Sciatica and taking the right steps to get back on track

Never heard of it.. What is it? 

The sciatic nerve originates from lumbosacral nerve roots (L4-S1) in the lower back. The L5 or S1 nerve root is commonly affected. The sciatic nerve travels from the lower back down the buttock, leg and calf into the foot. When this nerve is irritated or compressed anywhere along its pathway, it causes symptoms including severe pain, which is termed sciatica. Usually, pain begins in the back and spreads down the leg. Pain can have a sudden or slow onset and varies in intensity.

Signs and symptoms

Symptoms will vary depending on the spinal level affected, but include the following:

• Pain in the leg may be more severe than low back pain. It commonly radiates down the back of the knee, into the foot and toes. It may be dull achy or burning or sharp shooting pain.
• Sensation changes including numbness and pins & needles (termed “paraesthesia”) in the leg
• Muscle weakness and/or tendon reflex changes

Top 3 causes

• Disc herniations, as result of degenerative changes and trauma, is the most common.
• Foraminal stenosis: narrowing of small bony openings which the nerve travels through. This is generally due to conditions like arthritis, facet joint injuries or spondylolisthesis etc
• Soft tissue stenosis: irregular growths of soft tissue, such as cysts and tumours, which narrow the nerve openings

There are also several conditions that mimic sciatica (listed below), therefore sciatica can be misdiagnosed. It’s important you get properly assessed by a physiotherapist as treatment will vary accordingly!

• Piriformis syndrome: whereby the piriformis muscle spasms and irritates the sciatic nerve nearby
• Sacroiliac joint (SIJ) dysfunction
• Hip osteoarthritis
• Hip fracture

So what do you need to consider? What can you do?

There is a lot of information out on the web, so it can be hard to determine which sources are more reliable than others, who to listen to. We are going to help debunk the following queries and misconceptions you may have below.

Operative and non-operative management:

The evidence shows that long term results of operative and non-operative management (such as physiotherapy) are similar. The consensus is that operation is superior for reducing pain and disability in the short-term (up to 1 year), but there are generally no differences between either management after 1-2 years. Therefore, non-operative management is usually trialled first if able and if minimal progress is made over that period, other approaches are discussed.

Activity versus rest:

This depends on the individual and the severity of their symptoms – advice from a physiotherapist can help guide you in the right direction so you know what you should do and what you should avoid. Generally, resting in bed too much can be harmful, and there’s good evidence to support staying active and exercising in those with acute low back pain.

So how can we help?

We have a team of highly skilled physiotherapists that are well-trained in diagnosing and treating low back pain such as sciatica. We work with you and individualise treatment to you. Our physiotherapists combine a range of different strategies and techniques to help reduce your symptoms and manage it in the long-term.

• Physiotherapy manual therapy techniques
• Exercise on land (Clinical Pilates) or water (Hydrotherapy)

We highly recommend our hydrotherapy in our private salt-chlorinated pool! The unique characteristics of the water make it an ideal environment to complete exercises in; this includes warmth which reduces muscle spasm and induces relaxation, and buoyancy which reduces pressure off the disc and joints, supporting you and enabling you to move more pain-free and develop your confidence moving again. Exercises in the water will be tailored to you and your symptoms, which will include core stabilisation exercises. You’ll be guided by the physiotherapist in the pool step by step!

Evidence for physiotherapy treatment and hydrotherapy is well-supported to alleviate and manage sciatica symptoms. Book in to see one of our physiotherapists now if this sounds like you!

Written by Tiffany Taing, APAM Physiotherapist.

Photo by Toa Heftiba

References:

Dahm, K. T., Brurberg, K. G., Jamtvedt, G., & Hagen, K. B. (2010). Advice to rest in bed versus advice to stay active for acute low‐back pain and sciatica. Cochrane Database of Systematic Reviews, 2010(6). doi:10.1002/14651858.CD007612.pub2.

Fernandez, M., Ferreira, M. L., Refshauge, K. M., Hartvigsen, J., Silva, I., Maher, C. G., … Ferreira, P. H. (2016). Surgery or physical activity in the management of sciatica: a systematic review and meta-analysis. European Spine Journal, 25. https://doi.org/10.1007/s00586-015-4148-y

Jacobs, W. C., van Tulder, M., Arts, M., Rubinstein, S. M., van Middelkoop, M., Ostelo, R., Verhagen, A., Koes, B., & Peul, W. C. (2011). Surgery versus conservative management of sciatica due to a lumbar herniated disc: a systematic review. European Spine Journal, 20(4), 513–522. https://doi.org/10.1007/s00586-010-1603-7

Jensen, R. K., Kongsted, A., Kjaer, P., & Koes, B. (2019). Diagnosis and treatment of sciatica. BMJ, 367:l6273. doi:10.1136/bmj.l6273