Sciatica in one leg is known as unilateral sciatica and can exist on the left or right side, depending on the underlying causative process. Unilateral sciatica can be further divided in two distinct diagnostic parameters, including spinally-enacted sciatica and pseudo-sciatica. Regardless of classification or causation, sciatica that exists in only one leg is far more commonplace than bilateral sciatica which affects both legs.
Sciatic nerve pain can be brutal to handle and often creates far-reaching negative effects on the patient’s functionality, career prospects and general enjoyment of life. Chronic versions of sciatica might endure for years, or even decades, with many people suffering for virtually their entire adult lives. This is a scenario for which I have true empathy, as sciatica has always been one of my major struggles since the age of 16.
This discussion provides a comprehensive and objective view of unilateral sciatica pain syndromes. We will detail some interesting facts about sciatica, many of which are not generally known to patients or even to their doctors. We will also provide a comparative analysis to bilateral sciatica and recommend that patients also read our coverage of this condition for more information that might apply to their unilateral pain problems, as well.
Pain is just the beginning of the possible expressions of sciatica in the left or right leg. Pain might be joined by burning, tingling, numbness, regional weakness or functional loss in any area of the buttocks, groin, upper leg, lower leg and/or foot. There are even plenty of sciatica syndromes that do not involve any pain at all, but instead are composed of these other neurological symptoms. Regardless of whether pain is present or not, additional neurological symptoms, such as numbness and weakness, can be present in either subject form (area feels numb or weak, but neurological exam is normal) or objective form (area is truly numb or weak and demonstrates sensory and/or functional nerve deficiency).
Unilateral sciatica symptoms may be mild to extreme in nature. Some patients cite them as being slightly uncomfortable and annoying, while others report complete disability and the incapacity to cope with the high degree of pain. Sciatica symptoms might be ever-present or might come and go. Regardless of their frequency and duration, symptoms might be patterned, relatively patterned or completely unpredictable. Some of the variables for this classification include the type of expression itself, the location of the expression and the progression of the expression. Sciatica is truly one of the most widely variable of all chronic pain problems with many different profiles being reported from patient-to-patient and even many patterns within the same patient over an extended timeline.
Most people believe that the majority of sciatica pain is caused by herniated discs in the lower back. While it is certainly possible for a bulging or ruptured disc to compress a nerve root, eliciting sciatica, it is actually one of the rarest causative scenarios. Medical fact demonstrates that virtually all herniated discs are incidental to any dorsalgia symptoms that exist. More common causes of true spinally-motivated sciatica include central and foraminal stenosis causing compressive neuropathies on the individual nerve roots that eventually will form the sciatic nerve lower in the anatomy. Other rare, but possible origins, of spinal sciatica include various pathological spinal curvature abnormalities, such as lumbar scoliosis and hyperlordosis, as well as vertebral misalignment issues, such as lumbar listhesis. It is anatomically impossible for any part of the spine to compress the sciatic nerve itself, since this nerve is not yet formed at the spinal levels.
A popular myth concerning pseudo-sciatica is that it exists because of an abnormality in which the sciatic nerve runs through the substance of the piriformis muscle, rather than beneath it as is deemed typical. While more people with this irregularity do display piriformis compression of the sciatic nerve, plenty of people have it, yet demonstrate no symptoms now or ever. Additionally, many people do not demonstrate the nerve-through-muscle abnormality, yet still suffer from piriformis-related sciatic nerve compression.
Finally, a very common myth is that in order to suffer sciatica, something must be pinching the nerve itself or the nerve roots that form it. This is the least enlightened of all sciatica misconceptions, since the most common causes of sciatica do not involve any compression or even contact with the sciatic nerve or its formative nerve roots. These incredibly common causes include diabetes, various neuromuscular diseases and the epidemic incidence of mindbody oxygen deprivation.
Our first piece of advice goes out to all our readers who are patients: You must learn all about sciatica if you are to have any hope of curing it. There are good reasons why sciatica is so stubborn and resistant to treatment. You must understand why sciatica exists in order to have any chance at all of resolving it. Reading this article is a good start, but we have many other detailed dissertations on the subject of sciatica on this website, as well as a full sister website devoted to nothing but sciatica. Be sure to read through the sciatica section on this site and all the content on sciatica-pain.org in order to truly become well versed in the condition and the reasons why it fails to respond to treatment over very long timelines.
Our next piece of advice goes out to all the professionals who treat sciatica reading this essay: Doctors, do your jobs! Stop taking the easy way out and concentrate on providing your patients with proper and thorough diagnostic processing. We know that diagnostic evaluation is time-consuming and less profitable than treatment, but you are not in this world exclusively to make money. You make plenty already! You are here to help people. Without comprehensive evaluation of sciatica problems, you will continue to make the same mistakes over and over and over again; damning your patients to lives of pain due to you inability to recognize the many possible and individual causes of sciatica and how each must be treated uniquely. As far as research, there are many peer-targeted dissertations on sciatica-pain.org that are geared towards a professional audience. Go learn from them and use them to help your patients!