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.
What are the Signs and 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.
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:
Sneeze or Cough
Sit For a Long Time
Walk For a Extended Amount of Time
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 that you should consult your GP.
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.
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:
Lifting heavy objects
Accidents or Trauma
Being Over Weight
Pregnancy or Childbirth
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 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.
How is Sciatica Diagnosed?
In order for sciatica to be diagnosed, you don’t always have to see your general practitioner (GP) . Osteopaths, physiotherapistsand chiropractors are forms of physical therapist 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 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 imaging MRI’s or X-rays may be required in order to further understand the cause of nerve irritation.
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 natural healing response of the body.
Improving the function and movement of the body by stretching and releasing tight muscles
Releasing hormones called endorphins which can reduce pain
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 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 to 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 include: 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: Removal of part/all of the impaired disc that is compressing the sciatic nerve
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.
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.
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 both fantastics ways of improving the strength and stability of your spine and abdominal muscles. Book a FREE discovery Pilates or Yoga session and bodytonic clinic to find out how we can help you and your lower back. We can also complete home visits.
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.
Do not bend from your back. Instead Bend from your hips and knees.
Squat down to the object you are picking up as opposed to bending over
Engage your abdominal muscles when straightening your legs to lift the object up. This can done by keeping the object close to your body.
Refrain from turning or twisting your back when you are performing a lift
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.
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*:
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
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.
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, physical therapist or GP before trying out any of these exercises.
Do I need to go to the GP or visit my local hospital?
If you are experiencing any of the following symptoms, The Sciatica NHS website suggests that you should go to your GP.
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.