Sciatica is a condition involving a pain in the sciatic nerve, which runs from the lower back, through the buttock and down the leg to the foot. It is often confused with other conditions where the sciatic nerve is not directly affected.
It is a relatively common condition and up to 40% of people may experience it at some time in their life. It is rarely seen in people under the age of 20 as it is more common between ages 40 and 50 and then the frequency declines.
Most sciatica is caused by the development of a herniated or prolapsed (slipped) disc and, as we age, the narrowing of spaces in the spine where the roots of the sciatic nerve are found. On rare occasions there is a more sinister cause and this should be kept in consideration. It is hard to establish who is at risk of developing sciatica. Sometimes it is related to the patient’s occupation but smoking, pregnancy, extreme height and morbid obesity are associated with increased incidence of the condition.
There are other conditions of muscles and joints that mimic some of the symptoms of sciatica such as a hamstring muscle tear, lumbar spine or sacroiliac joints problems and piriformis syndrome.
The pain of sciatica is related to swelling and inflammation of one or more roots of the sciatic nerve in the spine. This can be partly due to disc material from a herniated disc, or other degenerative changes reducing the room for this nerve root and irritating it.
Pain from sciatica can be mild or severe and can come on suddenly or gradually. It may be cramping, stabbing or burning. It may involve the low back but typically involves the buttock, back or side of the leg to below the knee even as far as the foot. Other causes of buttock and thigh pain usually finish at the knee. Typically it affects one leg but sometimes both legs can be involved. Pain may be made worse by coughing, sneezing, bending and sitting especially with the leg out straight. There may also be pins and needles sensations, numbness of the foot or even weakness of the foot muscles. All of this should be examined by a clinician who, in addition to asking about the symptoms, should check if the nerve can be stretched and test the reflexes and strength of the muscles.
The person may lean to avoid compressing the painful nerve root and avoid movements that stretch it, and an MRI scan is sometimes indicated to show the state of the discs and nerve roots and also if they are being compressed.
Our approach to the treatment of sciatica
Where possible we distinguish true sciatica, directly involving the sciatic nerve and other conditions that give some similar symptoms and this is done by asking the relevant questions and carrying out a skilled examination. MRI scanning is not usually necessary early on and is reserved for complicated cases. The first goal of treatment is to settle down the acute symptoms using various methods aimed at reducing muscle spasm and mobilising stiff joints, such as manual therapy, exercises or sometimes acupuncture. Advice is given to help gain comfort, avoid aggravating the problem, to encourage resolution of the cause and reduce the likelihood of it becoming ongoing. Next come methods to help free any trapped nerve root and rehabilitate any weakness associated with the condition.
Conditions that give sciatic like symptoms but do not directly involve the sciatic nerve are often very amenable to our treatment of muscle and joint dysfunction.
Most cases of sciatica resolve albeit sometimes very slowly, and this should be understood when seeking treatment. Some find medications prescribed by the GP helpful, sometimes injection methods are useful, occasionally surgery is warranted to free the nerve root.
Case study for sciatica
Ms B, a 27- year old woman, was experiencing severe pain in her lower back, which initially spread down her right leg but had later progressed to the left leg also. She experienced pain when walking or sitting for long periods. She also had to stop driving as her feet became numb whilst seated in the car. In addition, she was finding it difficult to sleep.
She described the symptoms as being like a feeling of hot liquid being poured down the leg and a tingling/numb sensation.
Having examined her, relying on standard orthopaedic and neurological tests, we diagnosed Sciatica. We initially provided a very gentle manual treatment to relax the muscles that were causing much of the pain.
As her work was desk-based, we advised her to stand as much as possible at work, as the sitting was compressing her sciatic nerve. On our advice, her employer purchased a Varidesk desk, which enabled her to work whilst standing.
We also gave the patient some home advice, including avoiding sitting for long periods, wearing comfortable, low-heeled shoes, applying ice to the areas where she was experiencing the most pain and carrying out gentle stretches whenever possible.
As this was a mild flare up of Sciatica and not disc related, the patient reported an improvement in her pain levels immediately after the first treatment. However, the pain returned again within a few days. She returned for a number of follow up appointments and found that the pain was mostly gone after about 3 weeks, having followed the advice given over this period of time. Ms B has confirmed she is now pain- free although she finds that sitting for long periods can cause a flare up in her symptoms.
Are you experiencing lower back pain? At The Forge Clinic in Richmond we are not only extremely experienced in treating Sciatica and related conditions, but our clinicians are approachable and sympathetic: important when you are in pain and perhaps having trouble with mobility.
Unable to move or in too much pain to come to us? If you live within 5 miles of The Forge Clinic in Richmond, you can request a home visit. Please mention this when booking.