Sciatica or sciatic pain refers to pain that travels on the path of the sciatic nerve. This nerve is the longest nerve in the body; it extends from the lower back through the hips, gluteal muscles and branches down the back of each leg. It mostly occurs when a disc (cushioning between the vertebrae in your spine) bulges or there is an overgrowth of bone that puts pressure on a section of the nerve. This can lead to inflammation, weakness, burning, pain (sometimes sharp), numbness and tingling in the affected leg - these sensations are commonly known as sciatica.
What are the symptoms of sciatica?
As mentioned above there are a number of symptoms that can be associated with sciatica, some people suffer from less symptoms and some can suffer from multiple, examples include:
-Â Â Â Â Â Pain (sharp, burning), can travel down one or both legs
-Â Â Â Â Â Tingling (pin and needles)
-Â Â Â Â Â Numbness
-Â Â Â Â Â Muscle weakness
The pain may start slowly and progressively get worse after standing or sitting, during certain times of the day (e.g. evenings), when laughing, coughing or sneezing, bending, twisting or lifting in the lower back.
Â
What causes sciatica?Â
There are a number of methods that sciatica can occur but essentially it happens when there is pressure on or damage to the sciatic nerve. Common causes include:
-Â Â Â Â Â Tight glute muscles (piriformis) which is where the sciatic nerve passes through
-Â Â Â Â Â Piriformis syndrome (narrowing of this muscle)
-Â Â Â Â Â Bulging or herniated disc (problems with the cushioning between the vertebrae in the spine)
-Â Â Â Â Â Spinal stenosis (narrowing of the spinal canal)
-Â Â Â Â Â Spondylolisthesis (when a bone (vertebrae) slips forward onto the bone underneath it)
-Â Â Â Â Â General wear and tear
Sciatica can affect anyone but is most commonly seen in people between the ages of 40-60 years old.
Â
How is it diagnosed and treated?Â
Diagnosis of Sciatica
Sciatica is diagnosed mainly based on case history including symptoms, medical history and physical exam. In most cases imaging is not required but if necessary an X-Ray or MRI can explain the cause of the patient’s sciatica.
Treating Sciatica
In most cases, conservative treatment is preferred.
Non-physical therapy:
-Â Â Â Â Â Patient education
-Â Â Â Â Â Anti-inflammatories
-Â Â Â Â Â Corticosteroids
-Â Â Â Â Â Exercise
Manual therapy: As Osteopaths we provide a number of different treatment modalities for patients suffering from sciatica and lower back pain. Some treatment types include spinal manipulation, mobilisation or soft tissue techniques such as massage, dry needling, myofascial cupping in addition to patient education and tailored exercise.
What is some take home advice for patients suffering from Sciatica?
Some important things to know about Sciatica:
-Â Â Â Â Â Sciatica is not usually a sign of serious damage. Lower back issues are most commonly due to a simple sprain/strain of the muscles and joints rather than being due to something serious.
-Â Â Â Â Â Rest rarely helps - Bed rest can be helpful for sudden/severe pain but only for a very limited period. Once the pain has been present for a while, resting in bed can actually prolong the pain.
-     Staying active helps - staying active in a gentle manner may help in your recovery. Movement helps reduce muscle stiffness and weakening and assists in one’s return to normal activity as soon as possible.
The best advice is to keep gently active, even if it causes some extra pain. Taking pain relief regularly is sometimes needed initially to help you to keep moving - consult your GP about the appropriate medication for you. Other options for pain relief could include heat packs, hot showers, gentle exercises and stretches.
Â
Sciatica is a very common and often debilitating condition and Osteopathy can help! Here at KHC we would love to help relieve your pain through providing hands-on treatment, education, exercise and lifestyle advice. Book below for an appointment today:
Â
Â
For more information check out these helpful sources:
Jensen, R. K., Kongsted, A., Kjaer, P., & Koes, B. (2019). Diagnosis and treatment of sciatica. BMJ, l6273. https://doi.org/10.1136/bmj.l6273
Ropper, A. H., & Zafonte, R. D. (2015). Sciatica. New England Journal of Medicine, 372(13), 1240–1248. https://doi.org/10.1056/nejmra1410151