Sciatic Pain, or Sciatica, is a condition in which irritation of nerves in the back and the buttock leads to pain in the lower back, buttock, and the leg. Sciatica is a common condition, and 2 in 5 people will experience sciatica-like symptoms over the course of their lives, most often between the ages of 25-45.

Sciatica is caused by irritation of the Sciatic Nerve and the Nerve Roots that make up the Sciatic Nerve. The Sciatic Nerve is a collection of sensing and controlling nerves that travel from the spine, through the pelvis and buttock, and into the leg. The Sciatic Nerve supplies sensation to the skin over the back and side of the leg and thigh as well as the foot, and powers large muscles such as the hamstrings, gluteal (buttock) muscles, and muscles in the lower limb as well.

Causes

The Sciatic Nerve is most commonly irritated by mechanical factors in the lower back and in the pelvis. In the lower back, muscle spasm, nerve root irritation, disc or joint inflammation or collapse of a spinal disc can lead to irritation of the nerve. This causes pain in the areas of skin and muscle controlled by that nerve. Because the pain is felt in a separate location from where the irritation is taking place, it is called Referred Pain. In the Pelvis and the hip, tightness of hip muscles can compress the Sciatic Nerve itself. Compression of the Sciatic Nerve causes pain and discomfort in the area of skin served by the Sciatic Nerve, which typically includes the back of the leg and the whole of the foot. Similarly, because the pain is felt in a separate location from where the irritation is taking place, this is Referred Pain as well. 

Mechanical factors which cause Sciatica arise as a consequence of short-term damage, long-term muscular or structural strain, or as the result of age. Short-term damage can be caused by sudden impacts, abrupt bending or twisting while carrying a load, as well as from lifting objects using an inappropriate posture, or which are inappropriately heavy. Long-term strain comes about as the result of sustaining a posture over a period of time, typically months or years. Desk work, driving, and reclined postures can all cause long-term muscular strain. Age-related changes include arthritic inflammation of the spine and its joints, wear-down and degeneration of the spine, and bone wasting diseases which can all cause or worsen Sciatica symptoms. 

Symptoms

Sciatic pain can vary from a dull soreness, numbness, or tingling to feelings of an electric shock, throbbing heat, or stabbing pain. The severity can range from an annoying ache to pain so intense it makes it tough to walk or stand. In severe cases of Sciatica, muscles may become weak, and mobility may be negatively impacted as a consequence of changed muscle function over time. 

Because of the referred nature of Sciatic pain, the location in which the pain is felt may change. It may be felt closer to or further away from the spine. You may feel discomfort closer to the skin, or deep within the muscle. The behaviour of sciatic pain can be used to establish its nature and the factors which are most likely contributing to it. 

Prevention and Treatment

Sciatica is best prevented by maintaining flexibility in the lower back and hips by doing regular stretches, especially for people who have sitting desk jobs. For people who need to lift and move heavy objects, strength and resistance training to build postural control and balance is an effective means of preventing Sciatic pain. These exercises are also useful for people who work in sitting jobs as well.

Management and assessment of Sciatica depends on the cause of the pain, how it feels and changes over the day, what makes it better or worse, and the length of time the pain has persisted. Simple strategies include gentle stretching of tight muscles and sore joints with a view to relieving the pain, as well as using hot or cold packs for a little temporary relief. Effective pain medication includes anti-inflammatory medication if appropriate, or prescription medication if recommended by a physician. 

A physiotherapist can assess the nature of a person's sciatic pain, determine the most likely factors leading to and aggravating that pain, as well as minimise that pain and promote a healthy recovery. Once the pain has been minimised, the physiotherapist will prescribe and monitor a program of individual exercises to best address any functional or muscular weaknesses that may cause a flare-up in the future. Once the pain and the weakness has been managed, the physiotherapist will continue to monitor the patient and amend their exercise program accordingly to ensure continued benefits from their exercises and management. 

At Atlas Physio, we will provide you with education, structured management, and ongoing monitoring of your pain both in and out of the clinic. Contact us to arrange an assessment, and to take the first step on a course of corrective care today.