Physicians commonly misdiagnose sciatica, or sciatic pain, which is when a patient has pain running from their butt down the back of their leg. Although this may be along the pathway of the sciatic nerve, the sciatic nerve has no sensory innervation above the knee. That means you can’t feel pain from the sciatic nerve between your butt and your knee. You can only feel the pain from the sciatic nerve from below your knee down to your foot. When pain below the knee is truly present, only then can the diagnosis sciatica be given. But if the pain isn’t below the knee, but along where the sciatic nerve runs, this is termed sclerotogenous referred pain. But remember, as with anything and everything else, “diagnosing” is only really beneficial if you diagnose the process, not the symptom. So call it what you like!
Sclerotogenous referred pain occurs over the area where muscles and ligaments originated during fetal development. While sciatic pain will many times cause weakness and fatigue, sclerotogenous pain will (usually) not. Both sciatic pain and sclerotogenous can be present together and they can both occur from the same problem. Take, for example, an injury to the lower back involving the fifth lumbar disc. This injury can alter biomechanics resulting in sciatic nerve impingement. Since the fifth lumbar segment has a sclerotogenous referred pain region down the back of the leg, this type of pain can also be present. Treating the disc injury and attending to the inflammation will resolve both types of pain. A spasm of the piriformis muscle, (a deep muscle under your major buttocks muscle), can impinge the sciatic nerve, causing shooting pain down to the foot. This is a very common cause of “true” sciatica.
Check out the accompanying lower back/”sciatica” video here.
Can you comment on running with lumbar spine stenosis, spondylolesthesis and bulging discs?
Dr. Stephen Gangemi says
Briefly – if the muscles and all the connective tissue/fascia are functioning well (or with those conditions – once the imbalances are corrected) then the symptoms (pain, weakness) from those conditions should be greatly reduced. It’s no different than someone with severe arthritis – they can have little to no pain if the functionality of the soft tissue is resolved, even if the arthritis doesn’t improve.