Why ‘Sciatica’ Is NOT A Diagnosis & Why You Should NEVER Tell A Patient They Have It

Posted By: Andy Barker

I’ll hold my hands up and admit that I have given patients the diagnosis of ‘sciatica.’

I did this too many times to remember as a New Grad Physio.

But the problem…

It’s NOT even a diagnosis.

And even more than that…

Giving patients this ‘diagnosis’ made my job and is making your job as therapist, to manage patients with injuries like this, so much more difficult than it should be.

In this blog post you will discover WHY you should never tell a patient they have ‘sciatica’ and why your previous teaching and thought process surrounding patient diagnosis is all WRONG.

What 99% Of Therapists Get Wrong In Session 1

We are taught that the main aim of our initial assessment is to give the patient a diagnosis.

Maybe you’ve worked through your patient assessment and made a diagnosis to a patient and told them they have…

Shoulder Impingement…

Anterior Knee Pain… Or


Problem is, none of these are a diagnosis.

They are just symptoms.

Sciatica is an umbrella term for neural leg pain originating in the back.

It may explain a patient’s symptoms, but it does NOT explain what is causing these symptoms in the first place.

But why does this matter?

It matters a lot, to both your patient and you, the therapist.

And it is affecting your ability to help patients with injuries like these get out of pain and back to full fitness.

How Giving A Diagnosis Can Result In Poor Patient Understanding

By giving a patient a diagnosis, like sciatica, you are missing the main point of your initial assessment.

The main aim of the initial assessment is not to find a diagnosis but to identify your patients PROBLEMS.

Identifying PROBLEMS allows you to manage your patients in a better way, as it allows you to create
SOLUTIONS i.e. your treatment plan.

A diagnosis does NOT allow you to do this.

With an injury like ‘sciatica’ the patient has back related neural pain…FACT.

But their problem might not even be related to their back…

I’m sure your starting to see how other areas of the body can have such a big impact on injury incidence.

Your patient with ‘sciatica’ has neural leg symptoms but the reason their back is causing this problem might relate back to an old ankle, knee or even shoulder injury.

A big danger of focusing on the diagnosis is that patients do the same…focus on their diagnosis.

And if this happens, it makes your task as their therapist, to reduce their pain and get them back to full health, much more difficult.

Your goal as a therapist should not just be about fixing up your patient symptoms but should also include identifying what has caused their symptoms in the first place.

As therapists I think we are relatively good at treating ‘symptoms’ but most therapists are poor at identifying causes of these symptoms.

That is why so many patients and athletes fail rehab, suffer re-injury or never get back to their desired pre-injury activity levels.

Another ‘Diagnostic’ Problem…

Another problem with patients focusing too much on their diagnosis is that it takes their attention away from your treatment plan.

A patient may become fixated with the idea that their back is the problem, it’s the reason they get those ‘pins and needles’ or ‘shooting pain’ down the back of their leg.

And if this happens, they are less likely to focus on what is important…

…Your treatment plan.

Their plan of care that is going to get them out of pain and back to full function.

Failure for a patient to understand and acknowledge their actual ‘problems’ results in poor patient adherence to your treatment plan and resulting poor improvements in patient symptoms and function.

Why You Need A Problem List Not A Diagnosis…

What I have covered in this blog may be a very different way of thinking to how you currently operate and how you package the clinical information you give your patients during their initial assessment.

If giving every patient you see a diagnosis works for you, then keep doing it.

But I know it doesn’t for a large proportion of therapists and it is one of the main drivers why so many patients DON’T buy in to their treatment plans.

Problems make us come up with solutions.

Solutions are what is going to fix your patients problems.

A diagnosis is just a list of symptoms…

It does NOT help you or your patient.

If anything, it just causes a lack of patient understanding and increased confusion about their injury.

If you can get away from just thinking about and treating symptoms and start to think about what is causing your patient’s symptoms in the first place (i.e. their REAL Problems) then you are already way ahead of the curve as a New Grad Physio.

Some very ‘experienced’ therapists still haven’t grasped this concept yet and it is these same therapists that continually struggle to make the impact they really want with the patients they see.

Just remember…

Problems = Solutions.

Diagnosis = Confusion.

Thanks for reading
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