Sciatica, although common, is an often-misunderstood condition. It relates to irritation or compression of the sciatic nerve, which runs from the lower back down the back of the leg to the foot. It can be debilitating, but there are treatments that can help. In this article, we’ll explain sciatica’s root causes, its symptoms and how we can treat it.
Causes of sciatica explained
The word ‘sciatica’ describes the fact that the sciatic nerve is involved, but it doesn’t tell us anything about the underlying cause of the problem.
The sciatic nerve, the largest in the human body, is formed from several nerve roots that emerge from the lowest part of the spine. The nerve makes its way through the buttock and down the back of the thigh, supplying motor control to the muscles along the way. It then splits near the back of the knee, forming two nerves that provide motor control and sensation to the lower leg and foot.
Most of the causes of sciatica occur in the lower back. They include:
Discs are tough, fibrous cushions with a gelatinous core that sit between the bones of the spinal column. Sometimes, injury or wear means a disc can bulge outwards. The most common place for this to happen is in the low back, as this area has a lot of mechanical stress. Here, a bulging disc can put pressure on the roots of the sciatic nerve – this is the most common cause of sciatica, accounting for around 90% of cases. If the disc’s fibrous layers split and the gel centre leaks through, it can act as an irritant to the nearby nerve roots, too.
Spinal stenosis is narrowing of the channel through which the nerve roots pass. It’s largely age-related, due to degenerative changes in the spine, although, uncommonly, people can be born with a propensity to develop stenosis.
On its way through the buttock, the sciatic nerve passes very close to (or occasionally through) one of the deep buttock muscles, called the ‘piriformis’. Injury or spasm of the piriformis muscle can compress the nerve, triggering sciatica symptoms.
Similar to spinal stenosis, this age-related condition is marked by bony enlarging of the edges of the discs, the vertebrae and the small joints between them. This is much like osteoarthritis that happens in other joints; for example, arthritic knees and fingers commonly get larger. The result, however, is that the sciatic nerve roots are squeezed as they exit the spinal canal, and they can become inflamed.
Falls and fractures that affect the low back and pelvis can also trigger sciatica. Sometimes, a fall to the buttock can result in bruising and swelling of muscles that then compress the sciatic nerve. As the swelling recedes, so does the sciatica.
Tumours or infections
These are both rare causes of sciatica. Tumours, whether cancerous or benign, that develop in the low back or pelvis can compress the sciatic nerve. Similarly, infections in the bones or soft tissues can cause inflammation or abscesses that can irritate the nerve.
The vertebrae of the spinal column should stack neatly, one on top of the next. But sometimes an instability can develop due to damage or age-related wear and tear. This allows one vertebra to slip slightly on the one below. In some cases, the slip can impinge on the nerve roots as they exit through the spine.
Happily, identifying the right cause of sciatica will generally lead to an appropriate and effective treatment.
Symptoms of sciatica explained
The symptoms of sciatica can vary from mild to excruciating pain. There may also be tingling sensations, areas of numbness, and later, weakness. Here are some of the symptoms people with sciatica experience:
- pain that radiates from the low back to the buttock, hip and leg
- pain that is often described as stabbing, shooting or burning
- aching in other areas, as your weight shifts to compensate
- tingling or stinging sensations along the path of the nerve, and later numb areas
- pain that is worse with sitting or standing
- pain can be worse at night or after rest
- weakness anywhere in the leg or foot – for instance, you may notice you start tripping over your toes
Rarely, a severe disc herniation that results in sciatica can also cause a complication called ‘cauda equina syndrome’ (CES). This causes problems with bowel and bladder functions, pain and/or weakness in both legs, numbness of the groin, buttocks and inner thighs, or sexual dysfunction. If you experience any of these, it’s important to seek medical attention quickly, as the condition can cause irreversible nerve damage.
Always seek help if your symptoms are progressing. The pain may change from intermittent to constant, pins and needles may increase or develop to numbness, you may have a heightened sensitivity to pain or abnormal sensations, or you may start to feel weakness in the leg or foot. These suggest that things are worsening, but often, such symptoms can still be treated without surgery.
Diagnosis of sciatica explained
A physical examination from a physiotherapist or osteopath is usually sufficient to diagnose sciatica and its underlying cause.
Sometimes, a scan such as X-ray or MRI can be useful, but usually only in cases where there are concerning symptoms, or if your doctor thinks disc surgery might be a good option. This is because many people have disc herniations with no symptoms at all, so it should never be assumed that a bulging disc found on a scan is the cause of the sciatica. It’s more accurate to make a diagnosis based on the clinical picture.
Your physiotherapist or osteopath will not only determine why you have sciatica, but they’ll look for all the factors that have contributed to the cause. For example, perhaps you’ve been walking unevenly due to a stiff ankle, which has caused tension in the muscles on one side of your pelvis, or perhaps you have ‘fat wallet syndrome’!
Treatment for sciatica
Inevitably, for treatment to be effective, it must address the root cause of your sciatica.
Osteopathy and physiotherapy are ideally placed to do this. Evaluating your whole-body function, the therapist can identify any biomechanical problems, areas of strain, weakness or imbalance, and develop a plan to remedy them.
A plan like this can take a little time to have its effect. However, in the meantime, your osteopath or physiotherapist has ways to reduce your pain, improve your function, and give you self-help tips to manage your symptoms. Here are some ideas:
Hot and cold therapy
Ice is a great way to reduce inflammation and dull pain. Combine it with warmth to soothe aching muscles and stiffness.
Taking a break from those activities that aggravate your pain can help your body recover more quickly. If sleeping is difficult, your osteopath or physio can show you some tricks to find a comfortable position.
Over-the-counter painkillers can give you a break from the pain and allow you to rest – vital for recovery. If they give you no relief, get some advice from your GP about prescription painkillers that may be suitable in the short term.
Widely known for its pain-relieving qualities, acupuncture is increasingly gathering evidence for its effectiveness in easing sciatica.
Although you may be quite debilitated by your sciatica at first, some gentle exercise, such as walking, can help to ease inflammation, reduce pain, and normalise function.
How can osteopathy and physiotherapy help sciatica?
Osteopaths and physiotherapists treat in a holistic manner. That means they consider all the factors that contribute to a problem, and they look at the way the functions of all parts of the body combine to influence overall health.
As experts in musculoskeletal health, osteopaths and physios understand the anatomy of the sciatic nerve, and how it can be impacted by structures around it. They also understand what to look out for that might suggest medical intervention will help, and they will refer you to your doctor or specialist if necessary.
Physiotherapists and osteopaths have many techniques at their disposal to treat sciatica and can tailor treatment according to each patient’s needs and preferences. Manual therapy includes a variety of massage and joint mobilisation techniques, designed to ease pain, improve flexibility and help speed you on the road to recovery.
Spinal manipulation is a specialist technique that has been recommended by the National Institute for Health and Care Excellence (NICE) as a treatment for back pain and sciatica, along with exercise, which osteopaths and physiotherapists both offer as part of a comprehensive treatment plan.
Here at Woodside Clinic, you may have the option to integrate Pilates, acupuncture, massage or hydrotherapy into your treatment plan to give you the best long-term results. Your therapist will work with you to devise the best approach for your circumstances.
Sciatica is a painful condition and can significantly impact your quality of life. However, the underlying causes are rarely serious, and the condition isn’t permanent.
The key to effective treatment is identifying the root cause. If you’re ready to tackle your sciatica, get a personalised plan from one of our expert osteopaths or physiotherapists. Book an appointment today.