Sciatica is a term used to describe pain down the back of the leg, originating from the sciatic nerve. There are a number of different causes of sciatica, and you may or may not have back pain if you have sciatica.
Sciatica can cause numbness, pins and needles, weakness and other “altered sensations”, as well as pain. Sciatica may affect just one leg, or both legs at once.
Fortunately, sciatica is rarely serious (although it can be incredibly painful) and usually responds very well to conservative treatment.
The sciatic nerve is made up of several nerve-roots that leave your lower back and join together in your pelvis.
After these nerve roots join together, the sciatic nerve passes out of your pelvis and down the back of your thigh, before splitting into small nerves in your lower leg.
Irritation or injury to any of this nerve tissue from your spine down can cause sciatica.
What Causes Sciatica
The most common cause of sciatica is a bulging disc in your lower back. The disc pushes on one of the nerve roots exiting your spine, irritating it and causing the symptoms associated with sciatica.
Other causes of sciatica include pregnancy, tight muscles pinching the sciatic nerve or a direct blow to the nerve.
Very uncommon causes of sciatica include spondylolisthesis, tumours and infections.
It is unusual for the sciatic nerve to be injured, unless a severe trauma is involved or the problem has been going on for a long time. Nearly always, sciatica is a result of irritation of the sciatic nerve rather than damage.
Some conditions can mimic sciatica, such as sacroiliac joint irritation, hip arthritis, bursitis, hamstring injuries and knots in your buttock muscles. These conditions account for a surprisingly high number of “sciatica” cases.
Self Help For Sciatica
Because the majority of sciatica problems are the result of irritation rather than damage, it is useful to try to maintain normal activity levels and do all of the things you would normally do. This helps to prevent deconditioning and anxiety associated with returning to activity after a break.
Common sense must apply though. Pushing through the pain barrier can increase irritation of the sciatic nerve, causing symptoms to persist for longer.
There is an inflammatory component to most cases of sciatica. This is often responsible for a significant proportion of your pain and causes the sciatic nerve to become more sensitive.
Over the counter (ie. not prescribed) anti-inflammatories are helpful at reducing the effects of inflammation and easing symptoms. If you have stomach problems, heart problems or are on other medication, discuss this with your pharmacist before taking anti-inflammatories.
Ice packs offer another means of reducing inflammation, with no associated risks. In most cases they should be applied to your lower back and kept in place for 20 minutes. Direct contact with your skin should be avoided.
Topical gels and rubs have little proven efficacy, but can be worth a try.
When To See A Chiropractor
While most episodes of sciatica will spontaneously resolve given enough time, it is always useful to get checked over by a professional.
A check-up will help establish the cause of your pain, making it easier to take preventative steps.
Treatment, in the form of manual therapy, advice, exercises and education, is also very effective at relieving symptoms of sciatica and reducing the likelihood of recurrence.
We advise people wait 24-48 hours after the onset of sciatica before booking an appointment. This delay can give your body enough time to fix itself, without having any negative consequences if this doesn’t happen. Of course, you don’t have to wait if you feel you can’t.
An advantage of seeking chiropractic care is that diagnosis and a range of treatment methods can be provided under one roof.
When Not To See A Chiropractor
There are some times when patients with sciatica should not see a chiropractor. If you have any of the following your GP is more likely to be able to help:
- Significant, unintended weight loss
- Bowel or bladder changes, eg. faecal incontinence
- Recent significant trauma
Diagnosis Of Sciatica
Since there are numerous causes of sciatica, the condition is best diagnosed by thorough physical and neurological examination.
This process involves testing the sensitivity of the skin and the strength of muscles supplied by the sciatic nerve, as well as special neurological tests.
The function of muscles and joints is also checked to pinpoint why the sciatic nerve has become irritated, and other causes of leg pain are eliminated.
MRI scans and x-rays are rarely required and can even be counterproductive. Just because a bulging disc is discovered on a scan, it does not mean that this is the cause of your symptoms. Without physical examination this can lead to misdiagnoses and inappropriate treatment.
Treatment Options For Sciatica
In addition to self-management methods, there are a number of different treatment options for sciatica.
These treatment options can be broadly categorised as conservative and invasive. Conservative options centre on manual therapy and exercise, whilst invasive methods include injections and surgery.
Conservative Options For Sciatica
Because sciatica is rarely a serious problem (despite being very painful), conservative options should be exhausted before considering invasive treatments, which carry higher risks.
Manual therapy has been shown to be highly effective at relieving pain from sciatica, especially in conjunction with exercise and education.
Manual therapy may include manipulation (small movements of your spine that often come with clicks or pops), mobilisation (slow movements of the joints of your spine or pelvis) and stretching.
Massage can provide temporary relief but is rarely effective for sciatica without other types of treatment alongside.
Similar to massage, acupuncture has not been shown to be very helpful for treating sciatica without other allied treatments.
If conservative options have been exhausted you may be a candidate for more invasive treatments. Typically, you would also need a scan at this point to this ensure nothing unexpected is preventing you getting better.
Various types of injection are available for sciatica. Epidurals are injections into the sac encasing the spinal cord, whilst nerve root injections are used at the point where nerves exit the spine. These injections use a mix of anaesthetic and corticosteroid (a potent anti-inflammatory).
For best results, injections should be utilised alongside a rehabilitation programme to help prevent recurrence. Some people require more than one injection, but there is a limit to the number that can be safely administered.
Risks from injections include nerve injury and osteonecrosis (a condition in which bones degenerate).
Surgery is now very rarely offered for sciatica and carries a very narrow risk-reward ratio. Of surgeries that can be offered, microdiscectomy is the most common.
In a microdiscectomy, a small part of a bulging disc is cut away. This is a relatively minor procedure, with a recovery period of approximately 6 weeks. Fortunately, recent research has shown that bulging discs spontaneously recover in most instances, making surgery unnecessary for most people.
Prevention Of Sciatica
If you have had sciatica before, you are at greater risk of having sciatica again. This is true even if you follow all the best advice. But the risk of sciatica recurring can be massively reduced.
Proper rehabilitation, involving strengthening of the muscles around your spine, is the best strategy for preventing sciatica returning. Different people need to strengthen different muscles, so advice is helpful to make your rehabilitation as efficient as possible.
Strengthening, or core stability, is also a good way of minimising your risk of sciatica if you have never had an episode.
Increasing your level of general activity has also been shown to be very helpful at reducing your risk of sciatica and lower back pain. Walking more and sitting less is incredibly powerful.
Manual therapy has been shown to be helpful in reducing the recurrence of sciatica and lower back pain, helping maintain your body’s proper function.