Sciatica – What is it and how can it be helped?
‘Sciatica’ is a term commonly used to describe any symptoms involving the sciatic nerve and its distribution. The sciatic nerve primarily supplies the muscles of the back of the thigh and lower leg. It also receives sensation from most of the leg (except the inner side) predominantly the back and outside of the leg, sole of the foot and toes. Sciatica is a very common complaint and is often poorly understood and therefore not well managed. If not diagnosed properly the symptoms may linger and become debilitating, affecting people’s sleep, work, and daily activities. Many cases resolve within 4 to 6 weeks, however one paper stated that more than 30% of people still have clinically significant symptoms a year after onset of sciatica (1).
Sciatica can present in a range of different ways and severity, with patients reporting anything from sharp, stabbing, shooting pains radiating down the leg to more vague symptoms such as pins and needles, tingling or even numbness. Often the leg pain is accompanied by low back pain or buttock pain however someone could be said to have sciatic symptoms without lower back pain. Only low back pain, with no evidence of leg pain would not be classed as sciatica.
There are many causes for sciatica or ‘radicular pain’ as it is sometimes termed, ranging from disc bulges touching a nerve root to bony degenerative changes narrowing the canal where the nerve exits and even pinching or irritation of the nerve as it slides through tight muscles. Many people are prone to this problem especially people that sit or lift and those that are on their feet all day like shop or factory workers. Classically also builders, nurses, childcare workers, office workers, drivers to name but a few. Even joggers and sporty people can suffer owing to the repeated pounding and compression up through the hips and low back, especially if they are running with footwear that has little or no shock absorption. Because there is a lack of clarity in the definition and use of the term sciatica, statistics are not wholly reliable but men appear to be affected slightly more than women and those aged between 30 to 60 years of age are most prevalent.
So, what can you do about it? In most cases the best advice is to carry on your normal activities as much as possible but to reduce the amount of time spent in static positions such as sitting and standing and to avoid lifting and twisting movements. Gentle activity can be very beneficial such as walking, swimming or yoga. Home stretching exercises such as laying on your back and hugging one or both knees can help stretch the low back and buttock muscles as well as release any areas where the nerves may be pinched. Cold packs and heat packs placed over the low back and buttock area give some relief and GPs or pharmacists may advise the use of non-steroidal anti-inflammatories (NSAIDs) such as Ibuprofen. Paracetamol on its own has been found to be less effective in these situations.
As osteopaths are Allied Health Professionals (AHPs) and musculo-skeletal experts, many people visit an osteopath for sciatica related conditions and low back pain and sciatica accounts for a large portion of their work. On your first visit, the practitioner will question you thoroughly about the site, nature and pathway of your pain which can help highlight the nerves involved. Other case history questions will help determine where the problem is coming from. Safety screening questions will also help the practitioner determine if there may be anything more serious underlying which may need a medical referral. These situations are rare but symptoms such as worsening sciatica in both legs, numbness around the saddle area (anus and genitalia) and finding that you don’t have bladder or bowel control. These rare cases need urgent medical attention.
Following a detailed case history and examination, a management plan will be formulated. Soft tissue release techniques of surrounding tight muscles and gentle mobilisation of the hips, pelvis and spine often prove to be very effective. This in combination with education and advice about what maybe causing the problem, patient specific exercises and self-help measures, all assist with recovery.
1. Low back pain and Sciatica: summary of NICE guidance – BMY 2017;356:i6748
Bernstein, A; Malik, Q; Carville, S; Ward, S.
Blog created by ESO Clinic Tutor and Osteopath Robert Thomas. To find out more about osteopathy and the European School of Osteopathy visit www.eso.ac.uk/clinic or call for a consultation on Maidstone (01622) 685989.