Sciatica is a well-known term used to describe a type of back pain. It is a common ailment, affecting approximately 40% of New Zealanders at some point in their lives.
‘Sciatica’ is not actually a condition; Sciatica is a term used to describe a set of symptoms. There are many things that might cause ‘sciatica’, think of it as more of an umbrella term, rather than a medical disorder.
Here’s a closer look at what causes sciatica, its symptoms, and the most effective treatments available.
Symptoms of Sciatica
The hallmark symptom of sciatica is pain that originates in the lower back or buttock and radiates down the back of the leg. This pain can vary widely, from a mild ache to a sharp, burning sensation or excruciating discomfort. Sometimes it might feel like a jolt or electric shock. Sciatic pain can be both chronic or acute, it often starts gradually and intensifies over time.
Additional symptoms might include numbness, tingling, or muscle weakness in the affected leg or foot. For some, the pain may worsen when sitting, trying to stand up, bending the spine, twisting, or when coughing or sneezing.
What causes Sciatica?
There are many things that could cause sciatic nerve irritation or impingement:
- Herniated Disc: The most common cause of sciatica is a herniated disc. Each vertebra in the spine is cushioned by soft discs. When a disc is damaged, either through trauma or repetitive strain, it can bulge or break open. This creates pressure and inflammation around the sciatic nerve.
- Degenerative Disc Disease: As aging occurs, the spinal discs can deteriorate and shrink in height. This deterioration can lead to the formation of arthritic bone spurs and the narrowing of the spaces in the spine where the nerves travel, this can impinge on the sciatic nerve.
- Spinal Stenosis: This condition involves a narrowing of the central spinal canal, which puts pressure on the nerves located within the spine, including the sciatic nerve. It is more common in adults over age 60.
- Spondylolisthesis: This condition occurs when one vertebra slips forward over an adjacent one, narrowing the opening through which the sciatic nerve passes.
- Piriformis Syndrome: This condition occurs when the piriformis muscle, a muscle in the gluteal region, becomes tight and compresses the sciatic nerve. In some people the sciatic nerve runs directly through the piriformis muscle, predisposing them to sciatica and piriformis syndrome.
- Trauma: Accidents or injuries directly impacting the lower spine may result in inflammation and compression of the local nerves.
- Tumours: Tumours growing within the spine have the potential to impinge on nerve roots directly or indirectly by causing shifts in the bone structure. Tumours can also develop within connective tissue and nerve tissue affecting the function of the surrounding structures.
- Infection: Rarely, infections in the lower spine or pelvic region can inflame or damage the local tissues and nerves.
- Cauda Equina Syndrome: Cauda equina syndrome is a rare but serious medical condition in which the nerve roots in the lower end of the spinal cord become compressed and paralyzed, affecting motor and sensory function to the lower extremities and bladder, often requiring immediate surgical intervention. This is a medical emergency.
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Diagnosing Sciatica
The diagnosis of sciatica usually involves a physical examination with your doctor or physical therapist and a review of your medical history. During the exam, your therapist will check your muscle tone, spinal mobility, and will include neurological testing to help determine the root cause of your sciatic pain.
If your symptoms are severe or do not improve with initial treatment, imaging tests such as X-rays, MRI scans, or CT scans might be recommended to determine what is pressing on the sciatic nerve.
Can my Osteopath refer me for an MRI?
Your Osteopath can refer you directly for both X-ray and ultrasound imaging. In the case of an MRI your osteopath will refer you to an orthopaedic specialist who will review your case and arrange further imaging.
When should I go to hospital with Sciatica?
In most circumstances Sciatica can be well managed with physical therapy and pain medication, however, in severe cases there are a few warning signs to look out for. If you experience any of the following symptoms, please seek urgent medical advice.
- Changes in bladder or bowel function, increased urgency, or incontinence.
- Numbness, tingling and/or altered sensation in both legs, especially around the inner thighs, genitals, or anus.
- Progressive weakness and loss of movement in the legs or feet.
- Traumatic onset. If your symptoms occur following a physical trauma such as a car accident it is important to get yourself checked out immediately.
If in any doubt, in New Zealand you can call Healthline or visit your local walk in or emergency centre. Healthline are available any day or time for free on 0800 611 116.
You can choose to speak with a Māori clinician if you are calling between 8am and 8pm. Interpreter services are available, as well as NZ Relay support.
What are the best treatment options for sciatic pain?
Naturally, the treatment for sciatica will vary depending on the root cause. The primary aim will be to relieve pain and address the underlying condition that is putting pressure on the nerve. Here are some effective treatments options:
Physical Therapy such as Osteopathy, Physiotherapy and Chiropractic: Physical therapy is often a key part of the diagnostic and rehabilitation process. Exercises can help correct your posture, strengthen the muscles supporting your back, and improve your flexibility.
Medications: Over-the-counter pain relievers such as ibuprofen or paracetamol can be used to reduce pain and inflammation in mild cases. In more severe or persistent cases, your doctor may prescribe something stronger or more targeted to your condition.
Steroid Injections: In some cases, your doctor might recommend an injection of a corticosteroid medication into the area around the nerve root. Corticosteroid injections can help reduce pain by suppressing inflammation around the irritated nerve.
Surgery: In severe cases spinal surgery may be the most appropriate treatment option. This is usually reserved for cases in which the compressed nerve causes significant weakness, loss of bowel or bladder control, or if the pain consistently worsens despite trying other methods of treatment first. Surgical options could involve removing the bone spur or herniated disc that is pressing on the sciatic nerve.
Self-care: Managing sciatica isn’t just about medical treatments. Lifestyle changes will play a crucial role in both alleviating symptoms and preventing future episodes. Regular exercise, maintaining a healthy weight, practicing good posture, and avoiding prolonged sitting can all help reduce the strain on your lower back and your sciatic nerve.
Would a back brace help with sciatica?
A back brace may offer temporary relief from sciatica by providing support and stabilization, improving posture, and reducing spinal pressure. However, its effectiveness really depends on the underlying cause and severity of symptoms.
It’s not something we would recommend in the long term as prolonged use could lead to dependency and muscle weakness.
It’s best to consult with a healthcare professional to see whether this is appropriate for your back pain and to ensure proper fit.
Does ACC cover sciatica?
ACC provides cover for any pain or injury occurring through an accident and is available to everyone, including visitors to New Zealand. ACC will also cover injuries that come on gradually due to certain work tasks, such as repetitive heavy lifting.
This support applies to physical therapy, medical imaging, specialist referrals and any further interventions needed such as steroid injections and even surgery. You can also apply for ACC support for time spent off work if you’re injury is preventing you from being able to carry out your work duties.
For more information on ACC support visit their website: https://www.acc.co.nz/im-injured
Can Osteopaths lodge ACC claims?
Yes, Osteopaths can lodge ACC claims. You will usually go through this in clinic during your first appointment.
Can Osteopathy help with Sciatica?
Osteopathy is often used to successfully treat sciatica. Being holistic in nature your Osteopath will help you identify the root cause of your issue, whilst providing significant relief from the pain and discomfort associated with this condition. Here’s how osteopathy can help with sciatica:
- Correct Diagnosis
Getting an accurate and detailed diagnosis is the first and most important step of any injury. Without a proper diagnosis it is impossible to put together an efficient and safe treatment plan. Osteopaths undergo extensive training in the diagnostic side of musculoskeletal medicine and are well qualified to diagnose conditions such as disc injuries and sciatica.
Your osteopath will work with you to identify the root cause of your sciatica and help you map out a tailored treatment program that works with your needs and your lifestyle.
In severe or complex cases your osteopath is able to make a referral to your doctors and/or a specialist for further support and investigation.
- Improving Mobility
Osteopaths use techniques such as targeted stretching, massage, and joint articulation to restore the mobility of the spine and surrounding structures. Joint articulation and traction techniques help alleviate the direct pressure on the sciatic nerve, potentially caused by discs injury or arthritis. By improving spinal alignment and functionality, osteopathy can reduce nerve irritation and inflammation. With Sciatica in mind there are often compensatory patterns and additional imbalances in the pelvis and through the lower extremities. Osteopaths are trained to view the body as a whole and identify these wider patterns of dysfunction, this is vital to prevent re-injury and to keep symptoms at bay.
- Reducing Muscle Tension
Techniques like soft tissue massage, stretching and myofascial release are often used relieve the tension in the back, buttocks, and legs, that can contribute to sciatic pain. Reducing muscle tension helps to decrease any compression or tethering around the sciatic nerve, particularly in cases of piriformis syndrome, where the piriformis muscle compresses the nerve.
- Enhancing Circulation
Osteopathy can improve blood circulation in the affected areas, which helps reduce inflammation and promotes healing. Better circulation facilitates the delivery of healing cells, such as white and red blood cells, to the area and also the removal of cellular waste products that contribute to nerve irritation, pain and inflammation.
- Pain Relief
Through use of all the above techniques and by looking at your injury holistically osteopaths will be able to effectively diagnose and treat your sciatic pain. The primary treatment aim to get you better as quickly and as safely as possible.
- Education and Preventive Advice
As well as the hands-on treatment Osteopaths provide important lifestyle advice on things like posture, ergonomic adjustments, and exercise that will boost your recovery time and serve to prevent the recurrence of sciatica. They can guide you on what to and what not to do.
Osteo top tip: Don’t put your wallet in your back pocket. When sitting this creates an imbalance through the pelvis and lower lumbar region, which could leave you vulnerable to an injury such as sciatica.
Consulting an Osteopath
If you are considering osteopathy for sciatica, it’s essential to consult with a qualified practitioner who is experienced in treating this specific condition. They will conduct a thorough assessment, including a medical case history and a physical examination, to ensure that osteopathic treatment is appropriate for your situation. Your osteopath might also collaborate with other healthcare professionals to ensure you get the right care, a multidisciplinary approach is common.
Conclusion
Sciatica can be more than just a literal pain in the backside; it can significantly affect your quality of life and your ability to enjoy the activities you love. Understanding the symptoms and seeking the appropriate treatment can, however, lead to a significant reduction in pain and discomfort.
If you suspect you have sciatica, consult with a healthcare provider for a proper diagnosis and treatment plan tailored to your specific needs. Remember, early intervention can prevent the worsening of symptoms and lead to a quicker recovery.
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