Fort Walton Beach Chiropractor Specializing in SciaticaNew Patient: “HEY DOC, My butt and leg hurts, I have sciatica, had it for years now, can you help?”

Me: “Well that depends, who diagnosed you with sciatica and does the pain extend down into the lower leg and foot?”

Patient: ‘My (Medical Doc, Nutritionist, Orthopedist, Yoga teacher, Physical Therapist, prior Chiropractor, Massage Therapist, etc.) told me it was sciatica. I have pain in my butt, and my thighs mostly, but sometimes it shoots down my leg.”

Me: “Understood, do you have pain on the outside or inside of the calf? Do you have pain on the back of the lower leg? Do you have pain into your foot? Do you have weakness?”

Patient: “Well, not really, but it’s really bad in my butt and the back of my thigh?”

Me: “So did your (Medical Doc, Nutritionist, Orthopedist, Yoga teacher, Physical Therapist, prior Chiropractor, Massage Therapist, etc.) perform an examination of your low back, hip, and lower legs to include measuring your active range of motion, a functional squat test, sensory testing, muscle grade testing and deep tendon reflexes?”

Patient: {PERPLEXED FACIAL EXPRESSION}. “Ummm, no, I mean I don’t think they did any of that. They asked if I could touch my toes and where does the pain go, that was it.”

Me: “Did the (doc, therapist) touch the areas of pain?” Did they lay you on the back and lift your leg up in the air or anything else? Did they take any x-rays or order an MRI?”

Patient: “Well, no, they didn’t.”

Me: “So let me get this straight, your health care professional, asked you about pain, asked you to bend over and touch your toes, but did not perform an examination and acquired no imaging?”

Patient: “Yeah doc, that’s correct.”

This is where I tell them it is unlikely they have “sciatica”. The most common mis-diagnosis, or loose-diagnosis to walk into my office is a prior “sciatic” diagnosis. This is also where I tell them I’m not going to chase your pain, we are going to examine the tissue first, and then correlate the information gained from a proper examination to your pain locations.

Basic Anatomy and Function

The sciatic nerve is the largest nerve in the body, a thick flat band of tissue, approximately 20 mm wide and the major nerve of the lower limb. It passes through the buttock, but does NOT contribute to muscle or pain activity there. The sciatic nerve does have both motor (muscle and movement) and sensory functions of its terminal branches though. The sciatic nerve does NOT have direct sensory functions and does NOT have direct skin sensation functions. This is a key issue in misdiagnosis.

The sciatic nerve indirectly innervates the skin of the lateral leg, heel, and both the dorsal and plantar surfaces of the foot through its terminal branches the Tibial and Fibular nerves. Those nerves have additional branches called the Sural nerve, Deep Fibular nerve, Superficial fibular nerve, and the medial calcaneal branch. They are responsible for lower leg pain often called DERMATOMAL pain distribution.

Therefore, pain in the butt and back of the leg does not arise due to the sciatic nerve. More likely sources of this pain are from the myofascial system, the lumbar disks, the facet joints and the sacroiliac joints (SI joints), and often a combination of the above. Pain in the lower leg, below the knee, often accompanied by numbness and weakness is a true sciatica distribution.

This is why a proper patient history, a proper examination and possible imaging techniques are needed to understand exactly what tissue locations are problematic. Inflammation of the tissue is responsible for pain, but pain can be referred from its original source. Without first understanding the relationships of the anatomy, the dysfunctions of the patient, as well as where their pain locations are you cannot accurately come to a proper diagnosis or formulate a proper treatment plan.

If you have pain down your leg, or had a sciatic diagnosis that hasn’t improved, the doctors of Integrity Chiropractic are more than happy to perform the appropriate examination and imaging if necessary to properly diagnose the offending tissue and design a treatment plan to address the tissue, not just the pain.

  1. Koes, B. W., van Tulder, M. W., & Peul, W. C. (2007). Diagnosis and treatment of sciatica. BMJ (Clinical research ed.), 334(7607), 1313 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1895638/
  2. Teach me anatomy clinical pages with illustrations. https://teachmeanatomy.info/lower-limb/nerves/sciatic-nerve/
  3. Delgado-López PD, Rodríguez-Salazar A, Martín-Alonso J, Martín-Velasco V. [Lumbar disc herniation: Natural history, role of physical examination, timing of surgery, treatment options and conflicts of interests]. Neurocirugia (Astur). 2017 May – Jun;28(3):124-134. https://www.ncbi.nlm.nih.gov/pubmed/28130015
  4. Do I have Sciatica?  Probably not, if… https://www.randolphprwc.com/do-i-have-sciatica-probably-not-if/
  5. Davis D, Vasudevan A. Sciatica. [Updated 2018 Oct 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507908/