Sciatica is a word I hear a lot from patients attending our clinic. They could well be right, as it has been shown to be relatively common, with 15-40% of lower back pain sufferers also having sciatica.
However, what is sciatica? Why do I have sciatica? And how is sciatica diagnosed?
What: Sciatica refers to irritation of the sciatic nerve anywhere along its length from the back into the leg. The sciatic nerve (the yellow part of the images on the right and below) is one of the largest nerves in the body and innervates most of the muscles in the leg and buttock, and allows us to detect sensation in the same areas. For this reason, true sciatica usually causes pain that travels from the lower back, beyond the knee and into the foot. It may also be associated with changes in sensation or feeling such as tingling, pins and needles or numbness.
Causes: The reason sciatica occurs can be for several reasons but usually because of a physical compression of the nerve often at narrow points where the nerve (or at least a part of the nerve) must pass through or between. Typically, intervertebral discs (IVDs) can bulge and can potentially compress the spaces that the nerve root runs through. This creates a physical compression and/or inflammation that can irritate the nerve causing the symptoms of sciatica. It is now widely researched that psychological factors such as fear, anxiety and worry can also worsen pain levels.
Other diagnoses that can behave similarly to sciatica but are distinct can include: piriformis syndrome, (in red in the right image), facet syndrome, myofascial trigger points of the gluteal muscles, sacroiliac joint dysfunction and others.
Diagnosing the correct cause of your pain is important for appropriate treatment, expectation of recovery and on-going management.
Diagnosis: Sciatica can be diagnosed clinically. This means your case history (what you tell me), physical examination (what I look for) and response to treatment (do you improve as expected?) is enough to make a firm diagnosis without the need for further investigations such as MRIs. In rare cases, MRIs may be useful to rule out any suspected underlying cause.
The majority of true sciatica cases will resolve with conservative treatment (e.g. osteopathy, exercise and movement advice) and only a minority needing further referral for anti-inflammatory drugs. Experienced with dealing with such cases, I can provide you with the right diagnosis and a safe treatment program to help manage your pain or refer you to the appropriate specialist if necessary.
The aim of osteopathic treatment in sciatica is to reduce the inflammation/irritation around the nerve, and encourage normal movement of the body using manual therapy techniques whilst the cause of the pain heals (i.e. the disc bulge). Osteopaths can also advise you on specific exercises, self-management and ‘thinking’ strategies, which will help you on your road to recovery.
The majority of true sciatica cases will resolve with conservative treatment
(e.g. osteopathy, exercise and movement advice)
and only a minority needing further referral for anti-inflammatory drugs.