Sciatica represents a debilitating condition characterised by pain and tingling/numbness within the sciatic nerve distribution or an associated low back nerve root. It is most common in the fourth decade and is rare in the under-20s. A Common misconception often wrongly identifies any low back pain or radiating leg pain as sciatica. Sciatica entails pain directly resulting from sciatic nerve or root pathology.
Unfortunately, Sciatica can affect virtually all daily tasks including those that involve static postures and weight-bearing activities. Sleep can be significantly impacted which can in turn be detrimental to healing and thus recovery.
Comprising nerve roots from the lower lumbar and Sacral region the sciatic nerve, with a diameter of up to 2 cm, stands as the body’s largest nerve.
These nerve roots fuse to create the large sciatic nerve in the pelvic cavity. The sciatic nerve exits the pelvis, enters the posterior thigh and courses through the hamstrings and terminates at the knee giving rise to 2 nerves which then travel into the lower leg. Sciatica symptoms occur when there is pathology anywhere along this course of the nerve.
The most common cause of sciatica is a herniated or bulging lumbar intervertebral disc. In older patients, lumbar spinal stenosis (narrowing of the spinal canal/s) may cause these symptoms as well. Spondylolisthesis (forward slippage of a lower lumbar vertebrae) or a relative misalignment of one vertebra relative to another may also result in sciatic symptoms. Additionally, lumbar or pelvic muscular spasms or inflammation may impinge a lumbar or sacral nerve root, causing sciatic symptoms. Rarely, spinal or paraspinal mass, including malignancy, epidural hematoma, or epidural abscess, may also cause a mass-like effect and sciatica symptoms.
Due to the many different causes (described above) of Sciatica, we must identify the structure/s involved in your Sciatica to provide optimal treatment and management of your condition and rule out more serious pathology.
Sciatica can be diagnosed by taking a thorough history of your recent activity and lifestyle, a review of your medical history, and a thorough physical examination.
Imaging may be useful to rule out more serious pathology. It can be useful if your symptoms are not responding to conservative management. The most useful imaging for this condition is an MRI.
A Physiotherapist will take a detailed case history to understand the cause and contributing factors to your Sciatica.
They will then carry out a thorough Evaluation to identify factors contributing to your condition.
The Physiotherapist will then explain their findings and advise on the diagnosis, prognosis and factors contributing to your pain picture.
Depending on your presentation and expectations of the appointment, the Physiotherapist will advise on any relevant immediate relief options such as optimising pain medication, manual therapy techniques i.e. soft tissue release, joint mobilisations, or acupuncture. These hands-on techniques can provide relief and can sometimes help to dampen down the secondary responses to pain such as muscle tightness or abnormal movement patterns and postures.
The Physio will also agree on treatment goals and suggest self-management advice i.e. how to modify your activities, addressing risk factors, simple movement /posture strategies and/or an exercise program to address any movement/posture deficits. In some cases, the Physiotherapist may feel onward referral is necessary i.e. back to GP or a specialist. This will always be a shared decision-making process and often there is a lot you can be doing in the meantime.
