is a term that is frequently in use. I would suggest to most new patients I see that have lower back pain that goes into the leg to use the term ‘’sciatica’’. But what is it? Will your sciatica go away? What does it mean? And how do we deal with it and cure it?
Sciatica is one of the most commonly repeated ‘Google diagnoses’, but what does it actually mean?
Sciatica is a debilitating condition in which the patient experiences pain ahttps://pubmed.ncbi.nlm.nih.gov/29939685/nd/or paresthesias in the distribution of the sciatic nerve
Interestingly, from the above definition we see that the term sciatica isn’t a diagnosis, but a symptom. A lot of the confusion and ultimately over-use of the term is that there is/it consists of? back pain that turns into leg pain. After acknowledging the symptoms, it is important to identify the tissue compressing the sciatic nerve. This could be:
- A slipped disc (in about 90% of cases)
- Piriformis muscle
- Spondylilothesis (a slippage of the vertebra)
- Spinal stenosis
- Bone spur
The Sciatic Nerve
sciatic nerve is the longest and largest nerve in the body and can be as much as three quarters of an inch thick. It is the nerve that feeds the muscles that bring your heels up to your buttocks as well as contributing to the sensations in your feet and lower legs. The sciatic nerve is a bit like the M6 Motorway, as you can see in the picture to the right; it is comprised of a thick band as it branches off to cover many of areas of the leg.
Along the route to the leg, between 10-15% of people’s sciatic nerve pierces a muscle called the piriformis. This is significant in piriformis syndrome, which can cause sciatica when the muscle gets tight and pinches on the nerve.
Also mentioned on the list is lumbar spinal stenosis. Lumbar stenosis in the elderly population can contribute to sciatica. A stenosis is a condition where the hole in between the vertebra shrinks, which compresses the nerve as it comes out of the spine.
Spondylilothesis, which is a slippage of the actual vertebrae (not the disc, the actual bone) can contribute as it forms a misalignment of the vertebra, therefore impinging on the hold (foreman/is this word correct?) in which the sciatic nerve exits the spine.
A far less likely reason for this is a mass formed from either malignancy or a blood clot mass. This is rare however, so this shouldn’t be in a sufferer’s mind.
Who gets sciatica?
Only 5-10% of people suffering with lower back pain actually have sciatica. Demographically, both men and women are just as likely to develop sciatica, with an annual incidence of 1-5%. Sciatica occurs more frequently in truck drivers and machinery operators (mainly jobs that require a person to adopt an awkward physical position) particularly if you are aged from 40 to 70.
Patients attending the Clinic with sciatica typically come in complaining of a deep, burning pain in the buttock, alongside an altered sensation (and sometimes a heaviness) in the same side of the leg. There may also be occasional weakness experienced when bringing the foot off the floor.
Do I need a scan?
A commonly asked question – and one that usually gets the reply of ‘’what would a scan change?’’. Scans such as X-Rays and MRI scans are very useful if we’re not sure what the problem is. If we know what the problem is, and both parties are happy with the management plan, what would a scan add to the situation?
You may be thinking that it could determine how bad the condition is, or we could use the scan to guarantee that we know what the issue is. The problem with this is that scans can be notoriously unreliable.
A review by Brinjikji et al (2015) showed that MRI scans are unreliable as an indicator of pain, and that 90% of individuals aged 60 or older have degeneration and nerve damage, regardless of pain. Furthermore, more than 50% of individuals aged between 30-39 have disc degeneration and/or a slipped disc without any pain. This suggests that even if you have something that shows up on a scan, you won’t necessarily know if that is the reason for your pain.
Will my sciatica go away?
First of all, a major principle we have at the Clinic is explanation. A good, solid explanation with education is vital to the therapist/patient partnership. Initially, our general advice is to avoid strenuous activity and periods of prolonged sitting/standing. Movement seems to be key, according to research.
Manual therapy alongside an exercise program is the most beneficial option. The Osteopath, Physiotherapist or Sports Therapist will address the muscle tightness, while incorporating pelvic balancing techniques to facilitate stability. Alongside this, the exercise program will address the deficiencies found in the assessment.
Lifestyle advice will also be part of the package. Typical advice will be using hot/cold packs, activity modification to reduce time in an uncomfortable position, practising good posture, regular movement and lifting correctly.
Exercise is a great way to ease the discomfort found in sciatica. The following should be performed daily until there is significant improvement:
Typically, patients should expect to make a full recovery in 6-12 weeks, depending on the source of the impingement. If there is no improvement in 6 weeks, a scan should be considered, with the understanding that they are not 100% reliable. Psychological welfare could also delay progress, so if you, the reader, are suffering with issues such as depression, anxiety or PTSD alongside sciatica, you should consider informing your Healthcare Professional.
For any further questions, please don’t hesitate to ask:
0161 209 2980
Ed Madeley M.Ost