What is Sciatica?
Sciatica is a term that describes pain, numbness, tingling and/or weakness that travels down the back of the leg.
- It is usually one sided
- Can be mild or severe
- May radiate from the back or be felt only in the buttock
- May travel to the knee or down into the foot
- Pain is often worse when sitting
- Pain is searing or burning rather than an ache
- May cause weakness in the leg/foot
- Tends to develop over time rather than being caused by a specific event or injury
Sciatica isn’t a diagnosis in itself; it is the symptoms experienced when the sciatic nerve is affected in some way. The sciatic nerve is made of a number of nerves (L3 to S2) that exit the spine in the low back, which join together and travel as the sciatic nerve down the back of the leg and into the foot providing sensation and power.
Causes of sciatica in the low back:
- Herniated disc
- Degenerative disc disease
- Spondylolisthesis
- Spinal stenosis
Piriformis syndrome can also cause sciatica-like symptoms. This term describes when the sciatic nerve (which travels next to or through the piriformis muscle deep in the buttock) is squeezed or pressed on by the piriformis causing symptoms.
NB if you have progressive (worsening) leg/foot weakness or your symptoms are accompanied by bowel or bladder dysfunction, seek medical help immediately to rule out serious underlying causes.
How to treat Sciatica
It is important to be respectful of pain rather than fear it. Having pain does not mean don’t move, in fact the less you move the longer it is likely to take for symptoms to resolve.
Movement is powerful medicine
Most people with sciatica recover within weeks or months, but it depends on the cause, the individual’s own health and fitness, their history and what help they seek. Symptoms may resolve spontaneously without specific ‘treatment’, especially in mild cases, and recovery is generally faster if you are fairly active on a regular basis.
Movement is essential for inflammatory back conditions causing sciatica. Being on your feet and allowing gentle movement through your joints is the best way to help drain inflammation (remember, inflammation is necessary for tissue repair and healing, it’s not all bad!)
Ice application may help in acute episodes, 5-10 minutes per hour. You can also try ice-heat-ice. Avoid using just heat as this will perpetuate inflammation.
Stretching: do seek advice before launching into a big stretching programme especially if your symptoms are moderate or severe. Encouraging good movement in the upper back and hips, and stretching surrounding soft tissue/muscles can be very helpful. Individualised movement exercises to change movement patterns specific to the person can be powerful in addressing route causes. Again, this depends on the individual and the approach of the person treating them.
Lifestyle: Consider general health and activity levels – if you are overweight or lead a sedentary lifestyle, there is much that you can do to make significant improvements.
Conservative (non-surgical) treatment: If symptoms don’t improve within a couple of weeks individualised treatment such as osteopathy or physio-therapy can be really helpful: especially if that involves both hands-on treatment and movement/exercise prescription, rather than just one or the other.
Intervention treatment: If sciatica is caused by lumbar radiculopathy (a problem with nerves in the low back, such as disc injury), cortisone injections can be useful for pain relief and can help for a number of months. They don’t address the cause but can provide ‘window’ of pain relief making rehabilitation easier.
Surgery is a last resort if conservative treatment has not been satisfactory. Bear in mind that most people respond best to conservative treatment and surgical outcomes may not be as satisfactory, so it’s really important to commit to a conservative approach before considering surgery. If you are recommended surgery, try and get a second opinion. Surgery does not address causative factors and if you don’t make relevant changes in your lifestyle you may find that surgery is also just a temporary fix.
