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Sciatica? Not just a pain in the backside!

Sciatica? Not just a pain in the backside!

What is sciatica?

The sciatic nerve is the largest nerve in the body. It originates from the lower back and travels down the buttock and back of the leg to the foot. Sciatica refers to symptoms of tingling, numbness, pain or weakness which originate from irritation of the sciatic nerve. Sciatica is often but not always due to compression on the nerve roots in the lower back from a disc bulge or herniation. Other causes include bone overgrowth or spurs that narrow the bony canal where the nerve roots exit the spine, thus irritating the nerves.

What are the symptoms like?

Sciatic nerve irritation can result in mild to very severe pain depending on how irritated, inflamed, or compressed the nerve becomes. It is often described as a stabbing or burning pain and is typically felt in the buttock and down the leg to below the knee. Pain may also be present in the lower back. Other symptoms include pins and needles, tingling, or numbness in the leg. Weakness may also be present in the muscles of the leg if the signals from the sciatic nerve to contract the muscles become impaired.

What has happened to my nerve?

All nerves originate in the brain. The small nerves that ultimately converge to form the sciatic nerve travel from the brain stem through the spinal canal and exit through small tunnels on the side of the lumbar spine. After this they travel between muscles and connective tissue as they course through the body. Nerves become irritated when the tunnels they travel through or the surrounding tissues such as the discs or muscles compress or create friction against them. When this happens, the nerve becomes inflamed, and generates pain signals as well as impaired sensation and muscle contraction.

How can I get sciatica?

Sciatica is often caused by repetitive micro traumas over a long period of time. Poor sitting posture and prolonged sitting place excessive loads on the discs in the lower back, making disc bulges more likely. Improper lifting techniques or repetitive movements such as bending and twisting may also cause micro traumas which lead to small tears in the outer layer of the discs. This can eventually lead to a disc bulge, placing pressure on a nerve.

What else might it be?

Pain in the leg may also be due to other pathologies including hip joint problems, or pain arising from the sacroiliac joint (where the pelvic bone and the sacrum meet). However, pain from these diagnoses do not extend beyond the knee as sciatic pain does.  

How do you diagnose sciatica?

Sciatica often presents as pain during bending activities, such as when trying to put on shoes or socks. Coughing, sneezing, or bearing down when using the loo may also worsen the pain as it increases the pressure on the nerve roots in the spine. Sitting is generally painful during an acute bout of sciatica. Doctors and physiotherapists perform tests to diagnose sciatica by cautiously placing the sciatic nerve on a gentle stretch to see if this reproduces the patient’s symptoms. They also perform a screening of the patient’s reflexes, sensation, and muscle power to see which nerve roots are affected and whether or not the patient requires any additional care such as surgery in severe cases. There are certain symptoms known as ‘red flags’ which warrant the patient having immediate investigations. These include pain in both legs; sensation loss in between the legs or the buttock; or loss of control of the bowel and bladder. These are medical emergencies which should be urgently assessed by a doctor in A&E.

How do you treat sciatica?

Treatment for sciatica focuses on trying to alleviate compression on the nerve using a combination of hands on physiotherapy techniques and gentle exercises. Educating the patient is crucial as the awareness of which activities and postures to continue and which to avoid helps to create an environment where the body can best heal itself over time. Maintaining the exercises and improved posture and lifting techniques once the symptoms of sciatica have resolved is key in preventing a recurrence of sciatica.

Written by Rebeca- Physiotherapist at the Warr Clinic

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