Are you staying up to date?

As clinicians it is important that we are always staying up to date with evidence based practices and terminology.

One very commonly used label is “Sciatica” This diagnostic label dates back to Hippocrates who was allegedly, the first physician to use the term ‘sciatica’, deriving from the Greek ischios, hip. Many years later Galen treated sciatica by blood letting, to dispose of ‘the noxious humours’, which he held responsible. (Pearce, 2007).

The term “sciatica” has been around for 100’s of years and thankfully our understanding of what “sciatica” is, has evolved significantly and so has our treatment interventions. 

However, to this day Sciatica is widely misunderstood, misdiagnosed and mismanaged.

So what does sciatic really mean? 
Well it is an umbrella term that involves radicular pain, radiculopathy and somatic referred pain. 

In this recent review by Schmidt et al (2023) it has been recommended by the panel to discourage using the term “sciatica” in clinical practice and research without further specification of what it entails. The term “spine-related leg pain” is proposed as an umbrella term to include the case definitions of somatic referred pain and radicular pain with and without radiculopathy.
In this review they also created some adaptations to the grading system for spine related leg pain. Pictured below.

This emphasises the importance of a thorough history, combined with clinical symptoms and signs along with physical diagnostic tests to rule in / our neuropathic pain.

In 2018 Stynes et al. developed a scoring tool to assess the probability of “sciatica”.

This scoring system is a useful scoring tool that can aim in improved diagnostic accuracy and management. 

I hope this helps to keep you up to date 🙂

Check out the references for further info here: 

Pearce J. M. (2007). A brief history of sciatica. Spinal cord, 45(9), 592–596.
Schmid, A. B., Tampin, B., Baron, R., Finnerup, N. B., Hansson, P., Hietaharju, A., Konstantinou, K., Lin, C. C., Markman, J., Price, C., Smith, B. H., & Slater, H. (2023). Recommendations for terminology and the identification of neuropathic pain in people with spine-related leg pain. Outcomes from the NeuPSIG working group. Pain, 164(8), 1693–1704.
Stynes, S., Konstantinou, K., Ogollah, R., Hay, E. M., & Dunn, K. M. (2018). Clinical diagnostic model for sciatica developed in primary care patients with low back-related leg pain. PloS one, 13(4), e0191852.