What is Sciatica?
Sciatica refers to pain that radiates along the path of the sciatic nerve. The pain is a result of compression or irritation of the Sciatic nerve and is typically felt in the buttock, leg and/or foot on one side. The Sciatic nerve originates in the lower back from the L4-S3 nerve roots and travels to the foot, making it the longest nerve in the body. Sciatica is often referred to as a ‘trapped nerve’ in the hip or leg.
Signs and Symptoms
As there are many different branches of the Sciatic as well as many different causes of Sciatica, the symptoms felt will vary between individuals. Here are the most common symptoms we see amongst our patients suffering from Sciatica:
- Pain in buttock
- Pain in posterior (back of) thigh
- Pain in lateral (outside of) thigh
- Pain in posterior calf
- Pain in lateral calf
- Pain in lateral ankle
- Pain on top of foot or pain in sole of foot
- Pins and needles, tingling or numbness in the above mentioned areas
- Weakness in the leg or foot
Experiencing symptoms in different regions of the leg, such as the front or inside of the thigh, may indicate a different nerve has been compressed. The Sciatic nerve is the most common nerve to become trapped, however other nerves running from the lower back to the leg can become trapped by a similar mechanism and our Osteopaths can help patients with these too.
Sciatica can be accompanied with lower back pain, however if you are experiencing lower back pain just on it’s own you probably don’t have Sciatica.
Also known as a prolapsed or herniated disc, refers to the soft gel like substance in the inner disc (nucleus pulposus) herniating out of the tough outer casing of the disc (annulus fibrosus) and then pressing onto the nerve. Inflammation from small tears in the disc’s outer casing can also lead to sciatica, this is known as an Annular tear and is the stage before a slipped disc. Both of these are more common in the 35-55yo age range but can occur at any age.
The intervertebral discs in our spine are mostly made of water. Due to the natural ageing process, these disc dehydrate as we get older which makes them flatten and reduce in size (this is why we shrink as we age!). As this happens, the spaces where the nerve roots exit the spine become narrower, making it more likely to be irritated or compressed. Degeneration in the joints such as osteoarthritis can also lead to Sciatica via the formation of bone spurs irritating the Sciatic nerve. These degenerative issues become more common as we age. Other factors can accelerate the rate of degeneration such as sport, repetitive heavy lifting, or being over weight.
This is a condition involving narrowing of the spinal canal where the spinal cord runs. It is most common in the elderly population.
This is a condition involving an anterior or posterior slippage of a vertebra on top of another. As the vertebra moves, the nerve root can be compressed or irritated. The slippage can occur at any age but usually first occurs aged 14-30.
The piriformis is a small muscle in the buttocks responsible for external rotation of the hip. In 10-15% of the population the Sciatic nerve pierces through the muscle rather than underneath. Spasm or tightness in the muscle causes the Sciatic nerve to be compressed or irritated leading to Sciatic-like symptoms.
Due to the increase of a pregnancy hormone called relaxin, the ligaments of the pelvis become loose and stretch. Add in the extra weight of the baby and the pelvis is mechanically stressed. Muscles such as the piriformis may tighten as they work harder to offer support to the pelvis, therefore increasing the likelihood of the sciatic nerve being irritated. Occasionally the position of your baby can add pressure to the sciatic nerve too.
Spinal tumour, infection or injury
Tumours, infections and injuries can also lead to compression or irritation of the Sciatic nerve but are much less common.
How is it diagnosed?
You don’t always have to visit your GP to have your Sciatica diagnosed. Osteopaths are trained in musculoskeletal diagnosis and are able to diagnose the cause of the Sciatic pain. Call our clinic today if you would like to book an appointment or request a call back from one of our Osteopaths 01609 783 600
An Osteopath will take an in-depth case history and then carry out a physical examination, which may include:
- Postural assessment
- Range of movement testing
- Orthopaedic and Special tests
- Nerve stretch tests
- Reflex tests
- Muscle strength tests
- Sensation tests
In a minority of cases, further investigations such as X-Ray or MRI scans are required to gather more information on the exact cause of the nerve irritation.
Treatment options for Sciatica
Treatment options will depend on the cause of your Sciatica and the length of time you have had it for. Most cases of Sciatica respond well to a combination of hands-on therapy and exercise. Only a small minority of cases require surgical intervention.
Treatment options include:
- Physical Therapy such as Osteopathy, Physiotherapy, Chiropractic
- Medication (painkillers)
- Epidural steroid injections to reduce the inflammation
- Surgery (Discectomy or Laminectomy) to reduce the compression on the nerve
How long does it last?
The length of time Sciatica will last for will be dependent on the cause. Acute onsets caused by the likes of a minor slipped disc may only last 6-8 weeks. However Sciatica caused by degeneration, stenosis or larger slipped discs may last longer, and may require ongoing maintenance to keep symptoms at bay.
If you would like to speak to one of our Osteopaths to see if they could help you, call our clinic today and request a call back 01609 783 600
Can it be prevented?
There are no quick fixes for Sciatica treatment or prevention. Some cases of Sciatica cannot be prevented. However many cases can be prevented through small changes in your day-to-day life. Small, repetitive and positive actions each day compound to a big difference over the years and can reduce your likelihood of picking up an injury. For example, an overweight 20 year old who does not exercise, sits for long periods of time without getting up, has poor posture and does not take care when they lift heavy objects is much more likely to have developed issues in their spine by the time they reach 40 years of age.
Things to take into account are:
Regular exercise can improve the mobility and strength in your spine. Non-impact exercises such as Yoga and Pilates are particularly beneficial when it comes to improving spinal stability, which is essential for avoiding spinal injuries or Sciatica.
The body does not like repetition. A person who sits all day is subject to repetition as is a bricklayer who bends and twists all day. You don’t have to moving to be repetitive. Try take little and often breaks from repetitive actions, even if it is only for 10 seconds every 20 minutes to reduce the repetitive mechanical stress through your spine.
Poor posture leads to the increase of pressure on the ligaments, muscles and joints of the spine.
Heavy lifting with a poor posture is very bad for the spine. The stress through the spine and intervertebral discs will increase dramatically as the spine flexes and rounds with a poor posture. Remember to bend at the knees so that the spine stays straight and avoids the flexion. Make sure the object is close to you and be sure to engage your core so that the spine is supported and protected whilst doing the lift.
Best exercises for sciatica
Exercises for sciatica will depend on the cause. An acute slipped disc may want to avoid flexion-based exercises due to further aggravation of the disc. However a degenerative disc may respond well to flexion-based exercises as the intervertebral foramen will be opened and allow more room for the nerve to pass. Piriformis syndrome will respond well to piriformis stretching and myofascial release. And a Spondylolithesis may respond best to leaving the lower back alone all together, and focus more on improving the mobility in the upper back, pelvis and hips to take the pressure off the lower back.
However here are some video links to our YouTube page for common Sciatica related exercises we may prescribe.
- Acute low back pain
- Morning routine for low back stiffness
- Standing dynamic exercise for low back
- Piriformis and Gluteal stretches
- Piriformis myofascial release - coming soon
- Upper back mobility
- T/L Junction mobility
- Sleeping position for Sciatica
When you need to visit your GP, got to A&E or call 999
The NHS Sciatica website suggests if you have Sciatica a GP can:
- Suggest exercises or stretches
- Prescribe painkillers
- Refer for physiotherapy support
- Refer for psychology support – to help you cope with the pain
The NHS Sciatica website suggests you should go to A&E or call 999 if you:
- Have Sciatica on both sides
- Have weakness or numbness in both legs that is severe or getting worse
- Have numbness around your genitals, saddle or anus
- Find it hard to start peeing, cannot pee or cannot control your pee – and this is not normal for you
- Do not notice when you need a poo or cannot control when you do poo – and this is not normal for you
These could be symptoms of a serious spinal condition called Cauda Equina that requires immediate treatment in a hospital as soon as possible.
Ross is currently writing the content for this page. This page will provide information on common conditions that people suffer from, and how the staff at Northallerton Osteopaths can use their expertise to treat patients with these conditions.
Hip Pain and Knee Pain from Osteoarthritis
Tennis/ Golfer's Elbow
To Aid Relaxation