What is sciatica?
Do you suffer from pain that radiates down your back, glutes, and legs? You may be suffering from a condition known as sciatica. Sciatica is an umbrella term used to describe pain that travels down the back of the glutes and leg, as low down as the feet and toes [1]. Sciatic pain can also present in the form of altered sensation, tingling and muscle weakness. Despite what most people think, you don’t necessarily need to have lower back pain in order to have sciatica. In this blog post, we’ll talk about the causes of sciatica, the symptoms it can cause, and the treatments that are available. We’ll also look at the importance of seeking medical advice if you think you have sciatica, as sciatic pain can make simple actions such as playing with grandchildren or sitting at your desk a huge problem.
Causes of sciatic pain
Sometimes, there's no obvious moment of onset for sciatica and the condition builds up over a period of time [1]. A study showed that having a physical job is a major cause of sciatica, such as those of manual labourers and truck drivers. In other words, some individuals might have increased risk of back problems because they are forced to bend their backs all the time.
The sciatic nerve is the largest of the nerves that supply your legs, and it originates from the spinal cord, which exits through small openings in your lower back [2]. Upon entering the pelvis, the nerve passes through the muscles in your glutes, and then into your leg. Therefore, because of the small space it passes through, it is prone to compression by a variety of structures in the body.
Common causes of sciatica include:
· Herniated Disc: Disc herniation in the lumbar spine is the most common cause of sciatica hip pain. Herniated discs tend to place pressure on the nerve. They cause inflammation, which irritates the nerve.
· Degenerative Joint Disease: Bony spurs on the facet joints are formed in degenerative joint disease. This can make the intervertebral area narrow. It can also cause the intervertebral disc to wear down and reduce in height. The discs may experience a loss of space causing the exiting nerve to compress.
· Trauma: A sports injury or fall can place pressure on the peripheral nerve, resulting in symptoms along the nerve's path.
· Excessive Sitting: Piriformis muscle may tighten because of sitting too much. This can cause the sciatic nerve underlying the muscle to get compressed. Rowing or biking for long duration are other repetitive strain activities that can cause pain. The piriformis muscle is presented within the gluteal muscles. The sciatic nerve can experience a spasm when it contracts or shrinks.
· Excess Weight: Research shows that overweight and obese people are at greater risk of back and hip pain and sciatica in particular. Along with heavier uteruses during pregnancy, some other causes of sciatica pain include bad posture.
· High Heels: As high heels make your body weight shift forward, they can cause a wide range of spinal problems. As a result, the lower back is placed under more stress by flexing the hips unnaturally. As a result, your hamstrings may overstretch, which may lead to more sciatica symptoms.
Symptoms of sciatica
The most common symptom of sciatica is pain, which may vary in nature [2]. Some common symptoms include:
· Stabbing, tingling or pins-and-needles feeling, uncomfortable, or an abrupt sensation of numbness.
· Tingling, cramps, and weakness in the lower extremities.
· The pain generally presents in your glutes and lower back, but it may extend into your hamstring, calf, and foot (lower body pain) or you could just feel it in your lower extremities and not your lower back
· In rare cases, you can have pain on both sides of the body
· Pain can be worsened by a cough or sneeze, prolonged sitting or lying down, or prolonged standing.
Acute management
Acute management is the treatment used in the initial phase where pain has just begun and you need a relief from the pain [3]. It is not recommended to take any non-steroidal anti-inflammatory drugs (NSAIDs) as they often do not relieve symptoms of sciatica [2]. It is also not recommended to rest. While this might be useful for severe pain when the problem is new, but once the pain has been present for a while, resting in bed is more likely to prolong than to cure it.
Instead, it is recommended to get into the habit of being gently active, as gentle movement will help reduce your pain [4]. Other options for pain relief could include heat packs, relaxed breathing and distraction, such as listening to music.
Be aware of the activities that make the pain worse and avoid things like excessive lifting and staying in the one position for too long [4]. Doing activities in small amounts with rest breaks will avoid flaring up your symptoms. Remain at work if possible.
Gentle exercises, stretches and walking may help to ease your pain [4]. Begin to exercise regularly, for short periods of time and gradually increase the amount you do as it feels more comfortable.
These will all help to reduce pain but the most effective form of treatment in the acute stage is through manual therapy [2]. This can be performed by a remedial massage therapist, myotherapist or osteopath and can include massage, dry needling and gentle nerve stretching. Most patients will see relief and a reduction in symptoms in only 1-4 visits.
Prevention
Personalised rehabilitation programs, designed by a physiotherapist, will aim to reduce pain permanently and decrease your chance of suffering symptoms in the future [2]. This involves strengthening exercises that target the muscles that support your lower back and glutes. This is vitally important, as it will contribute to your body being able to cope with the demands placed on it day to day, as well as any recreational activities you love to do. A thorough long term management plan also involves targeted nerve mobility exercises to improve the movement of your affected nerves, as well as spinal mobility exercises to improve the movement of your spine.
Advice and education on positioning, posturing and the level of activity suitable for you to allow your symptoms to settle and keep you comfortable whilst our treatment is having the desired effect. Back in Motion Cranbourne will also give you the advice you need to gradually build back up to the activity level you want in a safe and non-detrimental way.
So if you are suffering from sciatic pain book in an appointment today!
References
[1] Alotaibi, H, Alanazi, A, Muhalhil, N & Alenezi, T, Ayed, A & Abukanna, A, Mohamed, A 2022. Overview of Causes, Risk Factors and Management of Sciatica: A Review. Asian Journal of Medicine and Health. pp. 64-70.
[2] Ostelo, R 2020. Physiotherapy management of sciatica. Journal of Physiotherapy, 66(2), pp. 83-88.
[3] Wang, Z & Ni, G 2021. Is it time to put traditional cold therapy in rehabilitation of soft-tissue injuries out to pasture? World J Clin Cases, 9(17), pp. 4116-4122.
[4] SA Health 2021. Advice for managing sciatica. Orthopaedic Spinal Services.