Sciatica is when the sciatic nerve - which runs from your spinal cord, through your posterior hip, and to your feet - is irritated. It usually gets better in 4 to 6 weeks but can last longer. Common causes of sciatica are postural related injuries, or activities such as lifting heavy objects, which can lead to the following:
Inter-vertebral disc bulge/prolapse (‘slipped disc’) - this is the most common cause. The discs are essentially soft cushions used to absorb shock/movement between each bone in the spine. When injured these can press on or irritate the nerves innervating the legs
Spinal stenosis/Inter-vertebral foramenal stenosis - is a narrowing of the part of your spine where nerves pass through
Spondylolisthesis – when one of the bones in the spine moves out of position, usually due to a fracture
The piriformis muscle is a deep muscle located in your buttock region, with the sciatic nerve running beneath it. If this muscle is tight, tense, or spasms, it can irritate the sciatic nerve
If you have Sciatica, you may have symptoms in your buttock/gluteal region, back of the leg(s), feet or toes
Pain - stabbing, burning, or shooting
Pins & needles or tingling
Symptoms getting worse when moving, sneezing, coughing, or straining on the toilet
If you are experiencing these symptoms anywhere in the legs (or arms), and not just the areas listed above, it may well be caused by irritation to a nerve other than the sciatic nerve.
Many cases of Sciatica can be managed through conservative treatment such as Osteopathy. It is first important to diagnose the specific cause of the symptoms so that they may be managed accordingly
Once a diagnosis has been made, and you are deemed safe to treatment, hands on treatment can be undertaken specific to your presentation/needs. This may include gentle rhythmical movements of the spine, traction or gapping of the spinal joints, as well as treatment into the hips and thoracic spine, with the aim to decrease the load placed onto the lower back
Medical acupuncture can also be used very effectively if the cause is deemed to be muscular (example the piriformis muscle as detailed in causes above)
Management depends on each individual patient. A combination of hands on manual treatment, a long with specific stretches and exercise to perform at home is usually an effective way to manage the symptoms of sciatica.
It is generally recommended that people continue with normal activity to the best of their abilities. Often all that is required for sciatica resolution is time; in about 90% of people symptoms resolve in less than six week
In most cases of sciatica, medical imaging is not needed. However, imaging may be obtained if bowel or bladder function is affected, there is significant loss of feeling or weakness, symptoms are long standing, or there is a concern for tumour or infection. If this is the case then an onward referral will be made.