Sciatica

Sciatica is a common problem that affects millions of people worldwide, characterised by pain caused by the sciatic nerve that carries messages from the brain down the spinal cord to the legs. The sciatic nerve is the longest in the body branching from the lower back through the hips and buttocks and down the back of each leg. Most commonly, sciatica affects only one side of the body and can vary in intensity, from a mild ache to a sharp, burning sensation or even excruciating discomfort. There can also be accompanying numbness, tingling, or muscle weakness in the affected leg or foot.

Diagram illustrating sciatica, showing the spine with a herniated disk compressing the sciatic nerve, causing pain radiating from the lower back down the leg.

What causes it?

The most common cause is a bulging disc in the lower back which is called a herniated disc. Discs are spongy cushions that separate the bones of the spine (vertebrae). Discs are important for movement and stability of your spine as well as providing shock absorption. If the elastic outer shell of the disc tears (the ‘annulus fibrosis’) from gradual wear and tear or a sudden, traumatic injury, then the jelly-like inner material (the ‘nucleus pulposus’) can come out and pinch or inflame the nearby nerve. 

There are other less common causes too such as spinal stenosis (narrowing of the spinal canal), degenerative disc disease, or even muscle imbalances such as piriformis syndrome. These conditions can put pressure on the sciatic nerve, triggering pain and discomfort.

What are the risk factors?

• Age: As you age, natural wear and tear on the spine can lead to herniated discs, bone spurs, and other conditions that can cause sciatica.

• Obesity: Extra weight puts added stress on your spine, increasing the risk of nerve compression.

• Poor posture and inactivity: Improper posture as well as sitting for long periods without movement can weaken core muscles and contribute to sciatica.

• Occupation: Jobs involving heavy lifting, repetitive movements, and awkward postures can increase risk.

• Diabetes: Diabetes can lead to nerve damage (neuropathy), increasing the risk of sciatica.

• Smoking: Smoking impairs blood flow and healing, potentially increasing the risk of nerve damage.

• Spinal Injuries: Previous spinal injuries or conditions like arthritis can increase the risk.

Diagnosis

Diagnosing sciatica is usually through a clinical examination. This will involve questions regarding the nature, location, and timing of the pain as well as whether it's accompanied by other symptoms like numbness, weakness, or tingling in the leg or foot. You may also be asked if you have any medical conditions, injuries, or family history that can identify potential contributing factors to sciatica. This will be followed by neurological tests to assess the integrity of the nerves, assessment of muscle strength and reflexes, and an examination of the spine to identify any abnormalities or areas of tenderness. The doctor may then decide to order imaging such as a spine X-ray, CT or an MRI scan to confirm the diagnosis and help guide treatment.

Do I need surgery?

Surgery is usually only recommended in cases where sciatica causes severe weakness, loss of bowel or bladder control, or pain that doesn't improve with other treatments. Surgery involves removing the bone spur or the portion of the herniated disc that's pressing on the nerve. Your doctor may advise NSAIDs and physiotherapy as initial management. Corticosteroid injections are also another treatment option that can help alleviate pain.

The role of physiotherapy

Physiotherapy plays a crucial role in the management and recovery from sciatica by aiming to address the root cause of the nerve irritation and promote long-term healing. The body can reabsorb the disc material that is causing symptoms, even for those with severe pain. So, treatment focuses on controlling pain and keeping people as active as possible. Treatments include:

1.        Manual Therapy: soft tissue massage and mobilisations can help reduce muscle tension, improve joint mobility, and reduce pressure on the nerve.

2.        Exercise Therapy: exercises to improve flexibility, strengthen core and lower back muscles, and enhance posture support spinal stability and can alleviate nerve compression.

3.        Education and Ergonomic Advice: proper posture, body mechanics, and lifestyle changes are important to minimise strain on the lower back during daily activities.

4.        Modalities: other treatments such as dry needling, heat/cold therapy, ultrasound, or electrical stimulation (like TENS) may be used to manage pain and inflammation.

5.        Progressive Rehabilitation: as pain subsides, therapy shifts towards restoring full mobility, improving endurance, and preventing recurrence through a graduated return to normal activities and functional movement.

While some cases of sciatica resolve on their own within a few weeks, physiotherapy can significantly speed up recovery and reduce the likelihood of future episodes. With the right guidance and commitment, individuals suffering from sciatica can achieve lasting relief and a return to pain-free living.

Conclusion

In conclusion, sciatica can be a painful and debilitating condition, but physiotherapy offers an effective, non-invasive approach to relief and recovery. By addressing the underlying causes, improving mobility, and strengthening key muscle groups, physiotherapy can alleviate symptoms and reduce the risk of recurrence. With early intervention and a tailored treatment plan, individuals can regain function, reduce pain, and return to their daily activities with confidence.

By

Cathal O’Kane

Senior Physiotherapist