Shooting pain in the back of the leg

The sciatic nerve is formed by the lower two lumbar and the upper two or three sacral nerve roots.  These converge in the pelvis to form the sciatic nerve which passes down the back of the leg to the foot.  So as you’d expect, compression of one of these nerve roots can produce symptoms all the way down the leg.

We find that sciatica is one of the most misunderstood conditions because of it’s association with back pain, which can also refer pain down the back of the leg.  Hence, people frequently misdiagnose themselves as having sciatica, often when they simply have some low back pain radiating into the buttock on one side.  People with true sciatica struggle to raise their leg when laying on their back because it pulls on the nerve and really sets off their symptoms.

The source is almost always a bulging intervertebral disc at the base of the low back (L5/S1), although joint degeneration in the area can also be to blame.  Far less commonly the nerve is constricted by one of the deep muscles of the buttock, as in piriformis syndrome.  Osteopaths work to try and open up the exit point of this nerve by releasing tight low back muscles and mobilising the relevant joints.

The McKenzie approach is sometimes useful for this problem, which involves mostly extension type exercises that aim to squeeze the bulging disc away form the nerve.  We also use nerve flossing to drag the nerve back and forth past its interfacing tissues as a further attempt to free it up.  Dry needling is the preferred technique for going after the piriformis syndrome cases as this muscle is very deep and therefore very hard to apply massage pressure on.

Unfortunately, the offending disc does not readily diminish the size of its bulge in most cases, however, the nerve can de-sensitise after a while and the problem usually backs right off.  These days, surgery is not rushed into because of this likelihood.  In cases requiring surgery, a cortisone injection into the nerve root is usually trialled first, and if that does not work, a microdiscectomy is most commonly performed to trim off the bulge.