What is Sciatica? How do we treat it?

I hear this term used a lot in my practice, everyone these days seems to have a ‘little bit of sciatica’.

Sciatica is a term that means leg pain caused by a nerve (your sciatic nerve to be precise). What we will look at is what is sciatica and what can be done to help reduce the symptoms.

Your sciatic nerve runs down from the side of your buttock and down the back of your leg following the line of your hamstring. The nerve’s function is to switch on the muscles to work and supplies the sensation to the skin of the leg.

The nerve comes out of a small space in the spine called your foramina. Now what can happen to the nerve is that it can either be compressed or irritated.

A compressed nerve means that the messages to the muscles and skin maybe blocked and you may experience numbness or pins and needles. If the nerve is irritated, you will experience pain down the leg.

So let’s do some myth busters:

‘ Is my nerve trapped?’

So if you get pain from your nerve the nerve is not trapped. The nerve is irritated, what this means is that inflammatory cells are causing the nerve itself to be painful.

Those of you that have suffered from true nerve root pain they will always remember it. The pain is very severe, unremitting and constant. It won’t be relieved by any position and is often worse at night. This is what I call true sciatica and treatment for this is very different from other types of leg pain from the back.

This type of nerve root pain can be challenging and can often take a few months to settle. It is often linked to a disc prolapse that leaks into the nerve space causing it to get irritated and often compressed (numbness and pins and needles). It may also be as a result of reduced space for the exiting nerve due to thickened facet joints.

When I am presented with someone who has an acute nerve root pain it can be very challenging because they do not respond in the same way. Often they will have latent pain, this is a pain after the treatment. So I always make sure that we do not do anything that may aggravate the symptoms. Firstly, I will use my hands on treatment mainly to reduce any tension or muscle spasm. I will gently work down the line of the nerve to massage the muscles around the nerve.

My Approach

My approach to nerve root pain is coming off the positions that aggravate the disc; such as lots of sitting or bending but keeping the back moving. Getting some pain relief may also help to take the edge off the pain. This maybe anti-inflammatory for the disc or nerve painkillers such as Gabapentin or Amytrypptilline. (Always under the supervision of a GP).

What we should be aware of..

What we should always be aware of is of more serious symptoms for low back and leg pains which are:

• retention of the bladder,
• incontinence of the bowel
• numbness around your perineal region.

If you experience these symptoms there may have been a disc prolapse which is affecting the spinal cord. This is serious and needs an urgent trip to A&E.

You always need to give your patient the option of getting an MRI or seeing a specialist; as often surgery has good results and this needs to be a discussion between you the patient and the surgeon.

Management Program

If you have covered all the above and want to sit it out then I have had good results with the following management programme:

• Reduce Sitting/ looking at working from home initially/ look at a standing desk at work
• Pain relief (as discussed above)
• The first few weeks will be looking to settle it all down with the above and then gradually we can start to get the body moving with specific exercises and activities such as walking/ swimming/ or cross trainers.
• Building up strength in non pain provoking exercises.

For me the key is to keep moving and slowly build strength that doesn’t aggravate the pain. This may start off as small exercises and a small amount of walking then gradually build up.

Its very hard to manage this problem alone so getting the right advice and course of exercises will make all the difference.

Remember, that nerve root pain has a life span and will settle down if you are doing all the right things. This can be from 6 weeks to 6 months but the key is to keep moving, get treatment early and seek further investigations if things are getting worse.

I have had great results with Sciatica so if you are struggling and aren’t seeing any improvements maybe its worth booking in to see us..