Sciatica – Pillar Health

What You Need to Know About Sciatica

Sciatica is a condition that refers to pain that radiates along the path of the sciatic nerve. The sciatic nerve is the longest nerve in the body, it originates in the lower spine and travels through the buttock, down the back of the thigh and leg and finally ends in the foot. Sciatica most commonly occurs when there is compression or pinching of part of the nerve, causing irritation, inflammation, leg pain and often numbness in the affected leg.

sciatica

What Does Sciatica Feel Like?

Sciatica symptoms can vary greatly from individual to individual. The hallmark symptom of sciatica is pain that radiates from the lower back to the buttock and down the back of the leg and into the calf. If you have sciatica, you may have symptoms anywhere along the sciatic nerve pathway as pictured, but usually, only one side of your body is affected. The lower back pain experienced ranges from mild achy pain to sharp, burning sensations with excruciating pain. Sometimes weakness, tingling or a lack of sensation is reported along the path of the nerve into the leg and foot. 

Common symptoms of sciatica include:

  • Pain
  • Numbness
  • Tingling sensations
  • Muscle weakness
  • Pins and needles
  • Aggravated or relieved pain with changes in posture.

Sciatica Is the Symptom of an Underlying Medical Condition

A common mistake is referring to any low back pain or pain that goes down the back of the leg as sciatica. Sciatica is a specific condition that is a direct result of sciatic nerve or sciatic nerve root pathology. The most common cause of sciatica is a herniated or bulging intervertebral disc. 

Common causes of sciatica include:

  • A herniated disc
  • Lumbar spinal stenosis
  • Lumbar spine degenerative disc disease, general degenerative changes in vertebrae or discs
  • Spondylolisthesis or a relative misalignment of one vertebra relative to another.
  • Muscle spasm and/or inflammation of the lumbar spine and/or pelvic muscles
  • Sacroiliac joint dysfunction
  • Bone spurs
  • Tightness of the piriformis muscle

The Sciatic Nerve and Sciatica

The sciatic nerve is the largest single nerve in the body and is formed by the union of 5 nerve roots in the lumbar spine and sacral spine. There are 2 sciatic nerves in the body- the right and left nerves, supplying the corresponding lower limb. The sciatic nerve provides direct motion coordination of the hamstrings, adductors and indirect motion function to the calf muscles, lower leg muscles and some intrinsic foot muscles. 

The Course of Sciatica

The sciatic nerve starts as a collection of nerve fibers in the lower spine. These lumbar nerve roots then combine to form one large nerve. The sciatic nerve then leaves the pelvis and enters the gluteal region (the buttocks). As the nerve moves through the gluteal region, it travels down the back of the upper thigh through the hamstring muscles. Above the back of the knee, the sciatic nerve divides into two nerves, the tibial and the common peroneal nerve, both of which serve the lower leg and foot.

Directly, the sciatic nerve innervates muscles of the posterior thigh and indirectly, via its smaller branches, innervates all of the muscles of the leg and foot.

nerves of the leg

What Causes Sciatic Nerve Compression and Sciatic Nerve Pain?

Any condition that compresses or structurally impacts the sciatic nerve can potentially cause sciatica symptoms. 

Your spine is made up of small bones (vertebrae) that are stacked on top of each other like building blocks. Between each vertebra is a cushion like structure called an intervertebral disc. Each disc absorbs the stress and pressure that occurs when the body moves and these discs prevents bone-on-bone rubbing. As we age, our intervertebral discs deteriorate and sciatica symptoms can occur due to degenerative changes of the spinal canal. A narrowing of the spinal canal in the lower (lumbar) spine leaves less space for the sciatic nerve to travel through and hence cause compression of the nerve and commonly, sciatica symptoms. 

6 Stretches for Sciatica Pain Relief

1. Reclining pigeon pose

Lie on your back. Bend your knees so that your feet are resting flat on the mat, about hip-width apart. Lift one leg and cross it over the other, keeping your knee bent. Your ankle should rest on your thigh just above your opposite knee, with your knee at roughly a right angle. Check your lower back and make sure you’re still laying flat against the mat. You don’t want to arch your lower back. To take the stretch further, thread your hands through your thighs and grasp your lower leg just under your knee by reaching one hand through your raised leg and reaching the other along your side.Clasp your hands together around your knee and gently pull to raise your knee and foot off the floor. Only pull towards your body as far as you can comfortably go and feel a stretch.

2. Sitting pigeon pose

While seated in your chair, place both feet flat on the floor with your ankles directly below your knees. Bring your right knee up to the chest and give it a good hug. Cross your right leg over the left at a 90-degree angle, keeping the foot flexed as to not place pressure on the knee.

3. Forward pigeon pose

Come onto all fours with your hands shoulder-distance apart and about a hand span in front of your shoulders. Bring your knee forward and place it on the floor just behind and slightly to the left of your left wrist, with your shin on a diagonal and your left heel pointing toward your right frontal hip-bone.

4. Knee to opposite shoulder

Lift your affected leg and bend your knee. With your opposite hand, reach across your body, and then gently pull your knee toward your opposite shoulder. Hold the stretch for 15 to 30 seconds. Repeat with your other leg.

5. Sitting spinal stretch

Sit on the ground with your legs extended straight out with your feet flexed upward. Bend your right knee and place your foot flat on the floor on the outside of your opposite knee. Place your left elbow on the outside of your right knee to help you gently turn your body toward the right.

Hold for 30 seconds and repeat three times, then switch sides.

6. Standing hamstring stretch

Place your foot on an elevated surface at or below your hip level. This could be a chair or step. 

Bend your body forward slightly toward your foot. The further you go, the deeper the stretch. Don’t push so far that you feel pain. Hold for at least 30 seconds, then repeat on the other side.

Release the hip of your raised leg downward as opposed to lifting it up. If you need help easing your hip down, loop a yoga strap or long exercise band over your right thigh and under your left foot. 

When Sciatica pain is Serious

Certain symptoms of sciatica may indicate a serious medical condition, such as cauda equina syndrome, infection, or spinal tumours. Symptoms that may suggest a serious medical condition may include, but are not limited to:

  • Progressive neurological symptoms, such as leg weakness, numbness or pins and needles
  • Symptoms in both legs or
  • Bowel and/or bladder dysfunction
  • Sexual dysfunction

If these symptoms develop, it is advised to seek immediate medical attention. Sciatica that occurs after an accident or trauma, or if it develops in tandem with other symptoms like fever or loss of appetite, is also cause for prompt medical evaluation.

Treatment options (risk factors for sciatica)

Seek urgent medical care from you GP if:

  • Your sciatic pain is sudden, severe and you have muscle weakness or numbness in your leg.
  • Your pain started following a traumatic injury.
  • You are having difficulty controlling your bowel or bladder movements.

Physical therapy

In most cases of sciatica, conservative management is effective and favoured. Your Physiotherapist will perform a thorough examination of your spine and lower limbs and will likely prescribe some of the following physical therapy modalities:

  • Education on positions and activities to avoid for pain relief
  • Use of hot/cold packs
  • Avoiding prolonged sitting and standing
  • Core strengthening exercises. 
  • Gentle stretches
  • Education on proper lifting techniques.

Your physiotherapist or doctor may send you for X-rays or arrange for computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan to check for problems in the spinal vertebrae (backbones) that may be irritating or compressing your sciatic nerve or nerve roots. Most cases of sciatica affect the L5 or S1 nerve roots.

Surgery

Surgery as a treatment option for sciatica should only be considered when conservative methods have failed. 

The most common surgical approach for Sciatica is Microdiscectomy. Microdiscectomy is a common surgical approach used to treat severe pain from sciatica that is caused by a lumbar spine disc herniation. The goal of a microdiscectomy is to remove the disc material placing pressure on the nerves to reduce nerve pain. The procedure is done under general anesthesia.

Medication as discussed with a medical professional may include: 

  • A short course of non-steroidal anti-inflammatory medication (NSAIDs).
  • Opioid and nonopioid analgesics
  • Muscle relaxants
  • Localised corticosteroid injections.

Make an appointment

If you have sciatica or low back pain and would like to talk to a Physiotherapist about how to best manage your symptoms, call us on (03) 8899 6277 or book online HERE