Contrary to popular belief, sciatica is not actually a medical diagnosis in itself; rather, it is a symptom of some other condition. The term “sciatica” describes pain (and possibly tingling, numbness or weakness) felt along the path of the sciatic nerve, which runs from your lower back, down through the buttock, hamstrings and lower leg.
In our last blog, we discussed lumbar disc injuries. Pressure on the sciatic nerve from a bulging or herniated disc is one of the most common causes of sciatica, but not the only cause. We will find out more about this later on.
First, we need to learn exactly what the sciatic nerve is!
The sciatic nerve is a large nerve, formed from the L4-S3 nerve roots that originate from the lower parts of the spinal cord, in the lower back. At each level of the lower spine, a nerve root exits from inside the spinal canal, and each of these nerve roots then come together to form the sciatic nerve. It passes from the spine, into the buttock, then into the back of the thigh and calf. The sciatic nerve controls sensation and function of the leg and foot.
What causes sciatica?
Sciatica is caused by pressure on the sciatic nerve, resulting in the nerve becoming irritated and causing referred pain. This pressure is usually from a bulging or herniated disc, but can also be from joint inflammation, lumbar spinal stenosis, compression of the nerve from bony arthritic growths, entrapment of the nerve within muscle (piriformis syndrome) or sacroiliac joint dysfunction.
Sciatica usually radiates from the lower back to the back of the thigh and down the leg. It usually affects only one side of the lower body. Although low back pain may be present along with the leg pain in people suffering with sciatica, the leg pain is generally markedly more severe than the low back pain. Patients often describe their symptoms as electric shocks running down the leg, or searing or burning pain.
Symptoms of sciatica can include:
- constant pain in only one side of the buttock or leg (rarely in both legs)
- leg pain that is often described as sharp, burning or searing (rather than dull)
- weakness or difficulty moving the leg, foot and/or toes
- sharp, shooting pain that may make it difficult to stand up or walk
- pain that radiates down the leg and possibly into the foot and toes
- pins and needles, numbness or a prickling sensation down the leg
- pain that is worse when sitting, lifting, straining or coughing
- pain that eases when lying down or walking
How is sciatica diagnosed?
Sciatica is diagnosed based on your description of symptoms and pain behaviour, combined with a thorough physical examination.
Physical examination will focus particularly on your spine and legs and will include testing for muscle weakness, loss of sensation and altered reflexes in the leg or foot. In some cases, imaging such as x-rays, CT or MRI may be required to assess whether any discs or vertebrae are compressing the nerve.
Occasionally sciatica symptoms may be indicative of something more serious, so your physiotherapist may ask questions about whether you have had problems controlling your bowels or bladder, whether you’ve been unwell or losing weight without trying or whether you’ve suffered a recent injury.
Treatment for sciatica can include:
- anti-inflammatory and pain-relieving medication
- joint mobilisation techniques
- massage therapy
- heat or ice treatment
- braces and taping
- acupuncture or dry needling
- exercises to restore normal flexibility, posture, strength and function
Occasionally, if symptoms are not resolving, more invasive treatments such as corticosteroid or epidural injections, or surgery may be required.
Sciatica generally resolves after a short period of rest and avoidance of aggravating activities. Although everybody recovers differently, due to the many different possible causes of sciatica, most sciatica sufferers will recover within 6 weeks with appropriate management. For more information, contact us today, or speak to your local healthcare practitioner!