Low back pain is an extremely common condition that affects almost everyone in some form. It is also common for people to report referred pain or symptoms travelling down the leg, particularly down the back of the leg. When that happens, many people immediately conclude it is sciatica, or tell me they have been diagnosed with sciatica without any thorough investigation.
To get the best outcomes, it is important not to assume you have sciatica just because the symptoms seem to fit. That assumption can lead to fear-avoidance of everyday activity, which causes further problems down the line, or to poor treatment if the practitioner does the same. So is it really sciatica? Here are five common myths about back pain and sciatica you should know.
Myth 1: It Is Always the Piriformis
If you have seen a physiotherapist or another practitioner before, you may have been told your sciatica is caused by the piriformis muscle compressing the sciatic nerve. Once called piriformis syndrome, this is now more often referred to as deep gluteal pain syndrome.
While the piriformis can be involved, it is heavily over-diagnosed and widely misunderstood, particularly across social media. Several other structures can contribute to sciatica, and in some cases the region is not the source of your symptoms at all. A thorough physical examination, and imaging if needed, is what identifies the real cause.
Myth 2: Sciatica Is a Diagnosis
Sciatica is not a condition in itself. It is a symptom, sometimes a very pronounced one, that usually stems from an underlying condition. Common examples include:
- Herniated disc
- Spinal stenosis
- Deep gluteal pain syndrome (previously piriformis syndrome)
- Hip joint pathology
- Peripheral neuropathy (nerve pain not coming from the spine)
Because of this, treating sciatica in isolation is not enough. There is a lot of misinformation out there, and a good health practitioner should not just be treating your sciatica, but actively working to identify the root condition causing it. Seeing a physiotherapist to determine the source of your sciatica is a strong first step.
Myth 3: Rest Is Best
As with most back pain we see in clinic, a big part of our advice is that rest alone is not helpful, because backs like movement. If all you do is rest, sciatica symptoms will often get worse and recovery is delayed.
People are still told to rest completely from time to time, and it can make them fearful of movement, which has real long-term effects on quality of life. This is why seeing a physiotherapist who understands low back pain and sciatica matters, so you can use movement as part of your recovery.
Myth 4: Keep Moving Exactly as Usual
On the flip side of myth three, you may have been told that movement is good for backs. That is true. But with low back pain that involves sciatica symptoms, you do not simply keep training as normal.
Continuing without modifying your training and avoiding aggravating activities can make your back worse and stall your rehabilitation. Movement for low back pain and sciatica is about finding the goldilocks zone: enough healthy movement to help, without aggravating the problem. A physiotherapist can guide you through that balance.
Myth 5: Nerve-Like Symptoms Always Mean Sciatica
The feature people hold onto most when self-diagnosing sciatica is the neurological symptoms felt in the leg or foot, especially down the back of the leg. These neurological symptoms can include tingling, numbness, pins and needles, burning, or shooting sensations.
But having these neurological symptoms does not automatically mean it is sciatica. A physiotherapist can carry out a thorough examination, including a neurological assessment, to rule out other causes such as:
- Peripheral neuropathy
- Peripheral vascular pathology
- Hip joint pathology
So, Is It Really Sciatica?
The key message is that sciatica is not a condition on its own. You need the advice of a physiotherapist or another musculoskeletal specialist to ensure an accurate diagnosis and an appropriate treatment plan.
If this has resonated with you and you need help determining the root cause of your symptoms, or you are dealing with low back pain in general, our lower back pain physiotherapy team can help. You can also start with our general physiotherapy service, and see the full range of our physiotherapy and rehabilitation options.
Frequently Asked Questions
Is my back pain sciatica?
Not necessarily. Pain travelling down the leg can be sciatica, but the same pattern can come from other causes such as hip joint problems or peripheral neuropathy. Because sciatica is a symptom rather than a diagnosis, an assessment is needed to confirm what is actually driving your back pain.
Is sciatica a diagnosis or a symptom?
Sciatica is a symptom, not a condition in its own right. It usually stems from an underlying issue such as a herniated disc, spinal stenosis or hip joint pathology, which is what treatment needs to address.
Should I rest if I have sciatica?
Complete rest usually makes sciatica symptoms worse and slows recovery. The right amount of appropriate movement, guided by a physiotherapist, is generally more effective than resting alone, while still avoiding activities that clearly aggravate it.
Do tingling and numbness always mean sciatica?
No. Neurological symptoms like tingling, numbness and pins and needles can occur with sciatica, but they can also come from other conditions. A neurological assessment helps determine the actual cause rather than assuming it is sciatica.
Related Reading
For more on managing back pain, see our guides on why your back keeps hurting, low back pain physiotherapy assessment, treatment and recovery, and how targeted movement can ease sciatica.
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