Sciatic nerve pain?
Lumbar radiculopathy or the more commonly used term of ‘sciatica’ refers to the symptoms of pain, tingling and numbness. Which arise from nerve root compression or irritation of the sciatic nerve (NICE 2020). You will experience pain into the buttock, back of the leg and/or feet of one side. Do you suffer from a sciatica nerve problem.
Sciatica symptoms are:
Shooting, burning or stabbing type pains typically into the buttocks. Also at the back of the thigh, leg and/or foot depending of where the sciatic nerve is being compressed or irritated. Moreover, you can experience pains all the time or occasionally depending on the severity. Tingling such as a pins & needles and feeling of numbness are commonly felt in the back of the leg. Feeling of weakness and you may experience difficultly walking.
Pain is typically worse with prolonged sitting, prolonged standing and turning over in bed. Moreover coughing and sneezing will increase pressure into your abdomen region causing pain. In addition, straining on the toilet may be difficult. In other words sciatica will affect the majority of your day to day activities.
You can experience sciatica with or without low back pain. Usually you will just experience pain into one leg (not both legs). You are less likely to have sciatica if you have low back pain with no pain referrals into your buttocks or legs.
NHS advice (2020)
You should visit your GP or hospital if you are experiencing any of the following symptoms:
- You have sciatica on both sides
- Experience weakness or numbness in both legs that is severe or getting worse
- You have numbness around or under your genitals, or around your anus find it hard to start peeing, cannot pee or cannot control when you pee – and this is not normal for you
- Do not notice when you need to poo or cannot control when you poo – and this is not normal for you
These could be symptoms of a more serious nature which may need to be treated in hospital as soon as possible.
Common Causes of Sciatic nerve pain
In 90% of cases of sciatica (NICE 2020) disc herniation/s of your inter vertebral disc/s in your lower back is the cause. Intervertebral discs are between each vertebrae and their job is to act as shock absorbers and prevent rubbing of the vertebrae. The discs consist of a gel filled inner layer (nucleus pulposus) surrounded by a hard fibrous outer layer.
Therefore you can injure or strain your discs causing part of the gel filled nucleus to herniate out of the fibrous outer casing (herniated or prolapsed disc). When you have a disc herniation this may compress onto the sciatic nerve which in turns causing symptoms into the buttock, thigh, leg and/ or foot. Common causes of a disc herniation are strenuous physical activity, heavy lifting, accidents or trauma,
Other less common causes of sciatic nerve pain are:
Spinal stenosis, this is a narrowing of the spinal canal which is more common in the elderly. Spondylolisthesis is where there is vertebrae that slips forwards or backwards on another vertebrae which subsequently compressing part of the sciatic nerve. Degeneration causes abnormal bony growths to develop (osteophytes or bony spurs). Sometimes bony growths can impinge the sciatic nerve where the nerve exits the vertebrae irritating the nerve which causes symptoms. Spinal trauma or infection. Moreover spinal tumours, however sciatica caused by a spinal tumour is extremely rare.
Piriformis Syndrome, the sciatic nerve travels down from your lower back through your buttocks into the leg. The sciatic nerve passes alongside the piriformis muscle. When this deep muscle of the buttock becomes really tight or spasms this can irritate the sciatic nerve which results in sciatic like symptoms.
How is Sciatica Diagnosed?
It’s not necessary to see your GP to gain a sciatica diagnosis. Manual therapists (Osteopaths, physiotherapists or chiropractors) are able to diagnose sciatica by taking a full case history. After that they will perform a physical examination with testing and will then explain the cause of your pains. Sometimes imaging such as X-rays or MRI’s are required to gain further information on the exact cause of the nerve irritation.
Sciatica Treatment London
There are many treatment options available and it is up to the individual to make an informed choice as to which avenue they wish to pursue. The length of treatment depends on the cause of the sciatic pain and the patient’s ability to heal.
Herniated lumbar discs account for less than five percent of all low back problems but are the most common cause of nerve root pain (‘sciatica’). Ninety percent of acute attacks of sciatica settle with non surgical management. Surgical options are usually considered for more rapid relief in the minority of patients whose recovery is unacceptably slow (Cochrane 2007).
An Osteopath will provide non surgical hands on treatment. The Osteopath will address the whole posture to get other areas moving more freely (typically upper back and hips). Also to reduce pressure onto the lower back and inter vertebral discs to optimise the body’s natural healing response. Improve blood flow and circulation to the affected area which helps optimise the inflammatory processes.
Our Osteopaths will use a combination of muscular stretching, joint articulations and joint manipulations (only when appropriate) techniques to increase movement and function. Also bespoke progressive exercises (muscular stretching and strengthening). Furthermore lifestyle and basic nutrition and hydration advice to optimise healing times to support you back into activity.
How long does sciatica last on average?
Typically the prognosis for patients with sciatica depends on the cause of the nerve compression and the patient’s ability to recover. For some it could be 6-8 weeks but for others it could take longer. Starting a structured rehabilitation plan as soon as possible is advisable to optimising your recovery.
Medication For Sciatica:
If you choose to see your GP they will prescribe medications to help reduce your pains. These can be painkillers and anti inflammatory medications. Similarly muscle relaxants, antidepressants and anticonvulsants depending on the severity your symptoms.
Epidural Steroid Injections:
Your GP may refer you for a steroid injection to help you with your pain. A corticosteroid or local anaesthetic will be injected into the epidural space around your spinal cord. Consequently this may give you temporary relief from your sciatic symptoms. This helps by reducing the inflammatory response around the sciatic nerve.
Surgical options: For Sciatic Nerve Problems
A small percentage of people will have surgery but this should be discussed with your GP or an consultant. The two main types are discectomy and laminectomy. A disectomy is where part or the entire damaged intervertebral disc that is compressing the sciatic nerve is removed. A laminectomy is where the back part of one or more of your lumbar spine vertebraes (lamina) are removed to create more space for the sciatic nerve. Therefore reducing the likelihood of the nerve being compressed.
How do you treat sciatica at home?
At Wellthy clinic we are big fans of meaningful movement as it helps increase blood flow to optimise inflammatory processes. Along with increase waste removal (lymphatic drainage), increase functionality of joints, strengthens muscles and self empowers you to feel a little bit better. For the first 2 weeks rest is the best option, then light stretching for 2-4 weeks. After that introducing body weight strengthening exercises with stretches at 4-6 weeks. Your graded exercises will be reviewed, changed and progressed accordingly in your sessions.
Hydration and Nutrition
Always stay hydrated by drinking a minimum of 8 glasses of water per day (2 litres per day) little and often. Hydration status will directly affect the height of your intervertebral discs. Therefore dehydration will affect your discs and your ability to recover. Eliminate caffeine, alcohol, squash, fizzy drinks and energy drinks. As these will not help with your hydration status which is important for your recovery. Moreover adopt an anti inflammatory diet by eating more anti inflammatory foods and reduce foods high in inflammatory content is a good start.
Is Heat or Ice better for Sciatic Nerve Pain?
At Wellthy clinic we suggest heat. Acute inflammation is a normal process therefore we want to encourage further blood flow to the region to aid and encourage the inflammatory processes. In other words we want to work with the body to optimise healing. Ice feels good short term as it reduces the inflammatory process but doesn’t address the cause of the problem. So for us we believe this isn’t the best long term solution.
Please see our best exercises for sciatic pain video.
Cochrane Systematic Review (2007) The effects of surgical treatments for individuals with ‘slipped’ lumbar discs https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001350.pub4/full?highlightAbstract=sciatica%7Csciatic
Cochrane Systematic Review (2016) Non steroidal anti inflammatory drugs for sciatica https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012382/full?highlightAbstract=sciatica%7Csciatic
NHS (2020) Sciatica available at: https://www.nhs.uk/conditions/sciatica/
NICE (2016b) Low back pain and sciatica in over 16s: assessment and management. National Institute for Health and Care Excellence https://www.nice.org.uk/guidance/ng59
NICE Sciatica (lumbar radiculopathy) National Clinical for Health and Care Excellence https://cks.nice.org.uk/sciatica-lumbar-radiculopathy#!topicSummary