WHAT IS IT?
Sciatica is the term used to describe the symptoms of leg pain felt along the path of the sciatic nerve. This leg pain can sometimes be accompanied by other nerve related symptoms such as tingling, numbness and weakness. It is important to note that sciatica is NOT a medical diagnosis it is a symptom of an underlying medical condition.
The sciatic nerve is the longest nerve in the body. It starts in the lower back and runs down through the buttock, hamstrings and into the lower leg on both sides. It branches off into other peripheral nerves throughout the leg. The spinal segments that the sciatic nerve originates from is the L4, L5 and S1 levels.
WHAT CAUSES SCIATICA
As mentioned earlier sciatica is not a diagnosis it is rather a symptom of a condition which is causing the nerve to be affected. While the symptomatic sciatica pain can be relieved and treated, it is important to identify the cause of the pain/symptoms. Typically it is indicative of a condition which is affecting the integrity of the lumbar spine.
The most common causes of sciatica symptoms are:
- Lumbar spine disc injuries/herniation: Extrusion of a spinal disc which compresses the sciatic nerve root
- Lumbar spine joint degeneration: Age related wear and tear through joints in the lumbar spine which can compress or irritate the sciatic nerve root
- Acute facet joint injuries: Acute injury or strain to the facet joints which can compress or irritate the sciatic nerve root
- Pregnancy: Irritation or temporary compression to the sciatic nerve from various pregnancy related causes including but not limited to; posture changes, hormone changes and loss of muscle strength.
DIAGNOSIS AND PROGNOSIS
In order to accurately diagnose your pain as Sciatica, your highly trained Physiotherapist will evaluate your symptoms through a subjective assessment based on their description, onset and the behaviour of your symptoms. They will also conduct a thorough physical assessment to assist in determining the cause for your sciatica symptoms.
We will also screen for any serious injuries throughout these assessments. Rarely will you require any further investigations or imaging however it may occasionally be required to determine the severity of nerve compression.
Fortunately the prognosis for sciatica is quite positive. There is some variance between prognoses as there are various different causes for sciatica symptoms, however 90% of sciatica symptoms will resolve within six weeks. Occasionally people will have longer term sciatica pain however this is normally indicative of a chronic condition or a more serious cause for their symptoms.
The assessment and therefore diagnosis completed by our highly trained Physiotherapists will determine the cause of your sciatic symptoms, and this will allow for an appropriate management plan to be formulated. This management plan will be implemented specifically to your injury, and will allow for us to progress you through it correctly to help you recover quickly and safely. Physiotherapy treatments will be very beneficial in assisting you recover from sciatica symptoms quickly and effectively.
Typically the treatment for sciatica symptoms are structured through a graded process to get you back pain free and to your full function. Obviously everyone will have a different process related to their injury, however below is a general guideline for treatment and recovery.
Stage 1 – Pain relief and protection phase
Initially it is important to manage both pain and inflammation that will occur during the acute phases of an injury. In addition to Physiotherapy treatment, you can assist in managing these through analgesics and anti-inflammatories as well as modalities such as heat and ice. Along with these it is important to have a period of relative rest, you will want to continue with gentle movements but avoid any aggravating movements or activities.
Stage 2 – Improving movement and strength
Typically starts within the sub-acute phase of an injury once the initial pain and inflammation has settled. Physiotherapy treatment will be especially beneficial to assist with improving range of movement. Your Physiotherapist will also prescribe you with mobility, stretching and depending on where you are in your recovery, strengthening exercises. When completing these exercises you should be mindful not to further aggravate your symptoms.
Stage 3 – Restoring full function
The next phase is aimed at returning you back to your previous level of function prior to the injury. Everyone will have different activities that they will be wanting to return to, whether that is work or sporting activities etc. This will also help to determine certain goals you will need to achieve through treatment. Your Physiotherapist will help guide you through this aspect of your recovery.
Stage 4 – Maintenance and preventing a recurrence
Sciatic symptoms do have a tendency to return in some capacity, typically this is due to insufficient rehabilitation. The aim of this phase is to correct some of the imbalances and instabilities that may have led to the sciatic nerve being irritated in the first place. It is important to continue with the strengthening exercises that your Physiotherapist will prescribe you with, to reduce the risk of a recurrence.
Sciatica pain is quite prevalent and it can be very debilitating when you are suffering from it. Saying this, the majority of sciatic pain episodes resolve within a period of weeks. In order for a timely recovery, it is important to have your symptoms properly assessed and managed depending on what is determined as the cause for your symptoms. Your Physiotherapist guided management will span from the acute phases of recovery to returning to work and sport while reducing the chance of recurrence.