The sciatic nerve is the largest nerve in your body. It runs from your lumbar spine, then down the back of your thigh to your knee, where it divides in two to extend to the feet. The nerve originates as nerve roots from the lower spinal cord and exits through neural foramen (tunnels between the vertebrae) to travel down each leg, supplying sensation to the outer lower leg and foot and motor control to the muscles at the back of the thigh, calf and foot.
When something irritates that nerve, it can trigger a particular type of pain known as sciatica.
If you’ve developed sciatica, you may experience symptoms such as:
- Pain in your lower back or buttocks that spreads down your legs
- Pain that gets worse when you move or makes it hard to move
- Numbness, tightness or weakness in your legs
- A tingling sensation in your legs, toes or feet.
In rare cases, sciatica can result in a change in bowel and bladder control (incontinence or constipation, difficulty urinating). That’s a red flag. If it happens, see a doctor immediately – it’s due to a rare but serious condition called cauda equina syndrome that needs urgent treatment.
Rest assured that most cases of sciatica are not so dramatic and respond well to treatment.
Sciatica is a painful symptom of another condition that’s irritating, inflaming, pinching or compressing your sciatic nerve.
The most common conditions that lead to sciatica are:
- A bulging or herniated disc in your spine
- Degenerative disc disease, where your spinal discs become worn down over time
- Spinal stenosis, a narrowing of your spinal canal and/or neural foramen that compresses your nerve roots
- Osteoarthritis, which can cause bony overgrowths (spurs) that press on your nerve
- Pregnancy, as hormones can loosen ligaments resulting in less support to your spine and pelvis. Your baby’s weight and position may also put pressure on your sciatic nerve.
Sciatica is very common but you’re at greater risk of developing it if you:
- Have a previous injury to your lower back
- Are getting older
- Are carrying extra kilos
- Don’t have strong core muscles to support your lower back
- Aren’t very active
- Have diabetes (which can lead to nerve damage) or osteoarthritis (which can lead to bone spurs)
- Are in an awkward position for much of the time, such as long-distance truck drivers or machine operators.
Treatment for Sciatica
Sciatica treatment starts with a thorough assessment. That involves listening as you describe your symptoms then examining you carefully, including checking your reflexes, power and sensation to see if the nerve is still working well. If it isn’t, we may need to refer you back to your GP or to a medical specialist.
In most cases, though, your nerve is still in good shape, just irritated and causing you pain. So, treatment focuses on relieving pain and addressing any underlying factors that may have contributed to developing sciatica. If your sciatica is caused by an underlying condition like spinal stenosis or osteoarthritis, then we also make sure you’re receiving appropriate treatment for that.
There’s no instant recipe for sciatic pain relief and treatment, though. As you can see, many different conditions may contribute to it. Other factors like your age, genetics, lifestyle and general outlook may also influence your recovery. It takes a skilled physiotherapist to tailor scientific evidence to your particular situation.
Treatment for Sciatica may involve
Education to improve your posture or lifting technique
Exercises to improve your core strength and provide better support to your lower back
Regular low-impact exercise such as walking or swimming to maintain fitness, provided they are not provocative of symptoms
Lifestyle changes to avoid prolonged sitting or standing if that triggers sciatica
Gentle stretches of your lumbar spine, gluteal and quadriceps muscles
You may need to consult a GP or pharmacist regarding prescription or over-the-counter medications for pain management. Corticosteroid injections may be used in some cases
A word of caution on stretching. Sciatica may present as a sense of tightness in your leg and many people respond by performing hamstring muscle stretches to address this “tightness”. The sciatic nerve does not tend to like this! Stretching an irritated nerve can worsen the situation and intensify your pain so we recommend you only do the gentle stretches and other exercises prescribed by your physiotherapist.
How can Milton Village Physiotherapy Help?
At Milton Village Physiotherapy, we understand how debilitating sciatica can be. We want you to be comfortable in your body and able to enjoy both activity and rest without the pain of sciatica.
We’ll assess you carefully then recommend evidence-based treatments to target your sciatica, that are likely to work best for your life stage, lifestyle and goals. We’ll develop a tailored program of exercises to help you move beyond sciatica and liaise with any other professionals involved in your care, for example your GP or specialist.