Nerve pain is agony, intense, sharp, stabbing crying type of pain. Sciatica is a disturbance in normal sensation or a disruption in movement of the affected area. Some nerve pain spreads out from one compression point along the entire nerve. The larger the area or the lower the pain travels down your legs to your feet, the worse it is. Damage to these branches of nerves can be mild or very severe. The earlier you get a diagnosis and treatment for nerve compression, the more quickly you’ll find relief. Nerves heal slow, so any form of damage, friction or compression must be eased as fast as possible to avoid long term pain. Sciatica may even cause long-term problems if left untreated.

Sciatica is one of the most common forms of nerve compression. Pain radiating from the lower back running down the buttock, into the hamstring, or around the front of the thigh, down the knee and into the calf and foot.

The Piriformis muscle functions to help the hip to rotate out words and abduct the thigh ( move it away from the body). Pirriformis syndrome occurs when the muscle compresses or irritates the sciatic nerve, causing pain in the buttocks along the back of the thigh, this presentation is known as sciatica. The Piriformis muscle is located deep within the buttock tissue, and connects the front of the sacrum (the fused bones at the base of the spine) with the top of the femur (thigh bone). It runs in close proximity to the sciatic nerve.

Nerves are the structures that carry information and sends messages throughout our body. These are like long cables that extend from your brain to all over your body. The bigger branches like the Sciatic nerve is at high risk of getting irritated or pinched by muscles, ligaments, bone or tendons causing swelling around the nerve.

Irritation

May be the result of repetitive movements. This may happen when you do a excessive repetitions at the gym, or doing the same movement over and over again. As the nerve slides over muscles, tendons and bone, it will become irritated and inflamed. The nerve’s outer protective barrier gets damaged and cause swelling, which causes extra pressure. Scarring may form around the nerve, which in turn disrupts its normal glide over the surrounding structures.

Entrapment

May be due to the surrounding structures that prevents the nerve from moving (sliding and gliding) as you move. This may happen when you were in a cast or after surgery. The pinched nerve is a secondary complication due to the immobility of the joints. The nerve gets trapped between the structures and its normal movement is compromised. This is also the end result of a untreated nerve compression and irritation

Compression

May be due to direct pressure on the nerve. This may happen from holding your body in one position for long periods, such as keeping elbows bent while sleeping you may wake up with some nerve compression symptoms. Doing this for a few weeks can cause the nerve to become pinched.

A pinched nerve occurs when there is compression (pressure) or irritation (friction) on one or more nerve branch. As these nerves run out from your brain they exit the spinal cord and bundle together as they run along certain pathways to your legs. Nerves are most vulnerable at places where they travel through narrow spaces and have very little soft tissue to protect them. Structures that can pinch a nerve are any place along the nerve pathway there it weaves between tissues like muscle, tendon, bone and ligaments.

We follow a structured plan to diagnose, classify the severity, and determine the hierarchy of priority that your nerve pain needs. We stress, screen and scan all the possibilities that could be causing your pain. Identify any other injuries to surrounding structures. If there is an injury to the ligaments, meniscus, muscles or nerve, or cartilage we will find it.

We understand the physiological healing stages you’ll go through, and custom-fit your treatment program. By knowing the extent of the tissue damage we can guide you through a structured program to recover faster and safely return to the things you love doing. That’s why our physiotherapists are the best at diagnosing this type of problem.

Why is it crucial to get/understand a diagnosis? Does it mean anything? Or is it a death sentence? or will you treat it differently if you know what you’re dealing with

Muscles and nerves cannot be seen on an x-ray, so this is not useful when diagnosing sciatica. X-rays will however show the integrity and alignment of joints in your spine. This allows us to see if something is wrong with the structure of the bones in your spine or if there is a loss of disc space.

Your physiotherapist can refer you to get x-rays taken if necessary.

Diagnostic ultrasound can be used to show the presence of a muscle tear (muscle strains), inflammation, swelling or simply increased contraction of a muscle (muscle spasms).

If you need an ultrasound, your physio will refer you.

An MRI scan can image all of the structures in your lower back, including soft tissue, discs, nerves and bones. If your physiotherapist suspects anything more than just a muscle spasm, you will be referred to the right specialist.

Is an MRI necessary for this diagnosis – if not when could it become a necessity?

Damage to these branches of nerves can be mild or very severe. The earlier you get a diagnosis and treatment for nerve compression, the more quickly you’ll find relief. Nerves heal slow, so any form of damage, friction or compression must be eased as fast as possible to avoid long term pain. Sciatica may even cause long-term problems if left untreated.

If treatment is delayed or you wait too long, we might not be able to reverse the damage from a pinched nerve.

Nerve pain is the most sensitive pain that we as humans can encounter. For some reason we see that patients that experience nerve pain leave it for quite a long period of time. Nerve pain can last from weeks to months before it relieves, if any. We encourage you to rather have it looked at if you suspect a nerve is being pinched to avoid permanent damage.

The longer you wait before seeing a medical professional, the more damage you might cause to the nerve. Prevent slow healing and long rehab. Our treatment usually relieves pain and other problems that might occur. Prolonged irritation of your sciatic nerve may cause the tendons to become scarred and lead to chronic symptoms such as constant pain, limited hip range of movement ( unable to give a big stride) numbness at the back of your thigh, knee or calf radiating into the foot, difficulty walking up a small step.

Physiotherapists are the first person to consult. We will be able to get the correct diagnosis as to the cause of the pinched nerve and advise you to consult with a GP to prescribe adequate pain medication. We will write a report to you your GP detailing the severity of your case.

Professional healthcare treatment for sciatica should be conservative in nature firstly.
Other treatment approaches include: Rest and activity modification (identify the movement or position casing the nerve irritation), rehabilitative exercises, desk ergonomic advise, referral to a GP/specialist for pain killer medication, referral for x-ray or MRI scans.

Initially Physiotherapy treatment focuses on decreasing the nerve compression and irritation by using Ultrasound and Laser. We use Strapping and Taping to limit the range of movement of the affected leg or arm, to avoid any further injury.

Acupuncture or Dry Needling around the soft tissue of the nerve, promotes the inflammatory reaction and repair of injured tissue.Electrotherapy can be used to desensitize the nerve. Massage, Soft tissue mobilization along the nerve pathway and the interfaces where the nerve crosses between or certain compression points. Nerve tissue mobilization are vital in regaining the normal glide action of the nerve. Dynamic, static and ballistic stretches together with eccentric loading exercises to condition the muscle fibers. Myofascial release over the injury site to guide the scar tissue formation has proven very effective in chronic nerve pain syndromes.
Physiotherapy treatment focuses on pain management and accelerating the healing process by using Ultrasound and Laser.

Strapping and Taping to support and protect from further injury and compression on the sciatic nerve branch.
Acupuncture or Dry Needling of the lower back muscles and the lumbar extensors.
Electrotherapy can be very effective at relieving the pain in the initial phase, but requires manual mobilization of the nerve root for long term relief. Do not be fooled (Many other physio ONLY resort to this type of treatment, there is so much more…)
Massage and Soft tissue mobilization
Myofascial release techniques along the nerve pathway are especially effective.
Dynamic stretches together with eccentric loading exercises to condition the muscle fibers surrounding the nerve tissue.
Compression braces like lumbar braces can help take the load off the vertebrae, but is not a long term solution.

Recovery Time

You can return to sports when normal pain-free movement of your legs, muscle strength and power have returned. If you have followed your prescribed physiotherapy program you will be fully fit within 4-8 weeks. If your symptoms are severe and persistent, even after non-surgical treatment you may require surgery. If so, your recovery time is likely to be at least 3 months.

• GP– Over the counter medications usually don’t give much relief from nerve pain. A doctor will prescribe something that will help with symptom relief while your physiotherapist treats the root cause of the problem.
• Biokineticist – Training with a biokineticist is useful in the late phase of treatment, when your pain is under control and doesn’t interfere with your day to day activities.
• Chiropractic – About 90% of Sciatica cases are caused by a lower back disc injury. Strong techniques or adjustments to an already injured disc often causes more damage.
• Sports massage – While massage is a useful tool for temporary pain relief, it won’t solve your problem.
• Ice and heat – These are useful modalities to use at home for pain management, under the guidance of your physiotherapist.
• Stretching – Even though your muscles feel tight, stretching will only make your sciatica worse in the early stages of healing.
• Acupuncture – This is another technique for temporary relief, but if you don’t treat the actual cause of your sciatica, the results of acupuncture on its own will leave you disappointed.

Surgery for a pinched nerve is rare. Back surgery is only considered for a pinched nerve if the compression cannot be relieved by conservative treatment or if there is progressive neurological disturbance that threatens permanent loss of function.

• Lower back disc injury
• Radiating pain from your lower back
• Pinched nerve in your lower back
• Piriformis syndrome
• Hip muscle pain

• Sciatic nerve pain
• Pinched nerve
• Sciatic nerve compression
• Lumbar radiculopathy