Sciatica is the term for pain stemming from the large sciatic nerve which runs from the lower levels of the lumbar vertebrae (lower back) and travels through the hip and gluteal muscles (butttocks) and down the leg as far as the ankle and foot. The pain can manifest itself anywhere along this path, and in the worst cases, the nerve pain can be down the full length of the leg.
Sciatica is very common (up to 40% of the population have some extent of sciatica in their lifetime), but that doesn’t make it any less painful, and the symptoms caused by sciatica can be incredibly debilitating and agonising. These include numbness, pins and needles, burning, aching, sharp pains amongst others. It is important that if you begin to feel sciatica, that the underlying cause of the pain is investigated and resolved before it can escalate to a level which can make even basic tasks like standing very painful.
The most important advice I give to people with sciatica is try to keep moving. Sitting still or lying down when the pain is causing you problems can simply make the pain worse. Neuropathic medication (painkillers which target nerve pain specifically) can also be very helpful to get through episodes of extreme discomfort and pain. However, this advice can simply mask the pain rather than solve it, and that’s where physiotherapy comes in.
Firstly, it’s important to identify where the sciatic pain is coming from. Often it will be coming from the spine itself, and usually this is because of a herniated disc (bulging disc often incorrectly referred to as 'slipped-disc') pressing on the nerve route. This is called radiculopathy and can come on due to trauma or without an obvious cause. If radiculopathy is identified, then an exercise programme and manual therapy programme should focus on the lower back itself. It can often feel strange when someone is treating your back for pain that may be felt more in the leg, but it’s important to target the origin of the problem. The other common place to have dysfunction causing sciatic pain is a muscle in the glutes (buttocks) called the pirifomis. The sciatic nerve passes right by the piriformis muscle, and so if the muscle gets tight then it can irritate the nerve. The muscle can be released with exercise and with manual techniques used by us as therapists, and again we want to identify why the muscle is tight, and give long term solutions to the pain.
The next thing is to target the nerve itself. I’ve usually got many tricks up my sleeve to help desensitise the nerve pain, which again whilst only treating the symptom, can give fast and effective relief for the period whilst the cause of the nerve pain is being corrected.
Finally, once the pain starts to ease, we can shift our attention to the reasons the pain was occurring in the first place. People are very keen to get rid of pain, but also should be keen to continue with rehab after the pain has gone. This is because there is always a reason why you’ll develop sciatica. Weakness, tightness or muscular imbalance are often the main causes, but it can be posture and/or lifestyle also. If your therapist shows you how to address these, and works with you to reverse your underlying weaknesses, then you will give yourself the best chance of the pain disappearing and just as importantly, never returning.
Fix the cause of the pain, and the pain itself will quickly ease. Simply target the symptom, and you will miss out on a long term outcome. Exercise is essential to achieve this.