On this page:
See also:
Sciatica
Sciatica is back pain which radiates down into the leg and is caused by pressure on the sciatic nerve. It can be caused by a number of factors although a prolapsed or slipped disc is one of the most common.
Sciatica Symptoms
- Acute low back pain (not always present, especially in piriformis syndrome).
- Pain radiating down the leg. This pain may be sharp and accompanied by pins and needles and / or numbness.
- Sciatica pain is often triggered by a minor movement such as bending over to pick something up.
- Pain may be made worse by sitting, lifting, coughing or sneezing.
- Pain is usually relieved by lying down, often on one side.
- Pain is often better in the morning after a nights rest.
- There may be muscle spasm in the lower back.
- Tenderness in the lower back or bum muscles when pressing in.
- Pain on the straight leg raise test which is not apparent when just stretching the hamstring only.
Sciatic Explained
The medical term is acute nerve root compression or radiculopathy. The cause of pressure can be varied from a slipped disc (also known as a herniated or prolapsed disc), disc degeneration or muscle tension (Piriformis syndrome) or something less common such as a tumors, bony growths (stenosis) and infections.
Slipped Disc
A prolapsed disc or slipped disc as it is sometimes known is not simply a disc that has 'slipped' out of place. Intervertebral discs separate the bones of the spine (or vertebrae) and their function is to act as shock absorbers or cushioning for the spine and allow movement.
They quite happily allow flexion and extension (bending forwards and backwards), lateral flexion (sideways movement) and twisting. However a combination of the two can put excess stress on the spine and damage the discs. This is particularly common in people who may lift heavy objects and twist with them for example unloading heavy boxes off the back of a lorry.
The intervertebral discs are filled with a gelantinous substance in the middle called nucleus pulposus and when a disc prolapses this jelly-like centre squeezes out and puts pressure on the spinal cord compressing the nerve routes and causing pain.
Depending on where the sciatic nerve is pinched will determine where you feel the pain, which can radiate to the front of the knee or right down the back of the leg to the foot. The L5-S1 disc is the disc most commonly damaged and the L4-L5 disc the next most commonly damaged. L4 and L5 are the bottom two Lumbar vertebrae at the base of the spine. S1 is the top of the Sacrum.
Piriformis Syndrome
Piriformis is a muscle found deep in the buttocks. The sciatic nerve runs very close to this muscle. Tension in the muscle can cause compression of the sciatic nerve which can cause sciatic pain in the bum and down the leg.
It is sometimes difficult to distinguish between sciatic pain caused by a disc problem, or caused by piriformis syndrome. Generally with piriformis syndrome there will not be any lower back pain and there is usually a less well defined point of injury.
Read more on piriformis syndrome here.
Sciatica Treatment
The treatment of sciatica really depends on the cause of the injury and the extent of the symptoms.
Severe cases (usually caused by a disc prolapse) may require the following treatment:
- Rest in bed if necessary in a position that is comfortable.
- A doctor may prescribe NSAID's (non steroidal anti inflammatory drugs) such as ibuprofen. Should always be taken under the direction of a doctor and not if the patient has asthma.
- Apply heat therapy or a hot bath may help to relieve muscle spasm.
- Use of a heat retainer or back brace can provide support in the early stages.
- See a sports injury specialist or doctor.
- Begin extension exercises as soon as pain allows.
In less severe cases and those caused by piriformis syndrome, less rest is required:
- Rest from activities which aggravate the condition.
- Gently stretch the hamstrings and buttock muscles (provided this is not painful).
- Apply heat therapy to help ease muscle spasm.
- See a sports injury therapist.
- Sports massage usually works particularly well for piriformis syndrome.
What can a sports injury specialist, physiotherapist or doctor do?
- Determine the cause of the sciatica.
- Prescribe anti-inflammatory medication e.g. ibuprofen or muscle relaxants if necessary
- Use sports massage techniques to relax tight muscles.
- Gently apply mobilization techniques to the spine (for spinal causes only).
- Use traction or advise on the use of and Inversion Table (again for spinal causes only)
- Apply electrical stimulation in the form of a Tens machine or Interferential.
- Perform a simple operation called a discectomy on a slipped disk if neurological signs (nerve related symptoms) continue or worse.
- Advise a course of Pilates exercises to strengthen the core muscles of the trunk.
After the acute painful phase:
- Restore pain free movement to the back through mobilization and stretching techniques.
- Ensure posture and correct lifting techniques are learned and maintained.
- Strengthen the core stabilizing muscles of the spine
More information on Sciatica:
