What is sciatica?
Sciatica is a common term that relates to leg pain associated with inflammation and hyper-sensitivity of the nerves that originate from the lower back, and track down the buttock and lower leg. These nerves are usually very robust and can handle pressure and stretching, but once they are sensitised they can be very painful, debilitating and distressing. It often restricts movement of the back and lower limbs due to the severity of pain and associated protective muscle guarding. It can also be very difficult to find positions of comfort, disrupting sleep. The nerve usually becomes very sensitive to any stretching.
Common labels for sciatica include: radicular pain, radiculopathy and the sensitivity may be related to a disc protrusion or prolapse or narrowing of the canal (stenosis) that the nerve exits in the low back.
In many cases sciatica is linked to nerve inflammation but not compression. This is where the nerve is inflamed by the chemical environment around the nerve, but is not mechanically compressed. Thus, there is no loss of nerve function, meaning that sensation, power and reflexes of the leg are normal.
Sciatica may also be associated with nerve compression (numbness and loss of power and reflexes in the leg). If you have a progressive loss of power in the leg, or loss of sensation over the saddle / genital area and an inability to pass urine, it is important to seek urgent medical attention.
The natural history of this pain condition is very good, with many reporting symptoms have largely resolved within 12 weeks. However, persistent sciatica / nerve pain occurs when pain persists beyond 3 months.
Risk factors for acute sciatica:
Carrying excessive belly fat, chronic stress, inactivity, deconditioning and unaccustomed physical loading of the back. Genetic factors also play a role. These factors can make the disc more vulnerable to load and create an inflammatory environment around the nerves that can make the nerve sensitive to touch, stretch, load and move.
Risk factors for persistent sciatica:
There are many factors that put people at risk of pain persistence including high levels of psychological distress, obesity, avoidance and protective guarding of movement and activity, and in some cases unresolved pathology.
Myths about nerve pain/Sciatica:
X Nerve pain / sciatica is always caused by a pinched nerve from a disc bulge or disc prolapse / protrusion
X Nerve pain / sciatica doesn’t get better with time
X Rest is needed with nerve pain / sciatica
X Exercise is dangerous with nerve pain / sciatica
X Nerves get tight and need to be stretched
X Nerve pain / sciatica means I need surgery
X Persistent sciatica means the nerve is still pinched
X If nerve pain persists after surgery it will never improve
✓ Nerve pain is caused by inflammation not compression
✓ Compressed nerves caused numbness and weakness not pain
✓ Sciatica / nerve pain usually gets better with time (3 months)
✓ Disc prolapses shrink and resolve over time (3-6 months)
✓ Nerve inflammation is influenced by things like belly fat, inactivity, poor sleep and stress
✓ Sensitive nerves don’t like being over stretched
✓ Reducing inflammation / sensitivity by targeting gentle exercise, good sleep, relaxation strategies can help reduce nerve pain
✓ Medication and spine injections can also help, but surgery is rarely needed or indicated
✓ The outcomes at 2 years are the same whether the person has surgery or not…and surgery comes with additional risks
✓ Persistent sciatica is not associated with findings of nerve compression on MRI scan
✓ After spinal surgery it is important to undergo a rehabilitation process to restore full function and prevent recurrence
Assessment of sciatica:
We know that sciatica is very painful and so we are very careful how we assess you.
We first need to take a full history to understand the factors associated with your problem such as how the pain started, your general health and well being, your sleep and physical activity habits. We will also ask you about your leg strength, sensation and bladder control.
We will carefully examine you to assess the sensitivity of your nerves, your power, sensation and reflexes to assess the function of the nerves. We will also examine your ability to relax, move and perform basic functional movements.
Treatment of sciatica:
While sciatica can be very painful, the good news is that sciatica settles down in the majority of cases – within 3 months.
Similarly disc protrusions and prolapses are reabsorbed by the body and shrink over time (3-6 months).
Like many inflammatory problems, sciatica may benefit from anti-inflammatory medication, steroid injections, gentle relaxed movement exercises and maintaining gentle and progressive physical activity.
Our physiotherapists at Body Logic Physiotherapy can examine you and determine if you need medical attention or not. They can guide you through a gradual rehabilitation process and provide you with specific strategies to get you back to on track. A prevention program once the pain has settled is key, as recurrence is common.
We work with other health professionals to assist with pain management if needed.
Surgery is usually only indicated where there is a progressive loss of power and sensation of the lower limb and an inability to pass urine.
If you have had surgery for sciatica we will guide you through a rehabilitation process to get you relaxed, moving and active again.