What is Sciatica?
February 5, 2019
Sciatica simply means pain in the sciatic nerve, however, it gives no description of why the nerve is causing the pain.
The sciatic nerve is the longest and thickest nerve in the body. Nerve roots exit the spine from the levels L4-S3 and join together to form the sciatic nerve. It's huge! It supplies the sensation and muscles of the leg. Therefore, sciatic pain can come in many forms: excruciating pain deep in the buttock; pain down the back of the leg; in the ankle and/or the foot. In addition, it can cause pins and needles, numbness and weakness in the leg and the foot.
It's said that around 40% of people will suffer from sciatica once in their life time.
Why Does it Cause Pain?
You will feel pain from the sciatic nerve if something in your spine is pressing on it, or if it's getting compressed somewhere in your tissues (muscles and fascia).
Common Causes of Sciatica:
- Prolapsed disc - AKA herniated disc or disc bulge
A disc can bulge and press onto the sciatic nerve. This is very painful indeed! Symptoms can include pain that is worsened with coughing, sneezing, blowing your nose. Sitting and bending for some is unbearable. Herniated discs can improve spontaneously and rarely, thankfully, however surgical intervention is usually needed to solve them. Note that they don't 'slip'. They are extremely strong and connected to the bones. They do not slip in and out. The term "slipped disc" is very misleading!
***Symptoms that require urgent medical attention***
- Numbness in the 'saddle' area in between the legs; from the genitals to the anus
- Difficulty passing urine and loss of control of bowel movements
- Severe pain and symptoms of numbness down both legs at the same time.
These symptoms are a sign of cauda equina syndrome and could require urgent surgery to prevent long term damage to these areas.
Facet (spinal) joint and sacroiliac joint inflammation
These joints are formed at the back of the spinal column and pelvis, close to where the nerve roots exit the spine. Dysfunction and inflammation of one of these joints can irritate the nerve and cause pain. This is very common and will improve over time.
Like with any pain, the cause can be from other pathology including cancer. Red Flags for this include unremitting pain, which is worse at night and not aggravated or relieved by movement. Other symptoms: night sweats, loss of appetite, unexplained weight loss, change in bladder or bowel pattern and general feeling of malaise. It goes without saying that a visit to your GP is highly important if you are experiencing this for further investigation.
A very common cause is piriformis syndrome. This muscle in the back of the hip/deep buttock can spasm/tighten or become strained- often due to repetitive pressure from sitting, or for example a fall which then can irritate the nerve. In some people the nerve runs through the muscle, so when it goes into spasm it clamps around the nerve! You can imagine how painful that can be! See below for a video clip to learn how to stretch this out.
When degeneration of the spine has become so severe, the joints and discs deform and start to impinge on the nerves before they exit the spine. It gets worse with walking, but the pain is greatly relieved by walking with a shopping trolley - or when cutting the grass! The stooped forward posture takes the pressure off the nerves by opening the worn joints.
Advice to ease Sciatica
It really depends on the cause as to whether certain exercises will help or not. Try what I'm suggesting below, taking it easy. You'll know if it's helping as it'll feel good to do.
The Cobra: A great exercise if you have a bulging disc. Not so good if you've got an inflammed spinal joint. You can choose to come up onto your forearms first, before onto your hands.
Here's a video clip showing how to stretch the muscles that can be compressing your sciatic nerve. If they are very painful to perform, stop immediately and call me.
Knee Hugs and Rocks: Lay on your back with your knees bent. Bring one knee into your chest and hold. It should ease the pain, if it worsens stop. Rock your knees from side to side, starting small and ending with bigger movements.
Ice/Heat: Alternate using a cold pack wrapped up in a towel for 10 minutes at a time, with heat (warm water bottle) for 15 minutes at a time. Place on lower back/outer to deep buttock. Use whichever one feels good the most. Short spells. You can alternate between the two.
How can an Osteopath Help?
When you visit us for an appointment we ask a load of questions, perform movement and orthopaedic tests, for example, checking your reflexes to find out where your sciatica is coming from, and to check the level of compression of the nerve. We then treat accordingly and give you exercises to help continue the healing process. We explain what we've found and what we will do. Treatments include massage, mobilisations and if certain criteria fits we might manipulate too. It really depends on what we find on the day. We always give advice on rehabilitation exercises too.
If you have sciatica and want it diagnosed and fixed, come in and see one of our osteopaths.
0141 942 0629