What is Sciatica? Management of Sciatica.

What is Sciatica?

Sciatica refers to pain that radiates along the path of the sciatic nerve, the largest nerve in the body. The sciatic nerve originates in the lower back (lumbar spine), travels through the hips and buttocks, and extends down each leg. When this nerve is irritated, compressed, or inflamed, it can cause a range of symptoms collectively referred to as sciatica.

Symptoms of Sciatica

Sciatica typically affects one side of the body and may include:

1. Pain: A sharp, burning, or shooting pain that starts in the lower back and travels down the leg.
2. Numbness or Tingling: A “pins and needles” sensation, often in the leg or foot.
3. Weakness: Difficulty moving the affected leg or foot.
4. Worsened Symptoms: Pain may intensify with prolonged sitting, standing, coughing, sneezing, or bending.

 

Causes of Sciatica

Sciatica is a symptom of an underlying condition rather than a standalone diagnosis. Common causes include:

1. Herniated or Bulging Disc

• When a spinal disc’s inner material protrudes outward, it can compress the sciatic nerve.
• This is the most common cause of sciatica.

2. Spinal Stenosis

• Narrowing of the spinal canal, often due to age-related changes, puts pressure on the sciatic nerve.

3. Piriformis Syndrome

• The piriformis muscle, located in the buttocks, can irritate the sciatic nerve if it becomes tight or spasms.

4. Spondylolisthesis

• A vertebra slips forward onto the one below it, potentially pinching the nerve roots.

5. Trauma or Injury

• A fall, car accident, or other injuries can lead to nerve compression.

6. Degenerative Disc Disease

• Age-related wear and tear on spinal discs can cause sciatic nerve irritation.

7. Tumors or Infections

• Rarely, tumors or infections in the spine may compress the nerve.

The common denominator of all these causes is the fact that the lumbar nerve root is compressed, which may result in inflammation. Evidence suggests that it is not so much the pressure on the nerve root that causes sciatica, but a combination of pressure-related, inflammatory and immunological processes.

 

Risk Factors for Sciatica

• Age: Degenerative changes in the spine occur with aging.
• Obesity: Extra body weight increases pressure on the spine.
• Sedentary Lifestyle: Prolonged sitting or lack of exercise weakens the spine and surrounding muscles.
• Occupational Hazards: Jobs requiring heavy lifting, twisting, or long periods of sitting can contribute.
• Diabetes: Increases the risk of nerve damage, including sciatica.

Diagnosis of Sciatica

Signs and symptoms that are indicative of sciatica and should be addressed during history taking are: the dominance of leg pain, more than back pain; the location of the leg pain (ie, to assess whether it radiates down below the knee and whether it aligns with one or more dermatomes); paraesthesia and/or sensory loss (roughly) in line with the dermatomes of the affected spinal root ; weakness and/or reflex changes in a myotomal distribution; and an increase in leg pain with coughing, sneezing and/or taking a deep breath.

A number of physical tests have a small added diagnostic value: loss of muscle strength, particularly loss of dorsiflexion of the foot when L5 is affected (often this loss is too subtle to cause foot drop); increased finger-floor distance (> 25 cm); absence of tendon reflexes; and a straight leg raise test (in particular, a negative test is informative because it indicates decreased likelihood of sciatica); and a positive crossed straight leg raise test (increased likelihood of sciatica).

 

To diagnose sciatica, a healthcare provider may:

1. Review medical history and symptoms.
2. Conduct a physical exam to test reflexes, muscle strength, and sensation.
3. Perform imaging tests:
   • X-rays: Detect bone abnormalities.
   • MRI or CT scans: Identify herniated discs, stenosis, or soft tissue issues.
   • Electromyography (EMG): Evaluates nerve and muscle function.

Treatment Options for Sciatica

For many individuals, sciatica can be managed with self-care measures, though it’s important not to remain inactive for too long, as this can exacerbate symptoms. If you’re experiencing severe or persistent pain, consulting a healthcare professional is recommended.

 

1. Conservative Treatment (First Line)

• Rest and Activity Modification: Short periods of rest followed by light activities.
• Medications:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen.
  • Muscle relaxants.
  • Nerve pain medications (e.g., gabapentin).
• Physical Therapy:
  • Stretches and strengthening exercises to reduce pressure on the nerve.
• Heat and Cold Therapy: Ice packs reduce inflammation, while heat soothes tight muscles.

2. Advanced Treatments

• Epidural Steroid Injections: Reduce inflammation around the nerve.
• Surgery (Rare Cases): Recommended for severe or persistent cases, such as:
  • Microdiscectomy: Removes part of a herniated disc.
  • Laminectomy: Removes part of the vertebra to relieve pressure.

Prognosis and Prevention

Most cases of sciatica resolve within a few weeks with conservative care. However, preventing recurrence is essential:

• Maintain a healthy weight.
• Exercise regularly, focusing on core and back strength.
• Practice proper lifting techniques.
• Adopt good posture.

By addressing the underlying cause and incorporating preventive measures, the frequency and severity of sciatica episodes can often be reduced.

Physiotherapy for Sciatica

Physiotherapy plays a vital role in managing and treating sciatica. It focuses on alleviating pain, improving mobility, and strengthening the muscles that support the spine, thereby reducing pressure on the sciatic nerve. A physiotherapist tailors the treatment plan to address the underlying cause of the condition, such as a herniated disc, spinal stenosis, or piriformis syndrome.

Goals of Physiotherapy in Sciatica

1. Pain Relief: Reduce pain and inflammation.
2. Nerve Mobilization: Free the sciatic nerve from irritation or compression.
3. Postural Improvement: Correct poor posture to prevent future episodes.
4. Strengthening: Enhance the strength of core and spinal muscles to stabilize the lower back.
5. Flexibility: Improve flexibility in the hips, hamstrings, and lower back.
6. Functionality: Restore normal movement patterns and prevent recurrence.

Components of Physiotherapy for Sciatica

1. Pain Relief Techniques

• Heat and Cold Therapy: Used to reduce inflammation and relieve muscle tension.
• Electrotherapy: Techniques like TENS (Transcutaneous Electrical Nerve Stimulation) provide short-term pain relief by disrupting pain signals.
• Ultrasound Therapy: Promotes tissue healing and reduces inflammation through sound waves.

2. Manual Therapy

• Massage Therapy: Relieves muscle tension and improves circulation to the affected area.
• Spinal Mobilization: Gentle manipulation of the spine to improve alignment and relieve nerve compression.
• Soft Tissue Mobilization: Targets tight muscles, particularly the piriformis or hamstrings, to relieve nerve irritation.

3. Exercises

Gentle exercises can help alleviate sciatica by reducing pressure on the nerve, improving flexibility, and strengthening the surrounding muscles. Always consult a healthcare professional before starting any new exercise regimen, especially if you’re experiencing pain. Below are some recommended exercises:

1. Child’s Pose (Stretching the Lower Back)

• How to do it:
  • Kneel on the floor, sit back onto your heels, and stretch your arms forward.
  • Keep your forehead on the floor and hold for 20–30 seconds.
• Benefits: Stretches the lower back and hips.

2. Cat-Cow Stretch

• How to do it:
  • Get on your hands and knees.
  • Inhale and arch your back (cow pose).
  • Exhale and round your back (cat pose).
  • Repeat 8–10 times.
• Benefits: Improves spinal mobility and relieves tension in the lower back.

3. Piriformis Stretch

• How to do it:
  • Lie on your back with both knees bent.
  • Cross the affected leg over the opposite thigh and pull the opposite knee toward your chest.
  • Hold for 20–30 seconds.
• Benefits: Stretches the piriformis muscle, which may relieve pressure on the sciatic nerve.

4. Seated Spinal Twist

• How to do it:
  • Sit on the floor with both legs extended.
  • Bend one knee and place the foot outside the opposite thigh.
  • Twist your upper body toward the bent knee and place the opposite elbow on the knee for support.
  • Hold for 20–30 seconds and repeat on the other side.
• Benefits: Relieves pressure in the lower back and improves spinal flexibility.

5. Pelvic Tilts

• How to do it:
  • Lie on your back with your knees bent and feet flat on the floor.
  • Flatten your back against the floor by engaging your core and tilting your pelvis upward.
  • Hold for 5–10 seconds, then release.
  • Repeat 10–15 times.
• Benefits: Strengthens the lower back and core muscles.

6. Knee-to-Chest Stretch

• How to do it:
  • Lie on your back with both knees bent.
  • Pull one knee toward your chest, keeping the other leg bent or straight.
  • Hold for 20–30 seconds, then switch sides.
• Benefits: Stretches the lower back and glutes.

7. Walking or Swimming

• Why:
  • Low-impact cardio can improve circulation, reduce inflammation, and strengthen muscles supporting the spine.

Tips for Exercise:

1. Avoid high-impact activities (e.g., running or jumping) that may aggravate symptoms.
2. Listen to your body: Stop any exercise that causes sharp pain.
3. Consistency matters: Perform these stretches and exercises 1–2 times daily for optimal results.

If your pain persists or worsens, consult a healthcare provider or physical therapist for personalized guidance.