Sciatica is a broad term that refers to symptoms that travel anywhere along the path of the sciatic nerve. The nerve comes from your lower back and goes through your hips and buttocks and down the backs of your legs.
Sciatica occurs when the sciatic nerve is ‘pinched’ or ‘compressed’ in some way. When this happens, the following symptoms can occur:
– Radiating pain in your lower back/hips/buttock area
– Radiating pain down your legs
– Radiating pain into your feet
– Numbness down your legs
– Muscular weakness, typically in your legs
– Gait dysfunction
– Sensory changes in your legs and/or feet
– Hot, cold, tingling, or burning sensations in the legs
If you have back pain alone, then it is unlikely it is sciatica. Visit our back pain page for more info.
Sciatica can be caused by a number of different reasons. The most common causes are:
– Disc pathology (otherwise known as a ‘slipped disc’, a prolapsed disc or disc bulge): this is when the soft cushion of material between the bones in your spine pushes out and makes contact with the nerve.
– Spinal Stenosis: this is narrowing of the neural foramen, which is a small opening between each vertebrae in your spine, where the nerve passes through.
– Spondylolisthesis: this is where one of the bones in your spine, called a vertebra, slips our of position, which can result in nerve compression.
– Back injury or trauma: significant sprains and strains of the back can result in sciatica.
As well as the physical causes listed above, there are a number of risk factors which can lead to an increased chance of getting sciatica. These are:
– Age related spinal changes, including arthritic joints, previous disc herniations or bony spurs
– Jobs requiring lots of manual work, lifting, twisting etc.
– Prolonged sitting and/or sedentary lifestyle
– Excessive smoking or drinking
– Diabetes: studies have suggested there’s a link between diabetes and developing sciatica
To determine whether you suffer from sciatica, your Physiotherapist will go through a comprehensive assessment, prior to any treatment.
The session will start with a ‘subjective assessment’; this is where the Physiotherapist will ask a series of questions about your injury, symptoms, functional ability, medical history etc.
The ‘subjective assessment’ is followed by a series of physical testing called the ‘objective assessment’. This is where the Physio will ask you to perform certain movements and do specific diagnostic tests on you, such as the straight leg raise. A combination of the subjective and objective assessment will provide the Physio with enough information to be able to diagnose, or rule out sciatica. This will help guide their treatment plan for you.
In some cases, if the Physiotherapist deems it appropriate, they will refer you to get some further diagnostic imaging done. These could consist of an X-ray, an MRI, a CT scan or a nerve conduction study.
During the assessment, the Physiotherapist will also be screening for ‘red flags‘. These are a series of signs and symptoms which suggest a more sinister pathology, such as Cauda Equina (see the ‘should I be worried’ section of this page for more info).
Physiotherapy and Massage Therapy are proven to be helpful with the treatment of sciatica and back pain. Massage promotes blood circulation, muscle relaxation and the release of endorphins. Physiotherapy helps by prescribing a set of personalised exercises along with hands-on treatment to help with your pain.
Ice or heat is often used in the treatment of sciatica. One of the best ways of utilising this would be to place heat or ice on the affected area for 20 minutes every 2 hours.
Analgesics are commonly prescribed for the treatment of Sciatica, however evidence from clinical trials suggests the relief of pain is limited.
For severe cases of sciatica an epidural steroid injection is often used. This treatment consists of an injection of a steroid in the affected area to reduce the inflammation and pain. The effects are temporary and can last from one week to a year.
For extreme cases of Sciatica elective surgery may also be an option, this surgery attempts to eliminate the underlying cause. When the underlying cause is lumbar spinal stenosis, a lumbar laminectomy surgery is recommended. With this surgery, the small portion of the bone and/or disc material that is pinching the nerve root is removed. In cases where a disc is herniated, a microdescectomy is recommended. With this surgery, a small opening is created and with the use of magnification the portion of the herniated disc that is pinching the nerve is removed.
If you are unsure if you have sciatica or not and would like to have an assessment as well as treatment, then please book an hour long Physiotherapy session.
If you already know you have sciatica, or some other type of ‘trapped nerve’ and are after some treatment to help reduce the symptoms, then either book in for Physiotherapy, Sports Massage, or Acupuncture. All of our therapists are trained and experienced in this area.
If you feel like you could benefit from a treatment from one of our practitioners – click here and book in today.
Most cases of sciatica can be treated successfully with Physiotherapy.
However, some of the symptoms of sciatica are very similar to that of more sinister back problems, such as Cauda Equina.
If you have any of the below symptoms (red flags), you should call 111 or attend A&E immediately:
– Sciatica on both sides
– Weakness or numbness in both legs that’s severe or getting worse
– Numbness around or under your genitals, or around your bottom (anus)
– You find it hard to start peeing, cannot pee or cannot control when you pee – and this is not normal for you
– You do not notice when you need to poo or cannot control when you poo – and this is not normal for you
These could be symptoms of a serious back problem that needs to be treated in hospital as soon as possible.