Sciatica
What is Sciatica?
Sciatica is characterized by pain felt along the sciatic nerve, formed from nerve roots originating from the spinal cord. Do note that sciatica isn't a diagnosis, rather it's a description of symptoms.
Where is the Sciatic Nerve Found?
The sciatic nerve is the longest nerve in the human body, made up of several spinal nerve roots. These root nerves pass through the disc spaces and join to form the sciatic nerve. The sciatic nerve exits the pelvis through the greater sciatic foramen, below the piriformis muscle, which is why it controls sensation and functions areas around the lower back (L4, L5, or S1), down through the buttock, hamstrings and into the lower leg.
In most cases of sciatica, full recovery from sciatica is highly likely. However, keep in mind that sciatica, especially when accompanied with severe pain, can also potentially result in permanent nerve damage.
What Does Sciatic Nerve Pain Feel Like?
Typically, sciatica nerve pain is described as a combination of tingling, numbness, weakness or sharp, excruciating pain. Often, the pain extends from the outer leg and hip area all the way to the back of the thigh. Sciatic nerve pain is generally caused by irritation or pinching of your sciatic nerve along the spinal column, which can occur when a lumbar disc is prolapsed or herniated.
What are Symptoms of Sciatica?
Sciatic pain is most commonly felt throughout the lower back, spreading to the buttocks, upper and lower leg and can even go as far as the foot. It can also present as a dull aching pain, sharp shooting pain, or even a burning sensation down the leg.
Sciatica also causes numbness in the back of the leg, impairing a person's balance or walking gait, which can be a major risk factor for the elderly or pregnant women. It is also critical to seek medical advice since long-term nerve compression or irritation produces irreversible nerve damage, resulting in some of the symptoms becoming permanent.
Sciatica can also be a symptom of other underlying health conditions such as lumbar radiculopathy which is characterized by pain combined with other symptoms like tingling in the legs, numbness, weakness, or slow reflexes along a nerve's course.
Other Symptoms of Sciatica
Pain in the buttock which may become worse when sitting
Tingling in the affected leg
Numbness in the foot making it hard to move
Shooting leg pain, resulting in difficulty standing and walking
Constant pain on one side of lower leg
Weakness in affected leg
What Causes Sciatica?
Sciatica describes a certain pain pattern in the leg and can have many sources making it difficult to diagnose. Sciatica can result from trauma to the leg, referred pain in the lower back, or even impingement of the sciatic nerve.
Age is a major risk factor of sciatica, with people people aged 30-50 being at a higher risk of developing this condition. Less active individuals or those working sedentary jobs with prolonged sitting also typically experience faster wear- and- tear of the lumbar discs (in the low back), which may lead to impingement of the lumbar nerves and making them more likely to develop sciatica.
Pressure on the sciatic nerve can also be caused by a herniated disc. Herniated spinal discs occur when the outer part of a vertebral disc in the lumbar spine is torn allowing the inner gel to press out through the fibres. This gel then puts pressure on the nerves and brings on sciatic symptoms. Compression on the nerves can also result from a bone spur on the spine, or narrowing of the spinal cord space (spinal stenosis). For more on this, please see our article on low back pain.
Other common causes of sciatica are joint inflammation, compression of the nerve from arthritic growths, a locked facet joint, bone spurs or other growths, and spinal degeneration due to degenerative disc disease.
Less Common Causes of Sciatica
Piriformis syndrome: a compression or irritation of the sciatic nerve by the piriformis muscle deep in the buttock
Lumbar spinal stenosis: narrowing of the spinal canal, which compressed the nerves
Spondylolisthesis: when a vertebra slips forward compared to the vertebrae beneath it causing a ‘kink' in the nerves
Sacroiliac dysfunction: when the sacroiliac joint, the joining between the lower spine/tail bone to the pelvis, are inflamed and/or sprained. This can result from trauma, muscle weakness, or overload on the sacroiliac joints.
Sciatica Pain Triggers and Risk Factors
Non-cushioned shoes can transfer the impact of your steps directly up your legs.
Wearing high heels for long periods shifts your body weight forward; a forward pelvic tilt, excessive tension on the hamstring muscles all lead to increased stress on the sciatic nerve.
Stress, tight-fitting clothes, older age, and obesity or excessive weight can add extra pressure on the sciatic nerve.
How is Sciatica Diagnosed?
A sports chiropractor can provide the clinical diagnosis of sciatica based on symptoms and by completing a thorough physical exam. For more complex cases, X-rays, computed tomography (CT) scans, or magnetic resonance imaging (MRI) scans may be needed to get a deeper look at the issue causing sciatic pain.
Recognising sciatica is simple, but identifying the underlying cause is not so straight forward.
A practitioner will focus on examining the spine and legs to confirm or eliminate its origin, testing for significant or unusual lower back pain muscle weakness, sensation deficits, and altered reflexes in your leg and/or foot. In severe cases, imaging tests may be required to check for bone spurs and a herniated disc (occurs when a disc is pushed outwards, putting pressure on the sciatic nerve).
Our practitioners may also note the patient's medical history of injuries, fevers, bowel or bladder control issues, previous cancers and unwarranted weight loss history. These will prove important in ruling out more serious and severe sciatica conditions such as bone fracture, infection or cancer.
When is Sciatica Serious?
Some sciatica symptoms, such as cauda equina syndrome (a rare but serious condition affecting the nerves in the lower part of the spinal cord), infection, or spinal tumours, may indicate a serious medical condition.
These symptoms may include, but are not limited to:
Progressive neurological symptoms, such as leg weakness
Bowel and/or bladder dysfunction
Sexual dysfunction
If such sciatica symptoms manifest, it is advised to seek immediate medical attention.
Sciatica and Pregnancy
Sciatica-like symptoms in conjunction with lower back pain are very common during pregnancy, with about 70% of women claiming to have back pain during pregnancy.
An increase in pregnancy hormones such as relaxin can cause your ligaments, tendons and joints to become more elastic and stretch more, particularly in the pelvic area. This is NORMAL during pregnancy as it aids in the body's expected natural birth. This also leads to muscle tension due to overcompensation because of joint instability. Pelvic pain and piriformis syndrome are the most common causes of sciatic pain during pregnancy.
This sciatic pain can be relieved via many alternative routes. Remedial massage, chiropractic care, and physical therapy are the most common forms of treatment that pregnant women seek out. Treatments are adapted to suit each woman during pregnancy and ensure the baby's and mother's safety.
At-home/self-treatments are also available. However, the body is delicate during this period, so it is highly advised to consult a therapist first to determine what is appropriate for your body.
Most women find non-weight bearing exercises, such as swimming, highly beneficial as the water helps support the baby's weight, thus taking some of the pressure off the mother's low back.
Stretches also help during pregnancy. It is advised to start off slow and light and then gradually build up to fully stretching the muscles out over a period of weeks to months.
However, it should be noted that stretching the sciatic nerve can further cause irritation and result in more pain. Nonetheless, slowly stretching out the surrounding muscles can help reduce load on the nerve, which will help ease the pain in the long run.
Hip flexor stretches are quite important during pregnancy as they commonly become tight and can affect pelvic alignment. The hip flexors are the muscles that lay along the front of the hip and assist in moving the leg forward to walk.
Stretches to Help Ease Sciatic Pain
Seated Piriformis Stretch
Sit on a chair/bench with feet flat on the ground
If your left side is affected, put your left ankle on your right knee – vice versa
Lean forward until you feel a stretch through your buttocks
Hold for roughly 30 seconds, repeat twice a day on each leg
Table Stretch
Stand with feet slightly wider than your hips, facing a table
Lean forward placing your hands on the table, keeping arms and back straight
Pull hips away from the table while keeping your hands on it, until you feel a stretch in your lower back and legs (moving your hips side to side can increase the stretch in the back and hips)
Hold for 30 seconds, slowly building up to a minute, repeat twice a day
Hip Flexor Stretch
Kneel on the floor
Place one foot forward at a 90-degree angle
Shift your weight forward until you feel a stretch at the front of your back leg and hip
Hold for 30 seconds and repeat on other side
Glute and Hamstring Foam Rolling
Place a foam roller on level ground
Sit on the foam roller and place hands behind you as support
Place left ankle on your right knee, or vice versa
Slowly move your body back and forth over the foam roller, targeting tender spots
Continue this movement for 30 seconds, eventually building up to 60 seconds
Repeat with more tender spots, and with other leg
How is Sciatica Treated?
There are many treatments available. Back braces and other postural supports can provide temporary relief for some people who need extra core support. Soft tissue massage therapy can help ease muscle spasms in affected areas. Exercises on a Swiss exercise ball can also help build up deep core muscles. Symptoms of sciatica can also be reduced by spinal manipulation in a chiropractic treatment.
Nevertheless, prolonged exercise rehabilitation and physical therapy that is self-managed and assisted by professional practitioners yield successful results. In fact, nonsurgical sciatica treatments often help majority of those who suffer from sciatica in as little as 4 to 6 weeks.
When standard sciatica treatments are ineffective, especially for acute or chronic pain, orthopaedic surgeons may advise getting an epidural steroid injection. Alternatively, in some situations, a brief course of oral steroids may be taken into consideration before administering steroid injections.
With the many ways to approach sciatica, the most important is to first determine the underlying cause then proceed with a treatment plan that is case appropriate.
An Example of How We Manage Some Sciatica Cases
Here's a 4-phase program we use to restore full painless function of the lumber spine, buttock, legs and feet of a patient with sciatica. Older patients may require more time in each phase.
Phase 1 – Managing the pain and inflammation of the nerve.
Sciatic pain is the main reason people seek treatment, although it's the last symptom to develop. The inflammation is part of the body's natural healing process, but sciatic nerve inflammation can be the main cause of the pain felt.
As a sports chiropractor, hands-on therapy would include a combination of muscle releases, dry needling, instrument assisted soft tissue manipulation, and fascial releases. We would then provide the patient with an at-home stretch program.
Phase 2 – Restoring Flexibility, Posture, and Strength
Once the nerve inflammation and pain have settled down, we then focus on restoring range of motion, resting muscle tension, lower limb flexibility and overall posture.
Different exercises will be assigned based on the assessed muscle recruitment pattern of a patient. Our clinics have programs that help patients regain previous muscle control, and even help develop and strengthen muscle control.
Swimming, hydrotherapy, or lighter bodyweight exercises may be used for early injury repair, to assist in movement with little to no pain and help speed up the healing process.
Phase 3 – Restoring Complete Function and Control
This phase is individualised depending on the patient's goals. If the patient hopes to run a marathon, we build them a program working towards that goal. Alternatively, if the patient simple wants to return to simple daily tasks, that road is a lot less complex.
Patients will be fitted with a goal-centred rehabilitation treatment program where compensations (such as a limp with walking, or a shifted posture) that may have developed during the injury are eliminated.
Phase 4 – Prevention
Sciatica does often return even after rehabilitation. Lack of proper rehabilitation, up-keep, and self-management is usually the main cause of sciatica returning.
The best way to maintain a sciatica-free lifestyle is to fine-tune mobility and core-control skills by self-managing and regularly seeing a preferred practitioner.
And remember, exercise prevents problems, even if it's light.
Take Home Tips for Sciatica
Always listen to your body and cease any activities that trigger sciatic pain.
Change your sitting position every couple of hours throughout the day and try to maintain proper posture.
Take breaks often. Stand and walk around during a break.
Always refer back to your chiropractor or other healthcare professional to seek proper medical attention before taking any action, especially when dealing with severe pain.
Keep in mind that in order to prevent sciatica, you need to start by taking care of your back, controlling your weight, and generally enhancing your physical health.
And pregnant moms, always make sure you speak to a health professional before trying something new!