Sciatica

What is Sciatica?

Sciatica is pain that radiates down the sciatic nerve. The sciatic nerves run from the lower spine down the back of the legs. Usually, people experience the pain radiating down one leg, but it is possible to have pain radiating down both legs. The sciatic nerve has five nerve roots branching out from the lower spine and sacrum. If anyone of these roots is irritated, it can cause sciatic pain symptoms.

The main symptoms are:

• Nerve pain radiating down one leg
• The sensation may consist of burning, tingling, weakness, numbness and/or shooting pain
• The pain may be worse when seated
• You may have trouble standing from a seated position

Why Does Sciatica Happen?

Sciatica is not a condition itself but a symptom of a condition. Most sciatica is caused by disk herniation and this is sometimes referred to as ‘True Sciatica’ however it can also be caused by Piriformis Syndrome (a condition in which the piriformis muscle of the hip is irritating the sciatic nerve)

Other potential causes are:

• General Spinal Degeneration
• Sacroiliac Joint Dysfunction
• Spinal Stenosis
• Spondylolisthesis

Trigger Point Pain Sometimes Mistaken for Sciatica

Another issue that people often mistake for sciatica is trigger points in the gluteus minimus muscle. Trigger points in the posterior portion of the gluteus minimus can refer down the back of the leg to the calf in a very similar path to sciatica. Trigger points in the anterior portion of the gluteus minimus usually refer down the side of the leg and can reach all the way down to your ankle or foot.

How is Sciatica Caused?

Discs are found between each spinal vertebra. When a disc tears, some of the inner part of the disc which is softer can push out and start putting pressure on the spinal nerves. This causes pain to radiate down the nerve pathway.

When is Sciatica Dangerous?

If your nerve pain continues or even intensifies over time and it does not seem to go away, then there may be something serious that needs attention. It’s very important to get an early diagnosis from a GP or physiotherapist so that you can start to treat the causes rather than just trying to deal with the symptoms with drugs or avoiding certain activities. In some cases, surgery can be needed to remove what is irritating your nervous system. Also, if you experience bowel or bladder incontinence then in addition to your normal sciatica symptoms you may have cauda equina syndrome and should seek medical advice as soon as possible.

Will Sciatica Get Better?

In many cases, sciatica will resolve itself naturally however if a severe disc herniation is present it may require other treatment options such as medication, physiotherapy, epidural injections and surgery.

Can Sciatica Be Cured?

Well yes. Sometimes sciatica will go away and will not come back however if the underlying cause is not treated then it is likely to reoccur. Your best bet is not to assume that it is going to just get better and go away but rather to find out if there are any deeper underlying issues that are causing the problem. You don’t want the pain to go away only to rear its ugly head again later in life. Make sure you take a proactive approach to your health maintenance.

Which Doctor to See?

The best bet is to start with your GP. They will examine you and may recommend you to a Physiotherapist to develop a treatment plan. Remedial Massage could make up part of your treatment plan in order to loosen any tight muscles that are contributing to the problem. If you have tried many approaches to reduce your pain but it remains you may like to use remedial massage as part of a management plan. Unfortunately, some people experience chronic pain which may fluctuate but does not really seem to go away. Such people often need to create a series of lifestyle changes that give them the best change of experiencing the least pain possible. Management is the last resort - you need to do your best to try to treat the cause of the pain first.

Can Remedial Massage Help Me with Sciatic Pain?

If your sciatica symptoms are arising due to piriformis syndrome then remedial massage can definitely help to loosen that muscle. If your problem is caused by a trigger point in the gluteus minimum, then remedial massage can be very helpful in addressing that issue also. Disc herniation is a structural issue, so it is important to see someone who is qualified to deal with those issues such as a Physiotherapist, Chiropractor or Osteopath.

Rehabilitation for Sciatica

Your course of rehabilitation will depend on what was the cause of your sciatic pain. A course of action may look something like this:

1. Diagnosis A physiotherapist or GP can formally diagnose your condition
2. Pain Relief Short term pain relief may be provided by over the counter pain killers
3. Manual Therapy If soft tissues are involved in the issue then some form of manual therapy such as remedial massage may help
4. Exercises Certain muscles may be weak and in need of strengthening. If your muscle weakness is severe you may need to start out doing some hydrotherapy (exercise in water) to ease the impact on your joints
5. Stretches Certain muscles may be tight and need stretching (see below)
6. Prevention Once your sciatic pain has cleared up, you may need to do certain self-care in order to prevent a reoccurrence. This would involve ensuring a healthy range of motion in the joints, a minimum strength in your core muscles and ways of managing your lifestyle. If you sit a lot for work, for example, you may need to assess the ergonomics of your work area and include more frequent breaks in your daily routine

What Stretches Should I Do?

The main two types of stretching that will help with your sciatic pain will be external hip rotation and hip flexion. Do the stretches on both sides but concentrate more time on the side with the pain.

For external hip rotation, the main stretch you will find recommende d is called pigeon pose. Be very careful to move slowly into this stretch. If you experience any knee pain then stop immediately and consult a professional on a safe way for you to do the stretch.

For hip flexion, you will want to do some variation on a forward bend which suits your level of flexibility. Here is an example which can be done safely and easily by many people but, once again, if you experience pain ask a professional.

General Notes for Stretching

For a stretch to be effective, you must find an appropriate level of stretch where it is on the edge between comfortable and uncomfortable. Once you find this level, count five breaths. This should take at least 30 seconds so make sure your breaths are deep and slow. That is the minimum time you must stretch. Some myofascial stretches can take up to two minutes to be effective. So, remember to hold your stretch for 30 to 120 seconds. You may find the tightness eases off in which case you should slowly, carefully and consciously move deeper into the stretch.