Sciatica is a term used to describe pain that radiates from your lower back and goes down your leg. The pain occurs along the path of the sciatic nerve, which comes from nerve roots in your lower spine and branches of the nerve that go all the way down to your foot.

Because the causes of sciatica can vary, that also means that the injury or condition can happen to anyone. Those from young or old, male or female, athlete or general population.

Anything that presses on the sciatic nerve, or on one of its nerve roots, can cause sciatica. In most cases, the problem is in the spine, even though you feel the pain in your leg. Some of the causes can include:

• Prolapsed/bulging/herniated discs
• A spinal injury
• Bone spurs
• Degenerative discs
• Pregnancy
• A tumour or abscess

As sciatica is a type of nerve pain, this means that it will trigger a burning, pins and needles, numbness, stabbing or shooting feeling that radiates from your glutes, down the back of your leg and down to your foot. Sciatica can also lead to muscular weakness in the affected leg or foot.

You can have lower back pain however most people mainly report leg symptoms and only have symptoms in one leg. It can get worse with prolonged walking, awkward positioning, prolonged sitting or straining. The following signs and symptoms are ones not to ignore as these may be a sign of a more serious or sinister pathology:

• Fever
• Severe weakness
• Symptoms in both legs
• Urinary and/or bowel incontinence
• Numbness around the genitalia
• History of lower back surgery
• Complicated pregnancy
• Symptoms that start from higher up in the back

As sciatica has distinct nerve pain symptoms, it can commonly be diagnosed by a detailed history of the presenting condition. This will then be followed by a comprehensive examination of your lower back and legs, utilizing various objective measures and special tests.

If the subjective and objective assessments are detailed, then imaging is generally not required. However, if the pain persists for more than 12 weeks, your doctor requests it or your symptoms start to progress, then imaging may be requested. Imaging can include:

• An X-ray of the lumbosacral spine may help visualize for fracture or spondylolisthesis.
• Non-contrast CT scan may be performed to evaluate fracture if plain films are inconclusive
• An MRI is the most detailed of all imaging, however this is used for cases where the neurologic deficit has gotten worse or to help rule out any pressing surgical pathology and concerns.

Most patients improve over time with conservative management. However, if the pain does not improve, the following medical management can be done:

• Pharmacology/medications: types of medications than can help include anti-inflammatories, antidepressants, opioid and non-opioid analgesics, muscle relaxants, anticonvulsants for neurogenic pain.
• Injections: injections that can assist include corticosteroid injections, epidural, RF ablation, nerve root blockers.
• Surgery: different surgeries can be done depending on the cause of the sciatica. Discectomies, foraminotomies, laminectomies are some surgery examples that can be used.

Physiotherapy plays a crucial role in relieving sciatica pain. Your physiotherapist will complete a comprehensive subjective and objective assessment to determine to potential cause and best treatment plan. Here’s how it can help:

• Pain Management
  • Manual Therapy: Massage or releases can help reduce pain, improve blood circulation to the affected area and release any tension of muscles to provide effective short-term relief. Sometimes applying mobilisations to the affect lumbar spine joints can also provided some short-term pain relief.
  • Taping: Taping can help unload the structures around the low back and provided some postural guidance.
  • Heat/Cold: Using heat or cold can provide short term relief and assist in reducing inflammation.
• Stretching and Strengthening Exercises
  • Stretching: Stretching and releasing of muscles and structures can help improve the flexibility of the lumbar spine, glutes, hips and legs. Mobility exercises can also be used to essentially stretch the sciatic nerve to reduce the intensity of the symptoms.
  • Strengthening: An appropriate strengthening program is important to complete as this will improve the strength and endurance of the muscles including lower back, core, and glutes.
  • Functional exercises: These will include walking, swimming, hydrotherapy, whole body movements or tasks specific requirements depending on what you need.
• Education
  • Understanding the cause of the sciatica pain, how to treat it and what to expect from your rehabilitation will improve the overall outcome and give you a sense of autonomy. Your physiotherapist will help explain the condition and prognosis. And there is no such thing as a silly question!
• Activity Modifications
  • During the rehabilitation, you made need to adjust your daily activities and exercising to avoid flaring the injury. Activity modifications can include frequency and duration of breaks, adaptations of techniques, and a gradual return to activity. Additionally, postural guidance or lifting techniques will be reviewed to ensure proper form is used.

There are many causes of sciatica, and the disorder is best managed with a team of healthcare professionals so that holistic care is given to the patient. Sciatica can be a frustrating and cause major disruptions to one’s lifestyle. With the right diagnosis and physiotherapy treatment, you can manage the pain and get back to your normal activities. Remember, early intervention is key to preventing serious or chronic problems.

So, if you or someone you know is struggling with sciatica, contact us today to schedule a comprehensive assessment and personalised treatment plan.

Our experienced physiotherapists are here to help you recover quickly and prevent future injuries.

Call us now on (02) 4721 1222 or book an appointment online.