Sciatica is diagnosed from leg pain radiating along the sciatic nerve distribution, usually below the knee, confirmed by examination testing sensation, strength, reflexes and nerve tension. Imaging and electrodiagnostic testing are used selectively rather than routinely. Pain travelling below the knee is considerably more suggestive of nerve root involvement than pain confined to the buttock and thigh.
Sciatica is diagnosed from leg pain radiating along the sciatic nerve distribution, usually below the knee, confirmed by examination testing sensation, strength, reflexes and nerve tension. Imaging and electrodiagnostic testing are used selectively rather than routinely. Pain travelling below the knee is considerably more suggestive of nerve root involvement than pain confined to the buttock and thigh.
Sciatica is a symptom rather than a diagnosis in itself: it describes pain arising from irritation of a lumbar nerve root, radiating from the lower back or buttock down the back or side of the leg. Pain travelling below the knee is far more suggestive of nerve root involvement than pain confined to the buttock and thigh, which is more often musculoskeletal. Which part of the foot is affected indicates which root: the great toe and top of the foot point to one level, the outer foot and sole to another.
Straight leg raise reproduces the pain when a root is irritated, and the angle at which it does so is recorded. Sensation is tested in each dermatome, strength in the muscles supplied by each root, including great toe extension and ankle movements, and reflexes at the knee and ankle. A pattern that fits one level supports the diagnosis. Weakness and reflex loss are the findings that raise the threshold for further investigation.
Most sciatica improves without imaging, and scanning early frequently finds degenerative changes that are present in symptom-free people too, which can lead to treatment aimed at the wrong target. Imaging is indicated for progressive weakness, suspected cauda equina syndrome, or symptoms failing to settle when surgery is being considered, and is arranged externally. Electrodiagnostic testing helps where the clinical picture is ambiguous or where a peripheral neuropathy might be mimicking a root problem, and is performed at both offices.
Clinical Neurology Specialists has been physician-owned since 1998, when Leo Germin, M.D., FAANEM founded it. Five board-certified neurologists and four advanced practice providers see patients at the Las Vegas and Henderson offices, each with its own AANEM-accredited electrodiagnostic laboratory.
Clinical Neurology Specialists is an adult outpatient neurology practice for patients 18 and older. The practice performs no surgery and operates no imaging suite, infusion suite or interventional pain programme, and provides no emergency or inpatient care.
Physician-reviewed. Reviewed by the physicians of Clinical Neurology Specialists — board-certified neurologists, AANEM-accredited electrodiagnostic laboratories, physician-owned since 1998. Reviewed 1 August 2026. This article is general education for adults 18 and older and is not a substitute for a consultation.
Sources and further reading: MedlinePlus: peripheral nerve disorders; MedlinePlus: EMG and nerve conduction studies; MedlinePlus, National Library of Medicine.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.