Sciatica

What is sciatica?

Sciatica is pain in the lower extremity resulting from irritation of the sciatic nerve. The pain of sciatica is typically felt from the low back (lumbar area) to behind the thigh and radiating down below the knee. The sciatic nerve is the largest nerve in the body and begins from nerve roots in the lumbar spinal cord in the low back and extends through the buttock area to send nerve endings down the lower limb. The pain of sciatica is sometimes referred to as sciatic nerve pain.

What are causes of sciatica?

While sciatica is most commonly a result of a lumbar disc herniation directly pressing on the nerve, any cause of irritation or inflammation of the sciatic nerve can reproduce the symptoms of sciatica. This irritation of nerves as a result of an abnormal intervertebral disc is referred to as radiculopathy. Aside from a pinched nerve from a disc, other causes of sciatica include irritation of the nerve from adjacent bone, tumours, muscle, internal bleeding, infections, injury, and other causes. Sometimes sciatica can occur because of irritation of the sciatic nerve during pregnancy.

What are the symptoms of sciatica?

Sciatica causes pain, a burning sensation, numbness, or tingling radiating from the lower back and upper buttock down the back of the thigh to the back of the leg. The result is lumbar pain, buttock pain, hip pain, and leg pain. Sometimes the pain radiates around the hip or buttock to feel like hip pain. While sciatica is often associated with lower back pain, it can be present without low back pain. Severe sciatica can make walking difficult if not impossible. Sometimes the symptoms of sciatica are aggravated by walking or bending at the waist and relieved by lying down. The pain relief by changing positions can be partial or complete.

What are treatment options for sciatica?

Usually, a brief period of rest from the aggravating activity and physiotherapy treatment will settle the acute pain. Your physiotherapist will perform hands on techniques that address the cause of your sciatica. Techniques do vary depending on whether the problem is a disc or facet joint injury.In addition to pain-relieving techniques your physio will provide exercises that assist your specific back deficiencies. This may include some loosening, stabilisation or strengthening exercises. Exactly which exercises work best for you will vary depending on the cause of your sciatica. Sciatica is difficult to treat successfully. If in doubt, please consult your physiotherapist.Starting physiotherapy as soon as possible can be very helpful. To ease inflammation around the nerve, your therapist may recommend that you use either hot or cold packs. They will provide you with exercises that either loosen or strengthen your back. Exactly which exercises work best for you will vary. It is best to seek professional advice prior to commencing an exercise program for sciatica.

A back brace or corset can provide excellent relief for most sufferers. Those who gain the most benefit are those who find their pain eases when they wrap/bind a towel or sheet (folded-lengthwise) tightly around their stomach and back. If this simple test eases your pain, you should use a back brace in the short-term. Back braces and strong deep core muscles help to avoid a recurrence in the future.

What is the outlook (prognosis) for patients with sciatica?

Sciatica usually eases after a period of rest and avoiding aggravating activities. Your physiotherapist can assist to ease your symptoms via spinal joint techniques, traction, muscle stretches or even strengthening exercises. You may wish to do Swiss Ball Exercises to exercise at home and avoid future pain and discomfort.

Everyone is different, but most people with sciatica feel better within six weeks. Pain that lasts longer than six to 12 weeks should undertake a specific exercise regime.

Persisting symptoms over six months may require the attention of a surgeon who specialises in treating back pain and sciatica.

Can sciatica be prevented?

Following treatment for sciatica, you will probably be able to resume your normal lifestyle and keep your pain under control. However, it’s always possible for your disk to rupture again. This happens to about five percent of people with sciatica.

Once the pain of sciatica passes, there are strengthening and postural exercises, stretches and other measures that help prevent its return. Please contact your physiotherapist for specific advice.

Here are some steps you can take in the meantime:

Practice Good Posture.

Stand up straight and stretch yourself upwards “trying to grow as tall as you can”. This will help to turn on your deep abdominal muscles that open the spaces in your spine where your nerves are vulnerable to pinching.

Avoid Postures that Hurt.

Depending on where your nerve is pinched, you may experience pain when sitting, standing, walking or even lying down. It is important to avoid whichever postures aggravate your pain. If it’s painful to sit for more than 5 minutes, limit your sitting to 4 minutes. Take regular breaks to stand and walk around. If you must be on your feet, prop one foot on a small block or footrest, and then switch feet throughout the day. Your body provides heaps of painful hints. Listen carefully and you will recover quicker.

Use Proper Sleeping Posture.

Take pressure off your back by sleeping on your side or on your back with a pillow under your knees. If you don’t feel pain, you are in the right position.

Avoid Wearing High Heels.

Shoes with heels that are more than 1½ inches high shift your weight forward, excessively arches your back and can further pinch the sciatic nerve.

For more advice about Sciatica, please contact your physiotherapist

Disclaimer: The information is for informative purposes and not to replace proper treatment. For more information or to book an appointment please contact Sydney Physios and Allied Health Services