What is Sciatica?
The sciatic nerve is the largest and the longest nerve in the body that exits at the spine and runs down from the low back, through the buttocks, and down the rear or sides of both legs. The term sciatica refers to constant or shooting pain experienced along the sciatic nerve pathway, commonly alongside with other symptoms including burning or tingling/pins and needles, numbness, or muscular weakness. These symptoms are usually only present in one leg and may be worse when sitting, and it can sometimes be difficult to stand up due to the pain.
What causes Sciatica?
The most common cause of sciatica is direct pressure on the nerve caused by a herniated or bulging disc, with other causes involving nerve compression from local joint inflammation, swelling, and nerve irritation. Other causes of sciatica include osteoarthritis, local injuries, poor posture, prolonged sitting, sudden heavy lifting, poor form during lifting through the hips and knees, and bone disease.
How can we diagnose Sciatica?
Our Physiotherapists are able to diagnose Sciatica through thorough history taking, patient symptoms and pain behaviour, and extensive physical examination. An x-ray or CT scan can be arranged by our Physiotherapists or your general practitioner, if there is any concern for significant structural involvement, however this is rarely ever clinically indicated.
One of our specialised clinical tests that our Physiotherapists’ conduct if suspecting Sciatica, is called the Straight Leg Raise (SLR) test. This is a neural tension test that assesses the mechanical movement of the sciatic nerve, and its sensitivity to mechanical stress. The SLR is used to rule in/out any space-occupying lesions such as a lumbar disc herniation that could be causing aggravation of the nerve, and is one of the most common neurological tests involving the lower limb.
The SLR is a simple test that involves the patient lying on their back while the Physiotherapist lifts the patient’s leg until there is pain or tightness felt in the back or down the leg, and movements with the head and/or foot are added to provoke symptoms. If this occurs then the test is considered positive and depending where and when the pain is felt, our Physiotherapists are able to localise where and what the potential source of the problem could be.
Physiotherapy Treatment of Sciatica
Our goal to treat Sciatica is to improve the mobility of the nerve and calm it down to therefore reduce pain and discomfort, and other associated symptoms. Reducing stiffness within the spinal joints and relieving muscular tension in the muscles of the lower back, buttock and legs, will effectively reduce or remove the direct pressure on the sciatic nerve thereby easing symptoms.
Interventions and techniques are implemented through phases, with the initial focus on pain relief and calming the irritated sciatic nerve. As the inflammation and pain settle, there is a focus on strength and flexibility restoration, and posture correction enforcement. The final phase focuses on regaining normal movement patterns involving the entire body and returning you back to your usual daily activities and/or work.
Our Physiotherapists can help to achieve this with the combination of the following interventions and techniques:
- Spinal mobilisations to reduce spinal stiffness.
- Massage therapy and trigger point therapy to ease muscle tension.
- Stretching the involved tight muscles and joints.
- Alternative techniques including dry needling or acupuncture, if indicated.
- Tailored exercise prescription to target physical deficits and to minimise pressure on the sciatic nerve.
- Thorough advice and education on posture, prevention of future episodes, and guidance on how to complete daily exercises at home to reduce pressure on the sciatic nerve.
If you are someone who is experiencing back pain and/or leg pain with or without various other associated symptoms, book in with one of our experienced Physiotherapists who will conduct a thorough assessment and guide you every step of the way. Our Physiotherapists will identify an appropriate treatment plan to help you experience relief from your discomfort and pain, with ongoing support and guidance through a stretching and exercise program to target your specific needs.
