Sciatica – what actually is it?

Sciatic is a very common condition characterized by pain and or neural symptoms along the sciatic nerve distribution.

We have all heard of someone who has had sciatica, but what is it? Sciatica is a common condition characterized by radiating pain following the sciatic nerve pathway from the lower back down to the back of the leg. This can also be accompanied by neurological symptoms such as pins and needles or numbness. Everyone who has sciatica can present slightly differently and symptoms can vary from mild to severe.

Where is the sciatic nerve?

The sciatic nerve begins at the L4/5 and S1/2/3 nerve roots in the lumbar spine. It travels down below the piriformis muscle, deep to the gluteal muscles, down the hamstring before splitting into the tibial and common peroneal nerve at the back of the knee. In a small percentage of people, the nerve runs through the middle of the piriformis muscle. It is the thickest nerve in the body being 2cm wide.

What does the sciatic nerve do?
Nerves have two main functions, to activate movement of a muscle and to supply sensation to an area. The sciatic nerve innervates motor control of the hamstring muscle and adductor magnus. Additionally, it provides motor control and sensation to the leg and foot via the tibial and common peroneal nerve.

Causes of Sciatica:

There are many potential causes of sciatica. It can be related to the spinal region, such as spinal stenosis, disc bulges, or herniations pressing onto the nerve roots. Alternatively, it can be due to other sources such as trauma, piriformis syndrome, or be present throughout pregnancy.

Symptoms of sciatica:

Symptoms typically involve radiating pain and/or neurological impairments such as pins and needles, numbness, temperature changes, decreased reflexes, and weakness following the sciatic nerve distribution. Pain is generally in the lower back, and buttocks and can radiate down into the leg. It is important to note that symptoms can vary a lot from case to case. Each person can present differently with pain in different regions and to different severities, different neurological symptoms, or no neurological symptoms.

Diagnosis of Sciatica:

Sciatica is generally diagnosed by a practitioner based on the patient’s subjective interview and a number of assessments. Where the patient describes their symptoms can give a good indication that it may be due to sciatica as it will clearly follow the sciatica nerve distribution. Several assessments will also be performed to further support a sciatica diagnosis. Often these will involve looking at how symptoms change with different lumbar back movements, or how they vary when placing the nerve on stretch. Imaging can also be used in some cases if symptoms do not improve with treatment. This will generally be of the lumbar spine and will indicate if sciatica is present due to spinal pathology.

Treatment of Sciatica:

Conservative treatment is the first line of treatment for sciatica and is successful in the majority of cases. Seeing an osteopath or physiotherapist is a great place to start to get a correct diagnosis and start hands-on therapy and exercise prescription. Treatment will typically involve manual therapy, such as soft tissue and trigger point release work throughout the lower back and gluteal muscles. This can help relieve pain and release off tight muscles that the nerve sits close to. Exercise is a really important part of the management of sciatica. It can involve stretching throughout the lower back and lower limb, nerve slider exercises that promote movement of the nerve along its pathway, as well as strengthening exercises. Self-release work can also be utilized to provide relief of symptoms. This can be done at home through foam rolling or using a spike ball to get a deeper release of the muscles.

Medicine can be used alongside hands-on treatment and exercises. Non-steroid anti-inflammatory drugs (NSAIDs) are one of the commonly prescribed medications for sciatica to provide relief of symptoms. In more serious cases surgical intervention may be recommended. This is often utilized in more serious lumbar spine causes of sciatica that have had an unsuccessful conservative treatment.

Sciatica is highly variable between patients with everyone presenting differently. However, it is not a pain that has to be tolerated with so many different treatment avenues available to those affected. If you think you may have sciatica come down and see one of our amazing physiotherapists or osteopaths here at 13th Beach Health Services.