Sciatica is pain which refers down the back of the leg. It is a symptom rather than a specific condition and can be caused by numerous conditions which all refer pain along the sciatic nerve. A thorough assessment is vital to determine the cause of the pain.
As with all examinations, the therapist should first gain information regarding the injury including how and when it happened; what the pain is like and where it is located; what aggravates and what eases the pain; if there are any other symptoms such as tingling, numbness, weakness etc and if there have been any previous injuries.
Once a thorough history has been taken, an objective or physical examination can begin.
This usually starts with observation. The therapist will simply observe the patient, usually whilst standing, looking for clues as to what is causing the pain from their position and posture, as well as the skin condition, symmetry with the other side and often the way they move too. Simple movements such as walking, or squatting are often used.
After this, the therapist will often palpate the area of pain. This means feeling the area. They are looking for areas of muscle tension, tenderness, temperature changes, altered sensation etc.
They will also observe their range of motion, firstly actively, where the patient moves themselves and then passively, where the patient relaxes and the therapist moves the body parts. This is to look at joint movement, muscle tightness and pain on movement. The therapist will usually want to look at the range of motion in the back and hips in particular.
Resisted muscle tests may then be performed to determine any changes in strength and if contracting particular muscles causes pain.
Special tests are assessments used to confirm the possibility of a specific condition or injury.
In sciatica, tests might include the slump test which is used to detect neural involvement and the straight leg raise which stretches the sciatic nerve.
If the cause of your sciatica is thought to be spinal - i.e. coming from the lower back in the form of a disc prolapse, degeneration, stenosis etc, then you will probably be referred for imaging, in the form of either an X-ray or MRI scan.
These will determine the exact cause of pain and what the extent of the injury is. This will help decide whether surgery is necessary.