What is Sciatica?
Sciatica is in reference to the sciatic nerve which travels down this path, and when irritated can produce shooting, sharp, throbbing or burning pain down the back of the leg through the buttocks, thigh and calf (Ropper et al. 2015). Usually, sciatica is felt down one leg, although in rare cases can be felt down both legs.
What causes Sciatica?
Sciatica is typically caused by irritation or compression to the root of the nerves that start from the spine and form the sciatic nerve. A common cause of sciatica is a herniated disc, although other structures within the spine, as well as musculature, may also be producing sciatic nerve symptoms.
Conditions related to Sciatica
A herniated disc is the displacement of disc material that can protrude and cause compression and inflammation of nearby nerves, although many people may have a disc herniation and not experience any pain.
Spinal stenosis refers to a condition of the spinal canal where nerves run down the spine which may be compressed, this is also a term used with herniated discs as it can cause spinal stenosis to compress nerve roots, although other structures such as bony or ligamentous structures in the spine can also be the cause of this narrowing.
Common symptoms / signs
Sciatica pain is typically felt from the lower back to the buttocks, then down the back and outer part of the leg. Although, symptoms can also be felt down the front of the thigh or into the foot. Sciatica is more likely to have a pattern of gradual onset rather than appearing suddenly. Pain can feel as if it shoots down the leg, or as a burning, throbbing sensation, which may be aggravated in certain positions. Individuals may find themselves walking or moving differently to avoid positions that aggravate their sciatica. Other sensational changes such as numbness or tingling can also be felt in the same areas. The muscles of the affected leg may also feel weaker than usual.
How is Sciatica treated?
Initial management of sciatica is aimed to minimise pain levels which may be through modalities such as soft tissue work, joint mobilisations, neural mobilisations and dry needling. Individuals with sciatica should maintain as much physical activity as they can and avoid prolonged bed rest as this can have detrimental effects in function and pain (Ostelo, 2020). Exercises can be introduced to improve trunk movements which can improve supporting musculature and desensitise pain (Fernandez et al. 2015).
If pain is significant, with advice from a GP or doctor, pain medication may be recommended for pain. If symptoms persist without improvement, referral to a surgeon may be suitable if the cause of sciatica could be surgically managed.
Risk factors of this condition include:
- Sedentary lifestyle
- Obesity
- Age-related changes to the spine
- Diabetes
Other causes
Sciatica may not be caused by structures in the spine, although uncommon the piriformis muscle found in the buttocks where the sciatic nerve runs under can cause compression (Ropper et al. 2015). This may present very similarly to compression at the spine, although symptoms may start more focally at the middle buttocks.
References
Fernandez, M., Hartvigsen, J., Ferreira, M. L., Refshauge, K. M., Machado, A. F., Lemes, Í. R., … & Ferreira, P. H. (2015). Advice to stay active or structured exercise in the management of sciatica. Spine, 40(18), 1457-1466.
Ostelo, R. W. (2020). Physiotherapy management of sciatica. Journal of physiotherapy, 66(2), 83-88.
Ropper, A. H., & Zafonte, R. D. (2015). Sciatica. New England Journal of Medicine, 372(13), 1240-1248.