Article by John Miller
What is Sciatica?
Sciatica describes pain felt along the sciatic nerve, which runs from your lower back, down through the buttock, hamstrings and into the lower leg. The sciatic nerve is the longest nerve in the body. The spinal sections it originates from include L4, L5 or S1.
Sciatica is commonly misdiagnosed, which can result is either slow or non-responsive treatment. Leg pain can have various sources. It can be a local leg injury or it may even be referred from your lower back. The main nerve that travels from your lower back to your leg is your sciatic nerve. Irritation or pinching of your sciatic nerve can cause severe leg pain known as sciatica.
Common Causes of Sciatica
Pressure on the sciatic nerve from a herniated disc usually causes sciatica. Otherwise joint inflammation, compression of the nerve from bony arthritic growths or a locked facet joint in the lower spine can commonly cause sciatica.
Leg pain can have various sources. Pain can be a local leg injury or it may even be referred from your lower back and travel along the sciatic nerve. The main nerve that travels from your lower back to your leg is your sciatic nerve.
Injury that irritates or pinching of your sciatic nerve can cause severe leg pain known as sciatica. You're most likely to get sciatica when you're 30 to 50 years old. It may happen due to the effects of general wear and tear, plus any sudden pressure on the discs that cushion the vertebrae of your lower (lumbar) spine.
While there are numerous causes of sciatica, the most common are:
Other sources include:
You're most likely to get sciatica when you're 30 to 50 years old. It may happen due to the effects of general spine wear and tear (spondylosis) or a traumatic injury that sudden pressure on the lumbar discs eg lifting, bending or sneezing.
What are Sciatica Symptoms?
Sciatica causes pain that usually begins in the lower back and spreads through the buttock, leg, calf and, occasionally, the foot. The pain can vary between dull, aching or burning sensations and sharp, shooting pains.
Sciatica can also cause tingling, numbness or muscle weakness in the affected leg. It is very important to seek medical attention in these situations as long-term nerve compression can permanently damage the nerve and its function. In these cases your symptoms may become permanent.
One or more of the following sensations may occur because of Sciatica:
How is Sciatica Diagnosed?
Sciatica is a clinical diagnosis based upon your symptom description, the behaviour of your pain and a thorough physical examination.
While the diagnosis of sciatica is reasonably simple, the primary cause of your sciatica may require further investigations to eliminate or confirm its origin. It is also important to determine how significant your sciatic nerve has been compressed.
Your physiotherapist will examine you, paying special attention to your spine and legs. In addition to asking you if you have low back pain that spreads to the leg and calf, your physiotherapist will test you for muscle weakness, sensation deficits and altered reflexes in your leg or foot.
They will also want to know if you've had an injury, fever, problems controlling your bowels or bladder, previous cancers and whether you've been losing weight without trying. The answers to these questions are important because if these symptoms are present, the cause of sciatica could be a serious condition, such as a bone fracture, infection or cancer.
Your physiotherapist or doctor may send you for X-rays, or arrange for a computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan to check for problems in the spinal vertebrae (backbones) that may be irritating or compressing your sciatic nerve. Most cases of sciatica affect the L5 or S1 nerve roots.
PHASE I - Pain Relief & Protection
Managing your pain. Pain is the main reason that you seek treatment for sciatica. In truth, it was actually the final symptom that you developed and should be the first symptom to improve.
Managing your inflammation. Inflammation is a normal part of your healing process post-injury. But, excessive inflammation can be the main cause of your sciatica.
Please contact your physiotherapist or doctor for their professional opinion.
PHASE II - Restoring Normal Flexibility, Posture & Strength
As your pain and inflammation settles, your physiotherapist will turn their attention to restoring your normal back joint range of motion and resting muscle tension, lower limb muscle flexibility and posture.
Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises for you specific to your needs. They may recommend that you undertake an ultrasound guided exercise program where you can view your deep core muscle contractions on a monitor.
PhysioWorks has developed a Back Pain Core Stabilisation Program to assist their sciatica patients to regain normal core muscle control. Other more advanced programs can include stability exercises and equipment such as a Swiss exercise ball. Please ask your physio for their advice.
Swimming and hydrotherapy exercises are beneficial in early injury repair due to lesser body-weight in the buoyancy of water. This allows more movement without causing pain.
PHASE III - Restoring Full Function & Dynamic Control
The next stage of your rehabilitation is aimed at safely returning you to your desired activities. Everyone has different demands will determine what specific treatment goals you need to achieve. Your physiotherapist is the best person to guide your rehabilitation.
PHASE IV - Preventing a Recurrence
Sciatica does have a tendency to return. The main reason it is thought to recur is due to insufficient rehabilitation.
Fine tuning your back mobility and core control and learning self-management techniques will ultimately help you to achieve your goal of safely returning to your previous sporting or leisure activities without sciatica.
Exercise is like cleaning your teeth. Exercise prevents problems.
Surgery for Sciatica
Surgery is occasionally required when your leg pain does not settle with a conservative (non-operative) approach. Persisting symptoms over six months may require the attention of a surgeon who specialises in treating back pain and sciatica. If you have some severe symptoms such as bowel or bladder dysfunction or extreme muscle weakness you may require emergency surgery.
Please check with your physiotherapist or doctor for their professional opinion.
What is the Prognosis for Sciatica?
Fortunately, sciatica usually eases after a short period of rest and avoiding aggravating activities. Everyone is different because of the various pathologies that cause sciatica, but 90% plus of sciatica suffers will be asymptomatic within six weeks.
About one in every 50 people experiences sciatica as a result of a herniated disc. Of these, 10-25 percent has symptoms lasting more than six weeks. About 80-90 percent of people with sciatica get better, over time.
All sciatica patients who suffer pain that lasts longer than six weeks should undertake a specific exercise regime to regain control of their symptoms in an effort to avoid spinal surgery.
Other Treatment Options
A back brace or corset can provide excellent relief for most sciatica sufferers. Those who gain the most benefit are those who find their pain eases when they wrap/bind a towel or sheet (folded-lengthwise) tightly around their stomach and back. If this simple test eases your pain, you should use a back brace in the short-term. Back braces and strong deep core muscles help to avoid a recurrence in the future.
Back braces are available from PhysioWorks or via the following web link: Back Brace
Your spinal muscles will often present in muscle spasm, which responds favourably to soft tissue techniques such as massage therapy. You should seek the assistance of a quality remedial massage therapist to assist your sciatica treatment.
Discover more about: Massage.
Acupuncture has been an effective source of pain relief for over 5000 years. While we do not fully understand how it works, acupuncture can assist you pain relief. Ask your physiotherapist for advice as most of our PhysioWorks physiotherapists have acupuncture training.
Find out more about: Acupuncture.
TENS machines are an electronic pain relieving device that will reduce your pain and your need for pain relieving drugs. More information can be found here: Tens Machine
Swiss Exercise Ball
The unstable surface that your Swiss Exercise Ball provides can help awaken your deep core stability muscles. Your physiotherapist can advise you specific exercises or you can download some exercise plans from the following web link: Ball Exercises
Poor sitting posture is a common cause of sciatica. To assist the support of your lower back many simple and effective products have been developed over time. These include:
Please ask your physiotherapist for their advice in what will help you most.
Common Sciatica Treatment Techniques
When Should You Contact Your Physiotherapist?
Contact your Physiotherapist if sciatica pain grows worse over a few days, or if it begins to interfere significantly with your daily activities.
Call your physiotherapist or doctor immediately if you experience sudden, extreme weakness in a leg, numbness in the groin or rectum, or difficulty controlling bladder or bowel function. Patients with these symptoms may have cauda equina syndrome and should seek immediate medical attention. This condition can cause permanent damage if not quickly treated.
How to Prevent Sciatica?
Following treatment for sciatica, you will probably be able to resume your normal lifestyle and keep your pain under control. However, it's always possible for your disk to rupture again. This happens to about five percent of people with sciatica.
Once the pain of sciatica passes, there are strengthening and postural exercises, stretches and other measures that help prevent its return. Please contact your physiotherapist for specific advice. Here are some steps you can take in the meantime:
Practice Good Posture.
Stand up straight and stretch yourself upwards “trying to grow as tall as you can”. This will help to turn on your deep abdominal muscles that open the spaces in your spine where your nerves are vulnerable to pinching.
Avoid Postures that Hurt.
Depending on where your nerve is pinched, you may experience pain when sitting, standing, walking or even lying down. It is important to avoid whichever postures aggravate your pain. If it’s painful to sit for more than 5 minutes, limit your sitting to 4 minutes. Take regular breaks to stand and walk around. If you must be on your feet, prop one foot on a small block or footrest, and then switch feet throughout the day. Your body provides heaps of painful hints. Listen carefully and you will recover quicker.
Walking and swimming can help to strengthen your lower back. Lift objects safely. Always lift from a squatting position, using your hips and legs to do the heavy work. Never bend over and lift with a straight back. Look up as you lift.
Use Proper Sleeping Posture.
Take pressure off your back by sleeping on your side or on your back with a pillow under your knees. If you don’t feel pain, you are in the right position.
Avoid Wearing High Heels.
Shoes with heels that are more than 1½ inches high shift your weight forward, excessively arches your back and can further pinch the sciatic nerve.
For more advice about Sciatica, please contact your physiotherapist.
Why does Pinching a Nerve Hurt?
Nerves have many functions, transmitting messages around the body, rather like a telephone system. They allow us to feel things that happen to us, such as things we touch or that touch us, hot and cold, and pain, and they cause our body to do things, eg making your leg muscles contract when you want to walk.
When a nerve is squashed, it may malfunction, and we might feel pain, numbness, pins and needles, and we might find our limbs are weak or do not work in the way they should. The nerve may also get inflamed and irritated by chemicals from the disc's nucleus, without surgery.
Pressure on the sciatic nerve from a herniated disc usually causes sciatica. The problem is also termed a radiculopathy, meaning that a disc has protruded from its normal position in the vertebral column and is pinching the root (origin) of the sciatic nerve.
The degree of pain is often "ridiculously" high as well. Less direct nerve pinching e.g. swelling around the nerve is usually a less severe dull ache. However, this can progress into a radiculopathy as swelling increases.
Other things can cause irritation of or pressure on a nerve in the spine. Sometimes this may be a rough and enlarged part of one of the bony vertebrae, brought about by ageing. Rarely, infections and tumours are to blame. Most times the cause is nothing too serious, but one of the reasons for seeing your physiotherapist or doctor if the pain persists is to exclude these serious and treatable causes.
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