagnose with sciatica based on leg pain, but genuine sciatic nerve root compression is just one of several conditions that can produce similar symptoms. Getting the diagnosis right matters, because the management differs considerably between them.

Conditions that are frequently mistaken for sciatica include:

• Piriformis syndrome or Deep gluteal pain — sciatic nerve irritation at the piriformis muscle in the posterior hip, producing buttock and posterior thigh pain without lumbar nerve root involvement. Often misidentified as true radiculopathy

• Proximal hamstring tendinopathy — deep buttock and posterior thigh pain worsened by sitting, sometimes accompanied by local nerve irritation, closely mimicking L5/S1 referral

• Lumbar facet referral — non-dermatomal referral into the buttock and posterior thigh from lumbar facet joint irritation, without true nerve root compression

• Peripheral nerve sensitisation — heightened neural mechanosensitivity producing leg symptoms along the sciatic nerve distribution without structural compression

• Vascular claudication — posterior leg pain and fatigue with walking that improves with rest; more common in older adults and occasionally mistaken for neurogenic claudication

• Hamstring strain — acute posterior thigh pain following a sprint or rapid eccentric load, occasionally confused with acute L5/S1 radiculopathy

At ADAPT. PERFORM., neural tension testing, lumbar assessment and peripheral differentiation are used to clarify the primary pain driver before committing to a rehabilitation approach. True nerve root compression, peripheral sensitisation and local soft tissue sources all have different optimal loading strategies.

How I Assess Sciatica in Bristol

At ADAPT. PERFORM., assessment includes:

• Lumbar movement testing

• Neural tension testing

• Strength and reflex screening

• Functional movement assessment

• Load tolerance profiling

I identify whether symptoms are primarily:

• Acute nerve irritation

• Load sensitivity

• Movement intolerance

• Or strength deficit-related

This allows us to tailor treatment precisely.