Sciatica pain and sciatic nerve pain

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What is Sciatica or Sciatic pain?

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Sciatica is the term used to describe pain which occurs in the buttocks, legs and/or feet. It is a consequence of there being compression or irritation of the sciatic nerve. The sciatic nerve is the longest nerve in the body and runs from the lower back and buttock to the feet. Sciatica symptoms and the duration of symptoms vary for each individual as it is dependent on its cause. Sciatica may also be referred to as a trapped nerve in the hip or leg.

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What are the symptoms of Sciatica?

Signs and symptoms of sciatica may vary between each individual, this is due to there being many different causes of sciatica pain. Sciatic symptoms may come and go or they may be constant for a prolonged period of time.

The most common symptoms of sciatica are:

Pain

Commonly sciatic pain is described as a burning, shooting or stabbing type pain that can occur in the thigh, leg and/or foot. It can be constant or intermittent and can vary according to postural changes. Activities such as bending forward may aggravate the pain.

The location of pain depends on which part of the sciatic nerve is compressed or irritated. The back of the thigh and leg are commonly affected. Other areas of the lower extremity that can be affected by sciatic pain are:

  • The front of the thigh or leg
  • The sole of the foot
  • The web in between the first and second toes

Altered Sensation

Tingling such as a pins & needles type feeling and numbness are commonly felt in the back of the leg and into the foot. The site of sciatic nerve compression will determine where about the altered sesnation is felt along the leg.

Weakness

Weakness in the leg and foot is a common symptom. This may cause a feeling of heaviness in the leg or foot making walking or lifting your foot off the ground feel difficult.

You may find the pain gets worse when you:

Sometimes sciatica is accompanied with lower back pain, however, usually the buttock or leg pain is much worse than the lower back pain. You probably don’t have sciatica if you just have low back pain.

Usually these symptoms occur in one leg. If you are getting symptoms in both of your legs, it is recommended to consult your GP as this could be a sign of a more serious condition.

It is recommended to seek immediate medical attention if you are experiencing:

  • Back pain and fever
  • Burning when you empty your bladder
  • Blood in your urine
  • Loss of bowel or bladder control

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What are common causes of Sciatica?

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The main cause of sciatica is due to damage to the intervertebral disc in the low back (lumbar region).

Thirty three spinal bones known as vertebrae are stacked on top of each other to form the human spine. Seven of the vertebrae make up the cervical spine (neck), 12 make up the thoracic spine (the middle back), 5 make up the lumbar spine (the lower back) , 5 make up the  sacrum and 4 make up the coccyx . Nerves run through the whole length of the spine. They connect the brain to each part of the body enabling messages to be sent and received, enabling you to move and feel things.

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Intervertebral discs (IVD) are found in between each vertebrae. They act as a cushion, aiding (along with muscles & ligaments) in holding 24 of the 33 vertebrae together (the scarum and cocycx bones are fused and therefore do not have IVD’s). The IVD’s prevent the vertebrae from rubbing together and consist of a gel filled inner layer (known as the nucleus pulposus) surrounded by a hard fibrous outer layer.

Sometimes a person / patient can strain or injure their discs which can cause part of the gel filled nucleus to herniate out of the fibrous outer casing. This is known as a prolapsed disc, herniated disc or a slipped disc. When the disc herniation occurs in the lower back it may compress onto your sciatic nerve causing symptoms into the thigh, leg, buttock and/ or foot.

There are many causes of disc herniation, below are a couple of common examples:

There are other, less common causes of sciatica:

  • Spondylolithesis this is when a vertebrae, most commonly in the lower part of your spine slips either forward, backwards or on top of another bone, subsequently compressing part of the sciatic nerve.
  • Spinal stenosis – is a condition which causes a narrowing of the spinal canal. It is more common in the elderly population.
  • Degeneration degeneration of the vertebrae in the lumbar spine can also be known as spinal osteoarthritis. This can cause abnormal bony growths to develop, known as osteophytes or bony spurs. Sometimes the osteophytes can form next to where the sciatic nerve exits the vertebrae (known as the intervertebral space) and subsequently can compress or irritate the nerve causing sciatic type symptoms. Again this is more common in the eldrly population.
  • Spinal injury or infection
  • Spinal tumours – sciatic pain caused by a spinal tumour is very rare.
  • Piriformis Syndrome the piriformis muscle is a small muscle in your buttocks which is responsible, along with other muscles in externally rotating your hip. The sciatic nerve can go alongside or pierce through the piriformis muscle. Spasm or tightness of the piriformis muscle can cause compression of the sciatic nerve resulting in buttock pain and sciatic like symptoms.

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What are the risk factors for Sciatica?

There are a few factors that can increase your risk of developing sciatica. These can include:

  • Injury to the lower back  – a current or previous injury to the lower back can put you at more risk of developing sciatic type symptoms.
  • Ageing  – age related changes to the spine such as bone spurs and herniated disks are common causes of sciatica.
  • Overweight – being overweight causes increased stress on your joints, particularly the weight bearing joints including the spine. This can cause increased risk for sciatica.
  • Weak core muscles – when we talk about the core muscles we don’t just mean the aesthetic six pack on the abdomen. Anatomically the core muscles refer to a group of four main muscles that surround the spine and protect it.  Individuals who have weaker core muscles are at more risk of developing lower back problems including sciatica.
  • Physical or active job – certain jobs that require using heavy machinery, or lifting heavy objects may increase your risk of developing lower back problems including sciatica.
  • Osteoarthritis – this condition is an age related, degenerative condition that affects the cartilage within the joint. Bony spurs can form as a result of this condition which can cause compression of the nerves as they exit the spinal column. When this happens in the low back it can cause sciatica.
  • Inactive lifestyle – individuals who have a sedentary lifestyle, sit for long periods of time and don’t keep their body moving are more likely to experience low back problems including sciatica.
  • Diabetes – individuals that have poorly controlled diabetes have an increased chance of developing nerve damage This can then increase the risks of developing sciatica.

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How is Sciatica diagnosed?

In order for sciatica to be diagnosed, you don’t always have to see your general practitioner (GP) . Osteopaths, Physiotherapists and Chiropractors are allied health professionals that have the ability to diagnose the causes of sciatic pain and potential treatment options. Your therapist will perform a consultation which involves taking a case history. In this history, the practitioner will ask you about the symptoms you have experienced and potentially still are experiencing. They will also complete a physical examination. Information obtained via this examination and case history will assist the practitioner in making a diagnosis.

Whilst your practitioner is taking the case history they may ask you questions such as;

  • What is the nature of the pain?
  • How long is your pain lasting?
  • When did the symptoms and pain start?
  • Where you doing anything particular when you first noticed the pain?
  • Have you previously injured the back or hip area?
  • Have you noticed any decrease in strength of the leg or foot?

During the assessment section of the appointment, a series of tests may be carried out by your practitioner. This may include; an assessment of your posture, reflex tests, muscular strength tests and nerve stretch tests.

In some cases further imaging or investigations may be required to understand the exact cause of the nerve irritation. This may include:

  • X-ray – this is a common type of imaging used to look at the bones and joints. It allows the practitioner to see any fractures and is the gold standard for diagnosing osteoarthritis.
  • MRI – this is used to look at the soft tissues of the body including the intervertebral discs, nerves and muscles. This type of imaging is used to diagnose disc prolapses.
  • CT scan – this imaging procedure combines a series of x-ray images taken from lots of different angles around the body to give a detailed look at the spinal cord and nerves. It gives more in depth visual information than a plain x-ray.
  • Electromyography – this test measures and evaluates the electrical activity of the muscles and nerves.
  • Blood Tests – these tests may be done to rule out any other causes of sciatic symptoms.

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Options when treating Sciatica

There are many options when it comes to treating sciatic pain. The treatment for sciatica and length of treatment will be dictated by the origin and cause of the sciatic pain.

Non- surgical options include:

Osteopathy

Visiting an Osteopath or Physiotherapist can help with sciatica relief.  A variety of hands on techniques can be used with the combined aim of:

  • Reducing the pressure being place onto the sciatic nerve
  • Improving overall blood flow and circulation to the affected area
  • Improving the function and movement of the body by stretching and releasing tight muscles

Information regarding pain management techniques, hot and cold therapy and advice about returning to activity can all be provided by our osteopaths and physiotherapists.

Your Osteopath or Physiotherapist may additionally prescribe you with a range of exercises with the aim of increasing the strength core muscles and lower back as well as improving your posture. These exercise programmes will be designed by our practitioners to ensure they are controlled and progressive. Your program will be tailored to your individual needs and based upon your specific symptoms.  In order to prevent the return of sciatic pain, it is important that the program is adhered. Continue reading to see a range of simple exercises to help manage your sciatic pain.

Medication

Based upon the severity of your pain, you may wish to visit your GP. Your general practitioner can prescribe oral medications aimed at relieving your symptoms:

  • Anti inflammatory medications can be prescribed as sciatic nerve irritation can result in pain and inflammation
  • Painkillers can be provided over the counter to manage your pain levels
  • To manage muscle spasms, muscle relaxant medication may be prescribed
  • Antidepressants or anticonvulsants can be prescribed if the nerve pain is really severe

Epidural Steroid Injections (ESI)

Steroid injections can by recommended by your GP to assist with pain management. This technique requires an injection of corticosteroid and a local anaesthetic into the epidural space (space around your spinal cord). Through reducing the inflammatory response around the sciatic nerve, ESI’s can provide temporary relief from symptoms of sciatica.

Surgical options:
Sometimes people with sciatic nerve pain may need surgery to their spine. This is a very small percentage of people and is very rare. Any surgical options should be discussed in detail with your GP or consultant. The two main surgeries for sciatic nerve compression are a discectomy or laminectomy. The main aim of surgery is to decompress the affected sciatic nerve.

  • Discectomy: this is a surgery in which part or all of the damaged disc that is compressing the sciatic nerve is removed.
  • Laminectomy – Removal of part of one or more of the vertebrae’s found in your lumbar spine (low back), known as the lamina. This reduces the likelihood of the nerve being compressed by creating more space for the sciatic nerve

Visit the NHS help website to find out more information about the different surgeries available for sciatic nerve compression.

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How long does Sciatica last?

The prognosis for sciatica is dependant on the cause of the nerve compression. For some patients symptoms may occur for 6-8 weeks, for others it may be a more long term prolonged pain. Suffering with sciatic symptoms? Book in for a free 15 minute consultation with one of our osteopaths to see how they can help you and your sciatic pain.

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Can Sciatica be prevented?

Not all causes of sciatica can be prevented. However, you can take steps to protect your lower back and sequentially reduce your risk of any further injury. Below are a couple of hints and tips towards protecting your lower back from further injury:

  • Exercise: Strength through the spinal and abdominal muscles will allow for greater stability through your spine. Pilates and Yoga are both fantastics ways of improving the strength and stability of your spine and abdominal muscles. Book a FREE discovery Pilates session at bodytonic clinic to find out how we can help you and your lower back.
  • Lifting Techniques: In order to reduce the risk of injuring your back, ensure that you have a good lifting technique. Please see the following tips to ensure you keep good form when completing a lift of any weight.
    1. Do not bend from your back. Instead bend from your hips and knees.
    2. Squat down to the object you are picking up as opposed to bending over
    3. Engage your abdominal muscles when straightening your legs to lift the object up. This can done by keeping the object close to your body.
    4. Refrain from turning or twisting your back when you are performing a lift
    5. Keep all lifts below the height of your shoulders
  • Posture: When standing and sitting be sure to maintain good posture when. Unnecessary pressure can placed upon the joints, ligaments and muscles of the back as a result of poor posture.

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What are the best exercises  for Sciatic Pain?

Maintaining movement is essential for people suffering with sciatic pain. Exercise and movement helps with; aiding blood flow around the body, strengthens muscles and prevents joints and ligaments from stiffening up.

Below are a couple of simple exercises to do if you are experiencing sciatic pain*

Pelvic Tilt

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Move into a lying position with your back on the floor. Ensure your knees bent. Inhale deeply before exhaling and pushing your lower back into the floor slowly. It will be noticeable that your pelvis tilts when completing this movement. Take another breath in before returning to the neutral position. Following this, raise your back off of the floor. Whilst doing this, be sure to arch your back, and tilt your pelvis in the opposing direction. Finally, bring your body back to its original neutral position. Repeat this exercise. Learning this exercise will provide you with an important foundation to learn advanced exercises. Book in a free sciatica consultation today!

Piriformis and Glute Stretch

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Lie with your back on the floor and your knees bent. Identify the ankle of the leg you want to stretch. Move this ankle over the opposite knee. Gently pull the knee with your hands towards the opposite shoulder. You should do this until a stretch is felt in the buttocks. To make this stretch more specific to the piriformis muscle, push on the knee instead of bringing it to the shoulder. You should do this until a stretch is felt in the hip or buttocks. These are both great stretches for sciatica.

Semi Cobra

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Lie on your stomach with your hands placed underneath your shoulders. Inhale and gently push up with your arms, maintaining a forward gaze. Gradually lift your chest off the floor. Hold for around 30 seconds.

Make sure your pelvis is still contacting the ground and  your buttock muscles relaxed. Take two to three slow breaths and then slowly return your torso to the floor and repeat. Be mindful to not push up too far and complete the exercises within a pain free range.

* It is recommended to get the OK from your Osteopath, Physiotherapist or GP before trying out any of these exercises.

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Do I need to go to the GP or visit my local hospital?

The Sciatica NHS website suggests that you should go to your GP if you are experiencing any of the following symptoms:

  • Experiencing sciatica on the left and right hand side
  • Experiencing severe or worsening numbness or weakness in both legs
  • Experiencing numbness under or around your genitals or  anus
  • Experiencing difficult when start peeing, or controlling your pee
  • Experiencing difficult when start pooing, or controlling your poo

If you a experiencing any of these could be symptoms, you may be at risk of a more serious back problem.  In order to seek further medical advice on how to treat your symptoms, visit your local GP or call 111.

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FAQ’s

Sciatica happens due to their being a pinching or compression of the sciatica nerve. There are many different causes of sciatic nerve compression. The most common cause of sciatica is a disc herniation. Common causes of a disc herniation include: being overweight, pregnant, lifting heavy objects, accidents or traumas. Other causes of sciatica include spinal osteoarthritis, spondylolisthesis and piriformis syndrome.

The treatment for sciatic pain depends on what is causing your symptoms. There are many different treatment options ranging from conservative, non surgical options. This includes, physical therapy such as osteopathy or physiotherapy, medication including anti inflammatories, analgesics and in some cases muscle relaxants and antidepressants as these can also help with nerve pain. In more severe cases surgical intervention may be required. If you are experiencing symptoms of sciatica speak to one of our qualified practitioners today to find out what is the most appropriate treatment plan for you and your symptoms.
In some instances sciatica can go away on its own with self care advice. However this is dependent on what the cause of the sciatic symptoms is. It is also best to speak to a qualified professional such as an osteopath, physiotherapist or GP to help better understand your symptoms, the cause of the symptoms and what the most appropriate treatment plan is.
The length and duration of sciatic symptoms is dependent on the cause. In cases where the symptoms are caused by a herniated disc symptoms can last around 8-10 weeks.
Keeping mobile is always a good option when experiencing sciatica type symptoms, however this must be done within your limits and not if it is causing you excruciating pain. Keeping moving helps with keeping the joints mobile as well as helping with blood flow which in turn helps with the healing process.
There is no quick fix when it comes to treating sciatica. The treatment modalities used are dependent on the cause of the sciatic symptoms. In cases where the sciatica is caused by a disc herniation there are a variety of treatment options available including hands on treatment such as osteopathy or physiotherapy. Adherence to prescribed exercises helps with optimal recovery.

There are a few things that should be avoided if suffering with sciatica. It is advised:

  • To avoid sitting for to long
  • To avoid lifting anything heavy
  • To avoid fully flexing your back
  • To avoid too much bed rest
  • To avoid long trips in the car

There are a few things that can make sciatica symptoms worse. These can include:

  • Sitting down for to long
  • Bending over
  • Long trips in the car
  • Lifting heavy objects
  • Awkward twisting of the spine
Most people recover from sciatica with little to no intervention. However, this is all dependent on the cause, in some cases permanent nerve damage may occur. For this reason it is important to seek guidance from a medical professional including your GP, osteopath or physiotherapist. They will be able to help figure out what is causing your symptoms and put forward the most appropriate treatment plan.
The reason why sciatic symptoms may increase at night is due to the position you may be sleeping in. For some lying on their back can increase the pressure onto the sciatic nerve which in turn can increase symptoms. This may especially be the case if the mattress being used is soft and unsupportive as it will allow the spine to bend.
Prolonged sitting in some cases can be bad for individuals suffering with sciatica. This is because increased pressure can be put onto the sciatic nerve. It is advised to keep mobile and change positions regularly when suffering with sciatica.
For some individuals suffering with sciatica, lying down may be the only comfortable position. For others this may increase their symptoms. When lying on your back it is advised to place a cushion underneath the knees as this helps to relieve pressure on the low back.
It is not uncommon for sciatica to occur during pregnancy. This can be due to the increasing size of the uterus and growing baby. As a result the centre of gravity of the mother can change which in turn can put pressure onto the sciatic nerve causing irritation to the nerve. It is also common to experience a disc herniation during pregnancy again this can be down to changes in weight and centre of gravity of the expectant mother.
There are many different medical professionals that can help treat sciatica pain. Physical therapists such as osteopaths, physiotherapists and chiropractors all help with treating sciatica and its cause. In some cases surgical intervention may be needed and in these cases an orthopedic consultant and surgeon will discuss the appropriate surgical interventions.