How Can Physiotherapy Help Treat Sciatica?
What Is Sciatica?
Sciatica refers to a painful and sometimes debilitating set of symptoms generally experienced through the lower back, buttocks and into the leg. It is caused by irritation or compression of the sciatic nerve. The sciatic nerve has its roots in the lower back and is the largest single nerve in the body. At its maximum width it is approximately 2cm in diameter and its function is to directly and indirectly, innervate large areas of the lower body.
The nervous system is a highly complex network that transmits signals to and from the brain to different parts of the body. It is divided into two parts; the central nervous system (CNS), which includes the brain and the spinal cord, and the peripheral nervous system (PNS); this is comprised mainly of nerves enclosed in long fibres that connect the CNS to the rest of the body. The electrical signals sent to and from the CNS to the PNS allow us to coordinate our movements, communicate sensory information and to regulate and control our bodies in terms of thoughts, movements, and automatic responses.
Why Is Sciatica Painful and What Are Its Symptoms?
The sciatic nerve is a significant nerve within the nervous system. Its roots are formed from the L4 to S3 region of the spine, where a collection of nerve fibres extend out of the spinal cord. It essentially connects the spinal cord with large areas of the lower leg and buttocks, including the skin and muscles of the thigh, leg and foot. If the sciatic nerve is damaged, compressed, or irritated, it can produce a variety of painful symptoms. These range from feelings of numbness, pins and needles or tingling, to sharp shooting or burning pains, typically felt through the buttocks and radiating into the leg. Leg pain is unilateral in most cases, as sciatica rarely presents in both legs. Sharp, aching pains and numbness are frequently cited in the involved leg and for some people the pain worsens when standing and walking. There may be some local pain in the lower back at the site of the irritation, however, in most cases the pain radiates downwards.
Symptoms of sciatica can be highly distressing, severely affecting the individual’s daily routine and quality of life. Simple activities such as a short walk, getting in and out of a car or taking public transport can be extremely painful and unpleasant.
Sciatica is typically diagnosed based on the individual’s description of symptoms and a physical examination – there is no single diagnostic test. During the physical examination, a health professional may use a series of diagnostic tests such as the nerve stretch test, motor weakness test, tendon reflex and sensory loss tests, to help reach a firm diagnosis.
Causes of Sciatica
Sciatica usually manifests when surrounding soft tissue structures or bone encroaches on the sciatic nerve as it exists the spinal cord, causing irritation or compression to the nerve root.
Lumbar Disc Degeneration
Disc herniation due to degenerative changes (wear and tear) is one of the most frequently cited cause of sciatica. Our intervertebral discs serve to absorb shocks during everyday movement and to prevent the vertebrae from coming into contact and grinding against one another. These discs are made of a tough fibrous outer material which protects the softer jelly-like substance of the nucleus. Wear and tear and degeneration due to the natural ageing process can cause our discs to dry out and lose height, making them more prone to cracks and tears, this is known as disc herniation. When a crack or tear occurs, the jelly like material of the inner part of the disc can seep out and compress nearby nerve structures, causing painful symptoms.
This describes a condition where one of the spinal vertebrae slips forward, and it can occur at any point along the spine but is more common in the lower back and depending on the exact location, can cause sciatica.
During pregnancy, hormonal changes cause the ligaments to soften and stretch in preparation for birth. This can cause general back pain, and in some cases, can result in compression or irritation of the sciatic nerve.
If the symptoms of sciatica are accompanied by fever, unexplained weight loss, saddle anaesthesia, bladder or bowel dysfunction, numbness around the genitals, sexual organ dysfunction, visible swelling and extreme pain; they should be investigated immediately as this may be an indication of a more serious underlying pathology such as cancer, infection, vertebral fracture or cauda equina syndrome.
Often sciatica will get better by itself within 4 to 6 weeks following a conservative treatment plan of exercise, physiotherapy and pain management. Most people with sciatica do not require surgery, as in many cases the cause of sciatica is disc herniation and disc material typically repairs itself over time.
During the recovery period it is important to try to remain physically active and to continue with everyday routines as much as possible. Conservative treatment methods essentially aim to relieve pain and maintain movement and function whilst the irritation or compression to the sciatic nerve, subsides and improves.
In some cases, sciatica can last longer and become chronic, and the cause of this will require further investigation and immediate medical intervention if any red flags are present.
Physiotherapy plays a fundamental role in the treatment of sciatica. Targeted exercises help to strengthen, stretch, and mobilise soft tissue structures in the lower back and abdomen, the pelvis through to the buttocks, thighs and into lower legs. This will help to alleviate painful symptoms, reduce muscle spasm, restore movement and mobility, and improve posture, core strength and stability, which is important during and after rehabilitation. Improved strength and mobility also help to create a better environment within the lower back that encourages any damaged soft tissue structures to heal, reducing further irritation or compression on the sciatic nerve.
Our highly experienced physiotherapists treat a wide range of painful conditions including sciatica. We work with individuals to produce a bespoke treatment plan that aims to alleviate pain, improve strength, mobility and posture in order for patients to return to normal activity and to help prevent any future reoccurring episodes.
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