The Ultimate Guide to Sciatica pain & Sciatic treatment
What is Sciatica or Sciatic Pain?
Sciatica is the term used to describe pain 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.
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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 that you should consult your GP.
What are the Common Causes of Sciatica?
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 and 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 can injure or strain their discs causing part of the gel filled nucleus to herniate out of the fibrous outer casing. This is known as a herniated disc, prolapsed disc or a slipped disc. When the disc herniation occurs in the low back it may compress onto the sciatic nerve causing symptoms into the buttock, thigh, leg 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 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?
You don’t always have to see your GP to have sciatica diagnosed. Physical therapists such as osteopaths, physiotherapists and chiropractors are able to diagnose the causes of sciatic pain.During your consultation a precise case history taking of your symptoms and thorough physical examination will be taken to help to diagnose and understand the cause of the sciatic pain.
During the case history the practitioner may ask you questions such as;
- When did the pain and symptoms start?
- Where you doing anything when the pain started?
- What is the nature and duration of the pain?
- Have you had any injury to the back or hip area?
- Have you noticed any decrease in strength of the leg or foot?
During the physical assessment the practitioner may carry out a series of tests including; a postural assessment, testing of your reflexes, strength of your muscles and nerve stretch tests.
In some cases imaging such as X-rays or MRI’s are needed to understand the exact cause of the nerve irritation.
What are the Treatment Options for Sciatica?
There are many options when it comes to treating sciatic pain. The treatment for sciatica and length of treatment required depends on the cause of the sciatic pain.
Non- surgical options include:
Osteopathy: visiting a physical therapist such as an osteopath can help with sciatica relief. The treatment would include a range of different hands on techniques that aim to:
- Reduce the pressure on the sciatic nerve
- Improve blood flow and circulation to the affected area which helps improve the body’s natural healing response.
- Release and stretch tight muscles to allow for improved movement and function.
- Release endorphins. These are hormones that circulate the body and act as natural pain relief.
Your osteopath will also advise you about pain management techniques, including the use of hot and cold therapy along with advice about returning to activity.
Exercises for sciatica may also be prescribed to you by your osteopath. These will be exercises specific to improving the mobility and strength in your lower back and core muscles as well as improving your posture. The sciatica exercise programme will be controlled and progressive, tailored specifically to the underlying cause of your sciatic symptoms. Adherence to the exercises plays a key part in preventing the return of sciatic pain. Click here to view a couple of simple exercises to help your sciatic pain.
Medication: if you decide to visit your GP, depending on the severity of your pain they may prescribe you with some oral medications to help you with relieving symptoms:
- Over the counter painkillers and anti inflammatory medications are prescribed as they can help with the pain and inflammation experienced due to sciatic nerve irritation.
- Prescription muscle relaxant medication may be prescribed to help with muscle spasms.
- If the pain is really severe then your GP may prescribe antidepressants or anticonvulsants as these can also help with nerve pain.
Epidural Steroid Injections (ESI): in some cases your GP may recommend a steroid injection to help you with your pain. ESI is a technique in which a corticosteroid and a local anaesthetic is injected into a space around your spinal cord called the epidural space. The aim of ESI is to give you temporary relief from your sciatic symptoms, it does this by reducing the inflammatory response around the sciatic nerve.
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.There are a couple of different options for surgery which 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 – this is a surgery in which the back part of one or more of your vertebraes in your lumbar spine (low back), known as the lamina is removed. This creates more space for the sciatic nerve and reduces the likelihood of the nerve being compressed.
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 15minute 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 reduce your risk and protect your lower back from any further injury. Below are a couple of hints and tips towards protecting your lower back from further injury:
- Exercise: Having good strength in your spinal and abdominal muscles are key in providing stability to your spine. Exercises such as Pilates and Yoga are a great way of improving your spinal and abdominal strength and stability. Book in to one of our free trial classes to see how Pilates or Yoga may help you and your lower back. We sometimes get asked for sciatic treatment at home, which can be possible, but usually the your treatment would be in one of our clinics in London.
- Lifting Techniques: ensuring that you have a good lifting technique is essential in reducing the risk of injuring your back. Whatever the weight of the object you are lifting ensure that you:
- Bend from your hips and knees, not from your back, and squat down to the object you are picking up.
- Keep the object close to your body and engage your abdominal muscles when straightening your legs to lift the object up.
- Avoid twisting or turning your back when you are lifting the object.
- Never lift a heavy object above the height of your shoulders.
- Posture: ensure that you have good posture when standing and sitting. Poor posture can lead to increased pressure onto the joints, ligaments and muscles of the back.
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*:
Lie with your back on the floor and your knees bent. Take a deep breath in. As you exhale slowly push your lower back into the floor, you will find that your pelvis tilts as you do this. Inhale and return slowly to the neutral position. Then lift your back off the floor, arching your back, tilting your pelvis in the opposite direction. Return to the neutral position and repeat. This exercise is a building block to more advanced exercises. Book in with one of our osteopaths to explore more advanced exercise programmes for sciatic pain.
Piriformis and Glute Stretch
Lie with your back on the floor and your knees bent. Take the ankle of the leg you want to stretch and place it 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?
The Sciatica NHS website suggests that you should go to your GP if you are experiencing any of the following symptoms:
- have sciatica on both sides
- have weakness or numbness in both legs that is severe or getting worse
- have numbness around or under your genitals, or around your anus
- find it hard to start peeing, cannot pee or cannot control when you pee – and this is not normal for you
- do not notice when you need to poo or cannot control when you poo – and this is not normal for you
These could be symptoms of a more serious back problem. It is worthwhile going to visit your local GP or calling 111 to seek further medical advice on how to treat your symptoms.