What is Sciatica?

In simple language, Sciatica is back pain running down on one side of the back of your leg. It is a commonly known medical term. The pain experienced may be sudden or gradual and it may be accompanied with pins and needles sensation in the leg. It can occur in any age group, however there are certain groups who have a higher risk of developing sciatica.

 

 Risk factors for Acute Sciatica:-

 

Anatomy of lower back related to sciatic nerve:-

To understand sciatic pain area, let’s understand few anatomical structures which may be involved in sciatica. In the lower back, there are 5 bones, placed one on top of each other with a flexible spongy disc connecting them. These bones sit on top of a triangular bone called the sacrum, which connects them to the pelvis. These bones in the lower back hold the spinal cord which throws out nerves that are like wires giving life to our muscles and other structures in the leg.

With the above explanation, sciatica happens when one of these wires namely “sciatic nerve” is pinched in between the bony structures due to the spongy disc compressing them.

 

Sciatica is not a sign that the sciatic nerve is permanently damaged or blocked. It is a temporary condition caused by inflammation. Once the inflammation settles, the pain goes away.

Research Says:-

In about 90% of cases, sciatica is caused by a herniated disc with nerve root compression. so if you are experiencing sciatic pain, there may have been an episode of your spongy disc being injured leading to sciatica.

 Indicators for sciatica:-

So these are a few symptoms that could indicate you are having a sciatica issue

1. Unilateral leg pain greater than low back pain
2. Pain radiating to foot or toes
3. Numbness and paraesthesia in the same distribution
4. The straight leg raising test induces more leg pain

How does sciatica occur?

Sciatica may occur due to sudden injury to the back like lifting a heavyweight, slipping and falling down on the floor, faulty weight lifting in the gym, or getting injured via some external source like a car accident or while playing cricket or football. However, in many cases the onset is gradual, typically the person has been experiencing back pain on and off, and eventually when not addressed with proper exercises it worsens to spread across one side of the leg.

There are many patients who walk into our clinic claiming to have sciatica but they clearly don’t!!!

The reason is there are many problems that may cause pain on one side of the back running down the leg but the way they develop is different and does not affect the sciatic nerve per see.

what other problems could feel like sciatica:-

1. Swelling in one of the bursae of the hip (hip bursitis/ GT tendinosis/GT tendinopathy)
2. IT band syndrome (A band running from side of the hip to the back of the knee)
3. Lower cross syndrome.
4. Piriformis syndrome (very common in runners, the sciatic nerve tends to get pinched under one of the muscles in the hip and cause shooting pain in the leg)

Hip bursitis is often misdiagnosed as sciatica

For example, a patient came in for sciatica treatment, she developed the pain a few days back after returning from her pilgrimage. Her pain was in the back and the side of the leg. All the tests from sciatica were positive but her symptoms were different, so further examination concluded to her being diagnosed as having Trochanteric hip bursitis. Once diagnosed correctly the treatment plan was changed and she was mainly put on a set of non-weight bearing exercises focusing on improving hip mobility and strength which eventually resolves her problem.

Sciatica that originates in the spine tends to present with a slightly different set of symptoms that are more localized to the lower back. If you suspect you have sciatica or piriformis syndrome, you should see a Physiotherapist or doctor who can perform the necessary diagnostic tests and prescribe an appropriate treatment plan.

What is the value of imaging in sciatica?

My view in this article is not just based on experience but also on research.

ACUTE SCIATICA:- diagnosis will be done purely on symptoms and examination nd treatment can be started.

Incase of RED FLAGS FOR SCIATICA like an infection or tumor, imaging is required which will be definitely recommended by your physician but the signs and symptoms may vary. Remember that!!

Diagnostic imaging may also be indicated in patients with severe symptoms who fail to respond to conservative care for 6-8 weeks. In these cases, surgery might be considered and imaging used to identify if a herniated disc with nerve root compression is present and its location and extent

If you are planning to go for surgery then your orthopedic will recommend you imaging but otherwise, for a visit to a physio, imaging IS NOT REQUIRED. it will not affect my rehab plan for you.

why this extreme view?

Well because even in patients with no symptoms or no issues and MRI or A CT scan has 22 to 36% chances of showing disc herniations which do not matter. what matters is, whether your symptoms are active and is it affecting your lifestyle.

Treatment for sciatica:-

The treatment is based on the symptoms and the patient’s fitness levels. an athlete facing sciatica will be prescribed a rather progressive exercise program while a regular homemaker lady will be given a slow and steady kind of exercise program. the program based on individual needs usually includes:-

• Manual therapy
• soft tissue mobilization
• neural mobilization
• core stability exercises
• leg strengthening exercises
• mobility routine exercises.
• electrotherapy.

check out these corestability exercises which may help with sciatica as well

Summary of  Sciatic pain:-

1. Most clients with acute sciatica have a favorable prognosis but about 20%-30% have persisting problems after one or two years
2. The diagnosis is based on history taking and physical examination
3. Imaging is indicated only in patients with “red flag” conditions or in whom disc surgery is considered
4. Passive (bed rest) treatments have been replaced with more active treatments
5. The consensus is that initial treatment is conservative for about 6-8 weeks
6. Disc surgery may provide quicker relief of leg pain than conservative care but no clear differences have been found after one or two years

Reference:-

1. Diagnosis and treatment of sciatica