WHAT IS SCIATICA AND HOW TO MANAGE IT?

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While many people think of sciatica as a condition that affects the legs, sciatica itself simply refers to low back related pain in the legs. That is to say that something in the low back is causing pain down into the leg and as far as the foot. The sciatic nerve is one of the thickest and longest in the body. When exploring the course of the sciatic nerve, it runs along out from the lower back and through the gluteal area (specifically through our piriformis muscle) where it then runs down the back of the thigh and divides to supply the shin and foot.

Some common symptoms of sciatica are:

  1. Pain in the back which also travels down into the leg
  2. Leg pain made worse by movements of the back
  3. Tingling or numbness into the gluteal region or legs or feet
  4. Pain with direct pressure onto your spine
  5. Acute or chronic pain

Common Causes 

  1. Bulging or Herniated disc:

Putting pressure on the roots that create the sciatic nerve can sensitize it and cause pain at the back and down the leg

  1. Entrapment of the nerve

As the nerve travels down the leg it must elongate as the knee and hip move. Overworked and tight muscles or fascia can lead to the nerve getting caught as it attempts to elongate with movement. This can lead to pain with activities like straightening the leg, bending the back with the leg straight, or bending the foot towards you

Solutions

Seeing a  Physiotherapist can help determine the underlying issue that is causing Sciatica. Once a full assessment and history is taken, our physiotherapists at For Health’s Sake will provide you with a treatment plan to best match where you are at. Assessments can focus on:

  1. Testing the mobility of the sciatic nerve
  2. Testing the sensation, reflexes, and strength of the back and leg
  3. Testing the muscle and joint movements in the back, hips, knees, and feet
  4. Completing a movement screen 
  5. Learning how your pain is affecting your life and wellness

Because nerve pain can be complex, the treatments can come in many ways such as: hands on therapies to the muscles and joints of the back and hips, acupuncture, gentle movements, and targeted strengthening. At For Health’s Sake we also take pride in treating chronic pain and injuries, understanding the role the body and brain can have in healing,  and can provide a second opinion if your pain has not resolved for months to years.

Food for thought on Physiotherapy and Sciatica 

  1. 60% of patients with low back pain present with leg pain, so it is not uncommon and can improve with the right approach
  2. Imaging such as X Rays and MRI’s are often not necessary, but a thorough assessment from a registered health professional is recommended if your pain persists  
  3. Sciatica shows similar outcomes from physiotherapy vs. Surgery so there is no need to jump ahead to invasive treatment options or strong medications before a thorough course of physiotherapy is trialed 

References

https://www.bmj.com/content/367/bmj.l6273.full: Jensen R., Kongsted, A. Kjaer, P., Koes, B. (2019). Diagnosis and treatment of sciatica. BMJ 19.367

https://pubmed.ncbi.nlm.nih.gov/21358478/: Hill JC, Konstantinou K, Egbewale BE, Dunn KM, Lewis M, van der Windt D. Clinical outcomes among low back pain consulters with referred leg pain in primary care. 

By: Elias Peixoto, Physiotherapy Resident