Welcome back once again to the ThreeSpires Physiotherapy blog where we take a look at all things physiotherapy and health related. In our last physiotherapy article we looked at a condition caused by lack of nerve conduction (foot drop), so in this article I thought we could carry on looking at nerves and this time examine irritation and pain from the sciatic nerve, often called sciatica. Anyone who has had sciatica can attest to how painful and debilitating it truly can be and is a condition that as physiotherapists we are involved with helping a lot of patients with. Before we carry on and just to remind anyone who is not a regular reader of this physiotherapy blog: we are a home visit physiotherapy service based in Lichfield and offering services in Sutton Coldfield, Tamworth, Cannock, Rugeley and Walsall.

What is Sciatica?

Sciatica is one of the most common musculoskeletal conditions that our physiotherapists help with and as many of our patients can confirm is extremely painful. Sciatica is a condition caused by irritation of the sciatic nerve and generally gives pain in the back of the legs, calf, buttocks and sometimes the feet, it may sometimes be associated with back pain but in general irritation of the sciatic nerve will give pain in the areas that it travels down to and through such as the buttocks, legs and feet etc... Often sciatica makes walking and getting out of the house and this is one of the reasons that our home visit physiotherapy servcie is so popular in helping patients with sciatica. Being able to have a physiotherapist come to the house (for example in Sutton Coldfield or Tamworth) and save you the difficulty and pain of a trip to a physiotherapy clinic is  extremely helpful and can save a great deal of the pain associated with sciatica.

Who Does Sciatica Affect?

Sciatica can affect anyone at any stage of life but most commony it affects people between the ages of 35 - 55 and upto 40% of people will have experienced an episode of sciatica in their lifetime (I know I have!). It seems to affect both sexes equally and both men and women suffer with sciatica. People younger than 35 tend to be less likely to get sciatica and it can affect pretty much any occupation from office workers through to manual labourers.

What Causes Sciatica?

1. Intervertebral Disc Bulge: Although there are several causes of sciatica, by far the most common cause is a bulging disc. In the lumbar spine between each vertebrae (bones) there is a disc and the disc is comprised of a hard and fibrous outer part and a much more jelly like inner part. Sometimes as we move this disc can be squashed and the jelly like inner part may break through and be pushed onto one of the nerves as they exit the lumbar spine and form the sciatic nerve. When this happens the nerve root can become extremely irritated and inflamed and can cause the pain down the legs that is associated with sciatica. 

2. Piriformis Syndrome: Apart from a bulging disc there are other causes of sciatica such as spasm in the piriformis muscle (which I discuss in a blog post here in more detail). The sciatic nerve runs very close to piriformis which is located deep in the buttock and can if it goes into spasm cause irritation in the sciatic nerve.

3. Disc Irritation: sometimes one of the discs in the back can become irritated. This can be from consistent poor posture or possibly overloading the area and this will give a generalised pain down the back of the legs. This kind of sciatica may be more diffuse and harder to describe than the pain associated with a disc bulge. 

The 3 causes above are the most usual causes of sciatic nerve irritation but sometimes it can be very difficult even with a thorough assessment to determine what the exact cause of the sciatic nerve irritation is. 

Treatments for Sciatica:

1. Physiotherapy: as per usual I am a bit biased here! If you think you have sciatica it is important to get a diagnosis from a good physiotherapist as there are other conditions that can appear to be sciatica (e.g. a hamstring strain) and it is important to get a thorough assessment of your condition. Furthermore by getting an early assessment it is my experience that this speeds up recovery significantly by getting treatment early and understanding how to effectively manage your condition.

2. Exercises and Stretching: gentle and appropriate exercises can help with sciatica but to know which would be best it is probably necessary to seek advice from a physio.

3. Analgaesia: in the early and extremely painful days of sciatica often the most important thing is to get some appropriate and adequate pain relief. You should seek advice from your GP about this.

4. Rest: there is a lot of information out there that suggests that people should keep going when they have back pain and for chronic long standing back pain this is certainly the case. However, for sciatica, rest is by far the best strategy in the early and very painful days. This may involve taking some time off work but will help settle things much more quickly than pushing through!

5. Steroid Injections: some patients unfortunately do not respond to physiotherapy and conservative management and they may need to consider having a steroid injection. These can be helpful but you would need a scan and a consultation with a consultant.

6. Surgery: in the past anyone having sciatica that did not resolve relatively quickly would have been offered a micro-discectomy. However, these are much less commonly done as research has shown that most people do not need surgery. Having said that, there are still some people who having gained no relief from all of the above options will find surgery helpful. 

In my own personal opinion the best treatment for sciatica is getting help quickly and in the early days. Having an assessment by a physiotherapist who can guide you as to the best strategies to employ and how to avoid making thinsg worse will save a lot fo pain, reduce the likelihood of surgery and lower the amount of time off work. Waiting until things have become horrendous is the worst way and will only make the recovery from sciatica longer.

Medical Disclaimer/Warning:

Lastly it is important to be aware of some symptoms that require immediate medical attention and are a sign of a more serious condition called Cauda Equina Syndrome. If you experience pain in both legs, tingling, a change in sensation or numbness in the saddle area between your legs, an inability to urinate or loss of control of your bowels then it is important that you seek immediate medical help.  

Okay, I hope that you have found this article about sciatica helpful. If you or anyone you know has sciatica and wuld like help or simply some ifnormation then please get in touch. For anyone reading: we are a home visit physiotherapy service, based in Lichfield but serving anywhere within a 20 minute drive including areas such as Sutton Coldfield, Tamworth, Cannock, Burton and Rugeley. We offer a wide range of services including paediatric physiotherapy, post-operative rehabilitation, neurological physiotherapy and neck and back pain relief. If you need further information or would like to book an appointment we can be contacted on 0788 428 1623 or via enquiries@threespiresphysiotherapy.co.uk