Sciatica – Its triggers, signs, treatment and management

Sciatica is pain that originates from the “sciatic” nerve. The sciatic nerve is a large nerve that is made up of the nerve roots from the lower back spinal cord. These nerves join together in the buttock and continue down the back of the thigh to supply the sensation and muscle function of the thigh, leg and foot.  When the sciatic nerve is irritated it can cause sever pain and changes to thigh, leg and foot muscular function and sensation.

Sciatica can be a short, self-resolving complaint, or may be a more long lasting or intermittent problem.  The cause of sciatica may help indicate its duration, intensity and outcomes for the patient.

Sciatica can be triggered by various different reasons.

Everyone at one time or another may have experienced an easily resolved form of sciatica caused by simply:

  • Sitting on a hard bench and pushing on the sciatic nerve causing pain and referral down the leg
  • Sitting with crossed feet and your leg and foot goes to sleep

However more acute and chronic causes of sciatica can include:

  • Slipped or bulging lumbar discs which cause muscle spasm in the back, gluteal and thigh region or compression of the nerve directly in the back and gluteal region
  • Arthritis causing spinal and disc degeneration which leads to nerve compression and irritation
  • Spondylolisthesis – vertebral body slippage – which causes nerve compression
  • Pregnancy related pelvic changes causing muscle spasm and joint strain, and hence sciatic nerve irritation
  • Obesity which puts lots of extra weight through the spinal joints, discs and hips and pelvis
  • Or more serious infection or tumour

Symptoms of sciatica can vary but often include at least couple of the following:

  • Aching in the buttock region, and down the thigh, calf and foot
  • Pins and needles in the thigh, leg and/or foot
  • Weakness and loss of power in the muscles of the leg and foot
  • Hot, shooting pain in the buttock, thigh, lower leg
  • Pain in the ankle and foot
  • Increase pain when sneezing, coughing, lifting and twisting the body
  • Pain may also be worse sitting or driving
  • Weakness or not able to control bladder or bowel function – if this occurs, go straight to your closest emergency department as IMMEDIATE medical attention is required

Treatments for Sciatica can be varied. Firstly, a diagnosis as to the exact cause of sciatica needs to be made by your Osteopath, your GP or other health care practitioner. We will ask you a serious of questions, as well as take you through a physical examination to help determine the underlying pathology and hence best management and treatment plan for you. This may also include referral for imaging such as CT scan or MRI.

Treatments can include:

  • Hands on manual therapy such as Osteoathy – this will include appropriate
    • Soft tissue massage,
    • Joint mobilsation
    • Joint articulation
    • Muscle energy technique
    • Active release technique
    • Myofascial release
    • Dry needling
    • Rehabilitation, strength work and stretching as appropriate
    • Taping and bracing as required

  • Plus advice on the use of:
    • Heat packs
    • Ice packs
    • Medications, either over the counter or prescription from your doctor
    • Lumbar supports for driving in the car or other ergonomic tools
    • Rest and Movement – as appropriate for presentation and condition
    • Appropriate mattress and pillow support

  • Other medical treatments such as
    • Epidural injections
    • Facet joint injections
    • Lumbar disc injections
    • Acupuncture
    • Surgery – but only if all other measures have been taken and not enough improvement has been made or will continue to be made to enable pain and function at a manageable level

As sciatica is really used as a term to describe the area of pain and restriction involved, rather than the cause, it is important to remember that correct diagnosis will lead to the best treatment, management, understanding, education and rehabilitation to help prevent the sciatica returning.