Originating from several spinal nerves (L4 – S3), the sciatic nerve is most well-known for causing pain along its course from the low back down the legs. The sciatic nerve is the largest in the body and an irritation, inflammation, or compression anywhere along its path can lead to sciatica.
We’ve all heard someone talk about sciatica – so let’s look at the facts and what we can do about it!
Symptoms
Here is where it gets interesting - sciatica itself is a symptom of something else! The way this condition presents itself tells us about the actual cause!
Commonly only affecting one side of the body, sciatica can feel sharp or like an electric shock and causes various other symptoms. The pain can range from a mild discomfort to severe and stabbing like. These symptoms can begin suddenly or gradually over time – depending on the mechanism of injury. Many other symptoms such as paresthesia (abnormal sensation), weakness and low back pain may accompany this condition. If the pain were on both sides of the body, the cause of your pain may be a disc herniation (slipped disc) or lumbar stenosis.
How is it diagnosed?
Sciatica is mainly diagnosed by means of a history taking and physical examination. Imaging is not always necessary. If your practitioner feels there are other concerns, they may send you for further tests – such as a CT scan or an MRI. X-rays do not show soft tissue (nerves, muscles, and tendons) thus they are not the preferred imaging used.
Risk factors/ Causes
- Age
Osteoarthritis of the spine may lead to bone formations that grow and impinge the sciatic nerve. This, and herniated discs are the most common causes of sciatica
- Obesity
This leads to unnecessary pressure on the spine and all its elements
- Occupation
Lots of heavy lifting, twisting and long drives may cause sciatica. Additionally – sitting for too long can also be problematic depending on your posture
- Diabetes
Due to the high blood sugar levels, your nerves may become damaged over time
Owing to these risk factors, the preventative measures are pretty simple – maintain a healthy weight, ensure you have the correct posture no matter your occupation, exercise regularly and control your sugar levels.
Other causes
Piriformis syndrome – this is when your piriformis muscle, situated near your gluteal muscles, compresses the sciatic nerve. You may feel that these muscles are tighter than usual
Traumatic injuries – this includes buttock injections, pelvic fractures, hamstring injuries and extreme stretching of the sciatic nerve
Gynaecological issues – endometrial tissue deposits near the sciatic nerve, an enlarging fetus in the uterus and even ovarian cysts can sometimes cause sciatica
What can be done about my sciatica?
Conservative treatment is a fantastic way to manage sciatica. Before committing to surgery, try visiting a chiropractor to see if they can help you reduce or manage your symptoms. Not all cases resolve through conservative treatment but approximately 80% do! Most patients recover within 3 months.
Your practitioner should explain the cause of your symptoms and their plan to help reduce them. Active rest is the way forward! It is no longer advised to stay in bed for hours to reduce your symptoms. In some cases – this can actually make your pain worse. Try maintaining your daily activities, introduce stretching as well as light aerobic activity such as swimming or walking.
"Movement is Medicine" – Carol Welch
In your treatment sessions, a wide variety of modalities will be used such as: adjustments, soft tissue work, dry needling, kinesiotaping, joint mobilization, flexion distraction, nerve flossing and thermotherapy. If you do not respond to treatment within 6 – 8 weeks, your practitioner may refer you to a neurologist, neurosurgeon, or orthopaedic surgeon. It is important to be mindful if your symptoms are worsening and inform your practitioner if this is the case.
In a study of conservative management of sciatica, 87% of chiropractic patients felt much better after 3 months as compared to those receiving treatment from other practitioners. Consider visiting a chiropractor next time you experience sciatica!
Koes, B.W., Van Tulder, M.W. and Peul, W.C., 2007. Diagnosis and treatment of sciatica. Bmj, 334(7607), pp.1313-1317.
Ropper, A.H. and Zafonte, R.D., 2015. Sciatica. New England Journal of Medicine, 372(13), pp.1240-1248.
Jensen, R.K., Kongsted, A., Kjaer, P. and Koes, B., 2019. Diagnosis and treatment of sciatica. Bmj, 367.
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