I am sure you may have at one point heard this word before. Be it from a therapist, a friend or from that last google search when you last had pain on your buttocks. Yeap, we know you tried to fix it with google.
Before we dive deeper into Sciatica let’s clear the air a bit. Sciatica is the name given to a group of symptoms in which the sciatic nerve is either compressed or irritated, it is not a stand along diagnosis at all.
The sciatic nerve is the largest nerve we have on the body and runs from the lower back (nerve roots L4 to S3), it runs through the pelvis all the way down to around the knee area where it then splits into the Tibial Nerve and Common Fibular Nerve. Through its course it passes in between different structures such as muscles and fascia. Due to the vast pathway of the sciatic nerve, many factors may contribute and cause sciatica as we will discuss below.
Sciatica may be caused by:
- Herniated disc (the most common cause).
- Nerve entrapment – where the nerve gets trapped between a muscle or a group of muscles, this commonly occurs in the gluteal area such as is the case with piriformis syndrome.
- Spinal conditions such as: stenosis, degeneration or spondylosis
- Sacro-Iliac Joint (SIJ) dysfunction.
- Inflammation of muscle and fascia around the nerve, or even infection of same muscles as it is in the case of abscesses.
- Pregnancy and other gynaecological conditions.
- Traumatic injuries where the nerve is affected.
Sciatica may present itself in many different ways due to the fact that it can be caused by different things, here are a few common symptoms:
- Pain in the buttock and/or lower back that may go down the back of the leg. The pain may be sharp, shocking or discomforting and is commonly aggravated by extended periods of sitting, standing and bending.
- Numbness, tingling, burning sensation going down the leg.
- Decreased muscle strength down the leg, some people report “feeling like knee may give way” or that “the leg feels heavy”
- Poor walking pattern such as limping or toe walking.
- Symptoms that worsen with coughing, sneezing or even defecating where your intra-abdominal pressure is increased through the valsalva maneuver.
The diagnosis of sciatica is made through a clinical assessment. The diagnosis consists of an interview where the history of the symptoms is taken. Information such as pain type, location, and distribution is recorded along with any other symptom behaviours. This interview then guides the clinician to do the clinical examination where certain special tests are performed. The general aim of these tests is to reproduce the symptoms by putting certain structures under strain and thus identifying the origin of the issue.
Diagnostic imaging is rarely used in cases of sciatica as it has shown itself not to be very useful. Imaging will generally be used in cases where the clinician identifies some red flags, wants to clear other concurrent injuries or when the symptoms persist even with conservative treatment.
The treatment is highly dependent on the cause of the sciatica in the first place. The basis of most physiotherapy treatments will be to eliminate pain and inflammation. This usually begins with activity modification and ergonomic adjustments. This is usually paired with some stretches and mobility treatment modalities. Some people may choose to supplement their treatment with other modalities such as ice, heat or medication (as per medical advice).
Some of the causing factors for sciatica are treatable and some are only manageable. Education then becomes a key component of the treatment. Education usually consists of information on condition, things to do and how to do them, as well as, how to modify certain activities and prevent reoccurrences.
The next stage of the rehabilitation is strengthening. This will consist of core and postural exercises, as well as specific muscle strengthening (according to the specific patient’s needs). The strengthening is then progressed to get the patient back into their normal daily activities and finally until they are able to return to their respective sports or even take on a form of physical activity, should they wish to.
Some extreme cases that do not respond to the conservative treatment above may proceed to treatment by epidural injection. Then where this does not yield positive results, then surgery is considered, provided the cause of the sciatica warrants it.
Sciatica cases are always very interesting because they open up a wide range of possibilities for assessment and treatment. As much as it seems to be quite simple and easily treatable, it can lead to serious complications if mismanaged. It is for this reason we advise to get professional assistance when dealing with sciatica.
Let us know if you have any questions or require any assistance.