What is sciatica?
Sciatica is the common term associated with pain running down the backside of your leg, which can include pain from the hip all the way down to your foot and is often described as one-sided with a sharp, shooting or burning quality that is exacerbated by sitting, coughing, or bearing down. It can also be associated with numbness, paraesthesias, or other sensory disturbances down the leg and foot. It is a relatively common condition, with a lifetime prevalence of up to 40%. Though many cases resolve on their own within 4-6 weeks, some cohort studies show that between ~30%-50% of patients suffer from persistent symptoms at 1 year.
Part of the challenge treating and studying sciatica is the multiple structures in the body that can contribute to overlapping and similar symptoms. For instance, sciatic pain (which inherently refers to pain originating from somewhere along the sciatic nerve tract) can occur from local irritation anywhere along the nerve tract (think compression from tissue around the nerve,) it can come from irritation in the spinal cord (e.g. stenosis of the spine,) or just as the nerve exits the spinal canal (disc herniation or facet-joint contributions.) For these reasons alone, you can understand that any single product promising relief from sciatica is unlikely to provide relief for everyone. Due to the complexity of the condition, a thorough evaluation from a medical provider, paired with a holistic, personalized and collaborative treatment program will give you the best chances of symptom resolution.
How or why does sciatica occur?
As you may assume from the above description, nailing down a specific reason as to how or why you’re experiencing this pain differs for every patient – but the common theme is irritation to some portion of the sciatic nerve. The analysis of the origin of your symptoms is further complicated by the fact that imaging does not always correlate with pain. As noted in the Low Back Pain page, patients who are completely pain free can often times show notable irregularities/abnormalities when put in an x-ray, CT or MRI scan. Therefore, if you do have imaging (which is not typically recommended for sciatica management) it’s crucial you have those images interpreted in context of a detailed evaluation. Through a detailed examination and discussion, often times your physical therapist will be able to ascertain the contributing factors that brought on your pain as well as a treatment program to address your symptoms and improve your chances of preventing future flare ups.
What does sciatica treatment look like?
Depending on your examination, your treatment plan will likely include many different interventions to include,
-Active strengthening/stabilization and endurance exercises (to improve strength/endurance & target potential muscle imbalances )
-Dry needling (to decrease local muscle irritation, tightness and pain, as well as facilitate healing to structures along the nerve tract.
-Nerve glides (to normalize neurodynamics and reduce intra-neural inflammation)
-Spinal manipulation / mobilization (to reduce pain, improve range of motion and resting muscle hypertonicity)
-Education (to improve your understanding of the condition to help you prevent future flareups.)
What can I do right now
Some things follow the manta of “no pain no gain.” Sciatica is not one of those things. Typically, the more you irritate it, the more irritable and intense the pain gets. Therefore, until your evaluation, try to keep moving and exercising while avoiding the positions that exacerbate your pain. Gentle, pain-free stretching of the muscles around your hip can be helpful, though again, avoid pushing into a painful range of motion at this time to prevent exacerbation of symptoms.
Lewis R, Williams N, Matar HE, et al. The Clinical Effectiveness and Cost-Effectiveness of Management Strategies for Sciatica: Systematic Review and Economic Model. Southampton (UK): NIHR Journals Library; 2011 Nov. (Health Technology Assessment, No. 15.39.) 3, Background. Available from: https://www.ncbi.nlm.nih.gov/books/NBK99305/