What is Sciatica?
Sciatica refers to pain that radiates along the sciatic nerve, which runs from your lower back down to your legs. It’s often caused by a herniated disc pressing on a nerve root. The nerve root is where the nerve originates, where it emerges from your spinal cord in your lower back, and then runs down your leg.
The sciatic nerve can also be aggravated by muscles in your glutes (your buttocks), particularly the piriformis muscle. This is called "piriformis syndrome". Piriformis syndrome is different than when the sciatic nerve root is aggravated in your lower back.
Regardless of the cause, when your sciatic nerve is aggravated or injured, it can lead to pain, numbness, tingling or weakness in the affected leg - you may feel this even as far down as your calf or foot.
Do you have Sciatica?
To figure out whether sciatic nerve root aggravation or something else is causing your symptoms, a physiotherapist will do a full assessment.
An assessment will first include a conversation to help the physio understand your story e.g. what your symptoms are, when they started, what makes them worse, and what makes them better.
They'll then look at how you move, observing how well you move, and what movements relieve or aggravate your symptoms.
Finally they'll do a series of physical tests - such as testing your strength in different positions, testing your sensation, plus other "special tests" to rule out other causes of leg pain.
Based on everything they learn from their assessment, the physiotherapist will give you their impression or diagnosis, to help you understand whether you have sciatica or not. And if you do have sciatica, they'll suggest whether it's caused by nerve root aggravation, piriformis tightness, or something else. Analysing the cause can be important, because the physiotherapy treatment will differ depending on the cause of your symptoms.
If you're not able to see a physiotherapist, there are some things you can do at home to guess whether you might have sciatica:
(1) Analyse your symptoms. Sciatica can cause pain all the way down to your lower leg. It is also more likely to cause numbness, tingling and weakness, compared to an injury to other structures in your leg that are not a nerve (e.g. muscle, tendon, or bone injury). It may or may not involve back pain.
(2) Do a home test for piriformis syndrome. Remember your piriformis is only one potential structure that can aggravate the sciatic nerve, and you can still have sciatica if your piriformis is not causing the problem. That said, here's the home test:
- Lie on your stomach with your knees bent (see photos below). Once your knees are bent, let your feet fall outwards.
- If one side doesn’t fall as far out as the other, this could be a sign of a tight piriformis muscle. Having a tight piriformis has been linked to irritating the sciatic nerve, which can present similar to sciatica.
Performing this test at home can help rule in or rule out a potential contributing factor to your sciatic nerve irritation:
How Physiotherapy Can Help
While sciatica can be very uncomfortable, physiotherapy can help. First, we can do a professional assessment to help you figure out the cause of your condition (as described above). Once we have a sense of the cause/diagnosis, at our clinic we focus on treatments that align with the latest research. A personalized approach might include:
- Manual Therapy: Techniques like spinal manipulation or mobilization to relieve pressure and improve movement.
- Exercise Programs: Strengthening and stretching exercises tailored to your unique condition.
- Education and Advice: Teaching you how to move safely and prevent further pain.
- Adjunct Therapies: Incorporating methods like acupuncture or electrical stimulation as part of a comprehensive plan (Lewis et al., 2015).
Other Options According to the Research
A recent review of the research compared multiple treatments for sciatica to find out which one may work best for you. Here’s what it discovered:
- Effective Treatments:
- Epidural Injections: These can provide significant pain relief and improve overall recovery for many patients (Lewis et al., 2015).
- Disc Surgery: In more severe cases, surgery can lead to notable improvements, especially when other treatments haven’t worked (Lewis et al., 2015).
- Nonopioid Pain Relievers: Medications like anti-inflammatories can help manage pain without the side effects of opioids (Lewis et al., 2015).
- Acupuncture and Spinal Manipulation: These alternative therapies showed promise in improving symptoms for some individuals.
- Treatments That Need More Evidence:
- Exercise Therapy: While it’s an essential part of long-term recovery, alone it may not provide immediate relief (Lewis et al., 2015).
- Traction and Bed Rest: These are less effective compared to other options and are generally not recommended as standalone treatments (Lewis et al., 2015).
- Avoid Over-Reliance on Opioids: Medications like opioids showed limited benefit and should be used cautiously, if at all, for sciatica (Lewis et al., 2015).
**We do not do injections, perform surgery or prescribe medications at our clinic. Our physiotherapists work closely with your health care team to ensure you get the care you need. As part of this team, our role as physiotherapists includes diagnosis, exercise therapy, manual therapy, acupuncture, education, and other drug-free approaches to pain relief. We also help you prepare or rehabilitate before and after medical procedures such as surgery or injections.**
The Road to Recovery
Recovery from sciatica takes time, but with the right support and treatment, you can reduce pain and improve function (Lewis et al., 2015). If you’re dealing with sciatica, don’t hesitate to reach out to our physiotherapy team. We’re here to guide you every step of the way and help you get back to doing what you love.
Written by Dillon Hunter, in collaboration with River East Physiotherapy
References:
Lewis, R. A., Williams, N. H., Sutton, A. J., Burton, K., Din, N. U., Matar, H. E., Hendry, M., Phillips, C. J., Nafees, S., Fitzsimmons, D., Rickard, I., & Wilkinson, C. (2015). Comparative clinical effectiveness of management strategies for sciatica: Systematic review and network meta-analyses. The Spine Journal, 15(8), 1461–1477. https://doi.org/10.1016/j.spinee.2013.08.049