Anatomy and Clinical Presentation
The sciatic nerve is composed of the spinal nerves L4, L5, S1, S2, and S3. Sciatica is the impingement of the sciatic nerve in the low back, pelvis, or buttock area. The most common cause of sciatica is age related changes in the spine such as disc herniations and bone spurs. Other causes include: piriformis syndrome (nerve compression in the pirifomis muscle), pregnancy, spinal stenosis, osteoarthritis of the surrounding joints, etc.
What is Sciatica?
Signs and Symptoms
The symptoms depend on which nerve is being compressed or irritated. Typically, the neurological symptoms include:
Muscular weakness (affecting gait)
Intense pain in the buttock
Pain radiating down the leg
Numbness
Altered sensation in the leg: hot, cold, tingling, burning
Management
In terms of neuromusculoskeletal complaints, it is important to start with conservative treatment first and then progress to more invasive therapies. Treatment options will vary depending on the cause of the sciatic nerve irritation. In most cases, a Physiotherapist or Chiropractor is recommended for conservative treatment of sciatica. Treatment may
include: nerve flossing, extension exercises, piriformis stretches, muscle activation, and/or flexion-distraction technique.
Medications such as analgesics, NSAIDs, and muscle relaxers may be prescribed by your medical doctor. In severe cases, an epidural steroid injection may be used to temporarily reduce inflammation and pain. In extreme cases, surgery may be elected.
Here are a few videos of neural flossing techniques that can be useful in the treatment of sciatica. Speak to your health professional before trying any of these at home:
Unsure if you have sciatica? Book with one of our health professionals for an assessment.
References
L Fishman, L., & Ardman, . (2006). Sciatica Solutions: Diagnosis, Treatment, and Cure for Spinal and Piriformis Problems. WW Norton & Company.
Ailianou, A., Fitsiori, A., Syrogiannopoulou, A., Toso, S., Viallon, M., Merlini, L., ... & Vargas, M. I. (2014). Review of the principal extra spinal pathologies causing sciatica and new MRI approaches. The British journal of radiology.
Lewis, R. A., Williams, N. H., Sutton, A. J., Burton, K., Din, N. U., Matar, H. E., . & Rickard, I. (2015). Comparative clinical effectiveness of management strategies for sciatica: systematic review and network meta-analyses. The Spine Journal, 15(6), 1461-1477.
Roelofs, P. D., Deyo, R. A., Koes, B. W., Scholten, R. J., & Van Tulder, M. W. (2008). Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database Syst Rev, 1.
Vroomen, P. C., de Krom, M. C., Slofstra, P. D., & Knottnerus, J. A. (2000). Conservative treatment of sciatica: a systematic review. Clinical Spine Surgery, 13(6), 463-469.
Luijsterburg, P. A., Verhagen, A. P., Ostelo, R. W., van den Hoogen, H. J., Peul, W. C., Avezaat, C. J., & Koes, B. W. (2008). Physical therapy plus general practitioners' care versus general practitioners' care alone for sciatica: a randomised clinical trial with a 12-month follow-up. European Spine Journal, 17(4), 509-517.
Albert, H. B., & Manniche, C. (2012). The efficacy of systematic active conservative treatment for patients with severe sciatica: a single-blind, randomized, clinical, controlled trial. Spine, 37(7), 531-542.
Sciatica (Lumbar Radiculopathy). (2015). NICE Clinical Knowledge Summaries. Retrieved 3 February 2017, from https://cks.nice.org.uk/sciatica-lumbar-radiculopathy