Sciatica is an intense, nagging pain that steals your sleep and makes everyday tasks like climbing stairs or driving an agonizing effort. The term is often used for any nerve pain in your lower back or leg, and it is one of the most common forms of nerve pain that we see and treat. Unfortunately, it is also well known for becoming a chronic, long-standing problem. The sooner you get the right diagnosis and treatment the better.

The Anatomy of your Sciatic nerve

The Sciatic nerve starts as nerve branches from your lower back. These branches start out separately from between the vertebrae and then come together to form the Sciatic nerve at the back of our hip.

What does it do?

Nerves are like the wiring system in your body, carrying messages from your brain, down through your spinal cord and then along a whole network of nerves branching out all the way to your fingertips. This is how your brain controls everything from your heart rate to the muscles you use when you take a step. Other nerves carry messages back to your brain, with information like temperature, pressure and the position of your body parts. The bad news is, if anything happens to a nerve before it gets to its destination, like a pinched nerve, the message is interrupted which causes pain and dysfunction.

The Sciatic nerve is a mixed nerve, which means it has branches to muscles, skin and a joint. It innervates your hip joint, hamstring muscles and a part of adductor magnus which runs along your inner thigh. Lower branches of the Sciatic nerve also supply the skin over your foot, heel and the outer part of your lower leg.

I have a sciatic nerve pain… How did it happen?

A pinched nerve occurs when there is compression (pressure) or irritation (friction) of one or more nerve branch. Nerves are most vulnerable at places where they travel through narrow spaces or where there isn’t a lot of soft tissue to protect them. Structures that can pinch a nerve are anywhere along the nerves path where there it weaves through and between tissues like muscle, tendon, bone and ligaments.

Nerve irritation happens due to repetitive movement, in other words 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 causes swelling, which causes extra pressure. Scarring may form around the nerve, which in turn disrupts its normal glide over the surrounding structures.

Sciatic nerve compression or entrapment happens when the surrounding structures prevent the normal gliding movement of the nerve. An entrapment happens after you were in a cast, after surgery or even from scar tissue after a hamstring muscle tear. Another common cause of Sciatic nerve entrapment is piriformis syndrome, where the piriformis muscle in your hip pinches the Sciatic nerve. If any of these problems are left untreated for too long, it leads to nerve compression and long term damage.

Causes of Sciatica

Symptoms of Sciatica

Tests to see if your pain is caused by your Sciatic nerve

 

  • Sit upright on a chair.
  • Lean forward towards your toes.
  • If this movement causes pain or pins ‘n needles you may have sciatica.
  • Stand with your feet slightly apart.
  • Reach down to touch your toes, without bending your knees.
  • If you feel pain, tension or pins ‘n needles in the back of your leg with this movement, you may have sciatica.
  • Lie on your back with both legs flat on the bed.
  • Loop a towel or belt under your foot on the painful side.
  • Lift the painful leg while keeping your knee straight.
  • The test is positive if you can’t raise your leg to 90 degrees without feeling pain or pins ‘n needles.

How severe is my Sciatica?

Diagnosis

Physiotherapy diagnosis

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

X-rays

X-rays give us an indication of the integrity and alignment of joints in your spine, but nerves and muscles cannot be seen on these images. Therefore, X-rays are not very useful when diagnosing sciatica.

If your physiotherapist suspects a spinal problem that may be related to your symptoms, we can refer you for X-rays.

Diagnostic ultrasound

Diagnostic ultrasound can give us an indication of scar tissue or swelling around the nerve, but only in areas where the nerve is superficial i.e. close to the skin. This is not a very useful test when diagnosing sciatica, but your physiotherapist can refer your for ultrasound imaging if necessary.

MRI

Although an MRI cannot diagnose sciatica, it can be used to confirm or exclude the underlying cause of your sciatica. The majority of sciatica cases are due to lower back disc injuries, but simply confirming a disc injury  won’t change the treatment plan.

Why is the pain not going away?

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.

What NOT to do

  • Keep taking medication that only gives you temporary relief.

  • Stretch through the pain, hoping it will help.

  • Exercise through the pain.

  • Ignore pain that spreads and keeps getting worse.

  • Leave it untreated, rather call us and get to the cause of the problem.

What you SHOULD do

  • Rest as needed.

  • Carry on with normal activities, as much as pain allows.

  • Make a mental note of daily movements that aggravate your pain.

  • Avoid activities that make your pain worse.

  • Make an appointment to confirm the diagnosis and start solving the problem.

  • Finish your treatment and rehabilitation program.

Making it worse

  • Stretching

  • Bending down to tie shoelaces

  • Picking up heavy boxes

  • Gardening

  • Sitting for long periods of time

  • Running

  • Deadlifts

  • Jumping

  • Driving

Problems we see when patients come to us with …

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.

Physiotherapy treatment

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.

Phases of rehabilitation

Early stage

Your physiotherapist may suggest various treatments such as electrotherapy to reduce the local inflammation.
They will perform a full assessment of your spine, pelvis and hips. We will use soft tissue release therapy and manual therapy to help alleviate your symptoms. We will assess the length of your quadriceps, hamstrings, gluteal, hip flexors and latissimus dorsi muscle to correct any asymmetry.

 

Intermediate stage

You should now be able to walk and sit with little or no pain.
In may begin with low level or exercises such as bridges.
Lower limb bodyweight exercises such as hip hitches and box step ups.
Non-impact conditioning exercises such as cycling(indoor), slow walking and working on a cross trainer.

 

Healing time

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.

Other treatment options

  • 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.

Is surgery an option?

Non-surgical management is always the first choice for Sciatica. 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.

What else could it be?

Also known as

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