Sciatica

Sciatica is a set of symptoms including pain that may be caused by general compression or irritation of one of five spinal nerve roots that give rise to each sciatic nerve, or by compression or irritation of the left or right or both sciatic nerves.

Symptoms

  • Pain in the rear or leg that is worse when sitting or standing
  • Burning or tingling down the leg
  • Weakness, numbness or difficulty moving the leg or foot
  • A constant pain on one side of the rear calf
  • A shooting pain that makes it difficult to stand up
  • Pain in the lower back and buttock

Although sciatica is a relatively common form of low back pain and leg pain, the true meaning of the term is often misunderstood. Sciatica is a set of symptoms rather than a diagnosis for what is irritating the root of the nerve, causing the pain. This point is important, because treatment for sciatica or sciatic symptoms often differs, depending upon the underlying cause of the symptoms and pain levels.

Causes

Sciatica is generally caused by the compression of lumbar nerves L3, L4 or L5 or sacral nerves S1, S2, or S3, or by compression of the sciatic nerve itself. When sciatica is caused by compression of a dorsal nerve root (radix) it is considered a lumbar radiculopathy (or radiculitis when accompanied with an inflammatory response). This can occur as a result of a spinal disc bulge or spinal disc herniation, or as a result of degenerated discs that can reduce the diameter of the lateral foramen (natural hole) through which nerve roots exit the spine. Pseudosciatic pain can also be caused by compression of peripheral sections of the nerve, usually from soft tissue tension in the piriformis or related muscles (see piriformis syndrome).

In a proportion of the population, the sciatic nerve runs through, or under the piriformis muscle rather than beneath it. When the muscle shortens or spasms due to trauma or overuse, it can compress the sciatic nerve. Conditions of this type are generally referred to as entrapment neuropathies; in the particular case of sciatica and the piriformis muscle, this condition is known as piriformis syndrome. Piriformis syndrome may be a cause of sciatica when the nerve root is normal.

Diagnosis

  • Based on symptom description
  • Pain behaviour
  • Physical examination


While the diagnosis is simple, determining the cause may require more investigations. It is very important to determine where and how significantly your sciatic nerve has been compressed.

Tests for muscle weakness, sensation deficits and altered reflexes in your leg or foot are required.

Assessing fever, problems controlling your bowels or bladder, previous cancers and whether you’ve been losing or gaining weight are important.

Treatment

Pain Relief, Inflammation Control & Protection

Managing your pain is paramount to effective outcomes. Pain is normally the limiting factor for normal movement which you need to recover.

Inflammation is normal but may hang around too long and create problems. To reduce inflammation avoiding postures or activities the cause pain, use cold therapy and techniques or exercises that unload the inflamed structures. You may be prescribed non-steroidal anti-inflammatory medication such as ibuprofen.

Restoring Normal Flexibility, Posture & Strength

Once pain and inflammation settle, you will aim to restore lower back, hip, thoracic, SIJ movement and muscle tension,strength. Normal muscle length, tone and strength prevents injuries.

The deep abdominal core muscle strength and recruitment patterns are vital to recovery and prevention of further injuries.

You may need to use an ultrasound guided exercise program where you can view your deep core muscle contractions on a monitor.
Swimming and hydrotherapy exercises are beneficial in early injury repair due to lesser body-weight in the buoyancy of water.

Restoring Normal Function & Control

Set goals that allow you to return to all of the activities you were doing prior to your injury.

General fitness is also very important in helping your back and general health. Walking programs, yoga or a pilates-based program should be gradually commenced.

Your exercises should be customised to your specific needs. Your physiotherapist is the best person to guide your rehabilitation.

Preventing Recurrence

Sciatica commonly returns due to insufficient rehabilitation.
Biomechanical assessment and maintenance program is highly recommended for at least 2 years. Specific pain management techniques are important for long term recovery in chronic patients

“Exercise is like cleaning your teeth. Exercise prevents problems”

Surgery

Surgery is occasionally required. Persisting symptoms over six months may require a surgeon. If you have some severe symptoms such as bowel or bladder dysfunction or extreme muscle weakness you may require emergency surgery.
Prognosis

About 90% plus of sciatica suffers will be asymptomatic within six to eight weeks.

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

Back Brace

A back brace may provide excellent relief. To test if it will help wrap/bind a towel or sheet (folded-lengthwise) tightly around your stomach and back. If it eases your pain, you should use a back brace in the short-term only.

Massage Therapy

Your spinal muscles will relax with massage therapy.

Acupuncture/ Dry Needling

Acupuncture has been an effective source of pain relief for over 5000 years. It helps relieve muscle spasm and sensitivity to pain.

TENS Machine

TENS machines are electronic pain relieving devices that will reduce your pain and your need for pain relieving drugs. They must be used on the correct settings to get the best results.

Swiss Exercise Ball

Swiss Exercise Ball can be used to strengthen your deep core stabilising muscles.

Posture Supports

Poor posture is a common cause of pain. To assist your posture try exercises and rehabilitation.