Sciatica

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Sciatica describes pain felt along the sciatic nerve, which runs from your lower back, down through the buttock, hamstrings and into the lower leg. The sciatic nerve is the longest nerve in the body. The spinal sections it originates from include L4, L5 or S1. See the diagram below for a general idea where you may feel sciatica symptoms.
Sciatica is commonly misdiagnosed, which can result is either slow or non-responsive treatment. Leg pain can have various sources. It can be a local leg injury or it may even be referred from your lower back. The main nerve that travels from your lower back to your leg is your sciatic nerve. Irritation or pinching of your sciatic nerve can cause severe leg pain known as sciatica.

Common Causes

Pressure on the sciatic nerve from a herniated disc usually causes sciatica. Otherwise joint inflammation, compression of the nerve from bony arthritic growths or a locked facet joint in the lower spine can commonly cause sciatica.
Leg pain can have various sources. Pain can be a local leg injury or it may even be referred from your lower back and travel along the sciatic nerve. The main nerve that travels from your lower back to your leg is your sciatic nerve.

Injury that irritates or pinching of your sciatic nerve can cause severe leg pain known as sciatica. You’re most likely to get sciatica when you’re 30 to 50 years old. It may happen due to the effects of general wear and tear, plus any sudden pressure on the discs that cushion the vertebrae of your lower (lumbar) spine.

While there are numerous causes of sciatica, the most common are:
lumbar bulging disc
spine degeneration
facet joint injuries
Other sources include:
piriformis syndrome
spinal stenosis
spondylolisthesis
sacroiliac dysfunction
You’re most likely to get sciatica when you’re 30 to 50 years old. It may happen due to the effects of general spine wear and tear (spondylosis) or a traumatic injury that sudden pressure on the lumbar discs eg lifting, bending or sneezing.

Symptoms

Sciatica causes pain that usually begins in the lower back and spreads through the buttock, leg, calf and, occasionally, the foot. The pain can vary between dull, aching or burning sensations and sharp, shooting pains.
Sciatica can also cause tingling, numbness or muscle weakness in the affected leg. It is very important to seek medical attention in these situations as long-term nerve compression can permanently damage the nerve and its function. In these cases your symptoms may become permanent.

One or more of the following sensations may occur because of Sciatica:
Pain in the rear or leg that is worse when sitting
Burning or tingling down the leg
Weakness, numbness or difficulty moving the leg or foot
A constant pain on one side of the rear calf
A shooting pain that makes it difficult to stand up.

Diagnosed

Sciatica is a clinical diagnosis based upon your symptom description, the behaviour of your pain and a thorough physical examination.
While the diagnosis of sciatica is reasonably simple, the primary cause of your sciatica may require further investigations to eliminate or confirm its origin. It is also important to determine how significant your sciatic nerve has been compressed.
Your physiotherapist will examine you, paying special attention to your spine and legs. In addition to asking you if you have low back pain that spreads to the leg and calf, your physiotherapist will test you for muscle weakness, sensation deficits and altered reflexes in your leg or foot.
They will also want to know if you’ve had an injury, fever, problems controlling your bowels or bladder, previous cancers and whether you’ve been losing weight without trying. The answers to these questions are important because if these symptoms are present, the cause of sciatica could be a serious condition, such as a bone fracture, infection or cancer.
Your physiotherapist or doctor may send you for X-rays, or arrange for a computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan to check for problems in the spinal vertebrae (backbones) that may be irritating or compressing your sciatic nerve. Most cases of sciatica affect the L5 or S1 nerve roots.

Treatment

PHASE I – Pain Relief & Protection

Managing your pain. Pain is the main reason that you seek treatment for sciatica. In truth, it was actually the final symptom that you developed and should be the first symptom to improve.
Managing your inflammation. Inflammation is a normal part of your healing process post-injury. But, excessive inflammation can be the main cause of your sciatica.
Please contact your physiotherapist or doctor for their professional opinion.

PHASE II – Restoring Normal Flexibility, Posture & Strength

As your pain and inflammation settles, your physiotherapist will turn their attention to restoring your normal back joint range of motion and resting muscle tension, lower limb muscle flexibility and posture.
Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises for you specific to your needs. They may recommend that you undertake an ultrasound guided exercise program where you can view your deep core muscle contractions on a monitor.
PhysioWorks has developed a Back Pain Core Stabilisation Program to assist their sciatica patients to regain normal core muscle control. Other more advanced programs can include stability exercises and equipment such as a Swiss exercise ball. Please ask your physio for their advice.
Swimming and hydrotherapy exercises are beneficial in early injury repair due to lesser body-weight in the buoyancy of water. This allows more movement without causing pain.

PHASE III – Restoring Full Function & Dynamic Control

The next stage of your rehabilitation is aimed at safely returning you to your desired activities. Everyone has different demands will determine what specific treatment goals you need to achieve. Your physiotherapist is the best person to guide your rehabilitation.

PHASE IV – Preventing a Recurrence

Sciatica does have a tendency to return. The main reason it is thought to recur is due to insufficient rehabilitation.
Fine tuning your back mobility and core control and learning self-management techniques will ultimately help you to achieve your goal of safely returning to your previous sporting or leisure activities without sciatica.
Exercise is like cleaning your teeth. Exercise prevents problems.

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