Sciatica
Sciatica is one of the more common conditions people come to see me with in clinic. It can be a very uncomfortable and unnerving thing to suffer from, often causing as much worry as the pain and discomfort itself. If you’re suffering with what you think might be sciatica, I can certainly assess and help you with it.
What sciatica can feel like
There’s no one universal symptom of sciatica and many people experience it in different ways. Some of the most common ways patients describe it are:
- A low back or buttock pain that travels down the back of the leg, can go past the knee and into the ankle or foot
- A sharp, burning or deep aching pain
- An electric shock sensation that shoots down the leg
- Pins and needles, tingling, numbness often felt in the buttock, leg or foot
- A heavy feeling in the leg
- Pain that is often worse when sitting, bending, twisting, or when you cough or sneeze
- Leg pain or symptoms that are more bothersome than the back itself
What is sciatica and why does it happen?
Sciatica itself is simply a term used to describe irritation of your sciatic nerve. This is the nerve that travels from your low back, down the back of your leg and into your foot. It is not, strictly speaking, a diagnosis in and of itself. One of the key goals in assessing sciatica is figuring out where that irritation is coming from.
There are many ways your sciatic nerve can become irritated. The common one most people think of is the disc bulge, or “slipped disc” as they’re commonly known. The term “slipped disc” is a bit of a misnomer though, as your discs don’t technically “slip” out. They’re pretty securely welded into place between your vertebrae. They can become squeezed, compressed and bulge, which can then cause that irritation on the nerve.
Other causes of sciatica (this is not an exhaustive list):
- Muscular tightness and spasm – sometimes muscular tension, through overworking, usually in response to injury or habitual movements, causes a compression on the sciatic nerve
- Inflammation – sometimes there isn’t anything physically pushing on the nerve at all. The body’s inflammatory response to injury and healing can irritate the nerve
- Spinal degeneration – this causes a narrowing of the normal space between the joints in our spine. The sciatic nerve runs through these narrow spaces and this can sometimes cause irritation by stretching, compressing or squeezing the nerve
How I assess and treat sciatica
Treating sciatica can be quite tricky and there is no ‘one size fits all’ approach. The most important first step is actually determining what is causing your particular symptoms. A thorough assessment, including some specific tests, will help confirm that it is the sciatic nerve that is involved and the underlying cause. I’ll also check for anything that might need referring to someone else. While it is usually not needed, if I feel it is something that needs a GP or further investigation, I’ll let you know and point you in the right direction.
The way we approach treatment will differ depending on the underlying cause and we’ll build the plan around your symptoms and most importantly, what you’re looking to get back to doing. The approach for a disc bulge will differ from the approach to a degenerative cause, for example. The best treatment approach is usually a mixture of hands-on treatment alongside specific movement and exercise advice for you to do at home.
If this sounds like what you’ve been experiencing, I can take a proper look and tell you what’s going on.
What to expect
Recovery timelines for sciatica are notoriously variable. While mild cases can improve within a few weeks, more significant irritations, or more chronic issues, can take 3 months or more. I will be up front and honest with you regarding how long I think it will take and we’ll be assessing progress as we go. The goal is to help you be more comfortable so you’re more confident in moving your body again. While sciatica can be stubborn, if we’re not making meaningful headway within the first three to six treatments, we’ll change the approach or consider what other options might be best for you. It’s also worth saying that progress is rarely linear. It’s common to hit setbacks along the way. So long as the overall trajectory is upwards, we’ll be on the right path.
While sciatica can be incredibly disabling and worrying, it is usually not serious. There are a few exceptions and some symptoms that you should keep an eye out for, that could be an indication of a more serious spinal issue. If you have any of the following symptoms, seek urgent medical help either by visiting A&E or calling 999:
- Loss of feeling, tingling, pins and needles in your genitals, back passage or inner thighs
- Numbness, pins and needles or weakness in both legs
- A sudden loss of sexual function
- An inability or difficulty to start, stop or control urination or loss of sensation when passing urine
- Inability to control a bowel movement or not noticing when you need to go
These symptoms can indicate cauda equina syndrome, a medical emergency where the bundle of nerves at the base of the spine becomes compressed. If this is left untreated, it can lead to permanent paralysis, loss of bowel or bladder control and sexual function.
The vast majority of people will not have these symptoms. The estimated occurrence of this is roughly 1-3 people per 100,000 of the general population each year. However, if you are concerned you might have these symptoms, seek urgent medical care rather than booking an appointment with me.
Sources: NHS — Sciatica · Buckinghamshire Healthcare NHS Trust — Cauda Equina Syndrome
Written by David Graham, GOsC Registered Osteopath (reg. no. 10852)
Common questions about sciatica
Most of the time, x-ray, MRI and other scans are not necessary. A thorough clinical assessment can identify what is going on. Scans are not all that helpful in telling us how much pain you might be experiencing and often show normal changes in the spine we all experience with age. Most importantly, scans often do not change how we manage your pain. The time a scan might be useful is if we’re not getting anywhere or your symptoms are getting worse. If I think you genuinely need a scan, I’ll tell you and refer you.
Yes. I’ve helped many patients who have had sciatica over months or years. Typically, the longer you’ve had it, the longer it usually takes to get better. I’ll give you an idea of what I think is a realistic timeframe for your situation after a thorough assessment. Our goal will be to gradually reduce your pain, improve your comfort and get your function back.
Staying active is better than complete rest, even though this might seem counterintuitive when you’re experiencing pain. What that activity looks like will depend on your condition, and this might mean very gentle movement in the early stages. Part of my job is to help you find movement that is manageable and safe for you and I will advise you of this during treatment so you can continue your recovery at home.
This is the hardest question to answer and it really depends on what I find in the assessment and how long you’ve had it. It’s impossible to give a concrete number without guessing, and I wouldn’t like to do that. What I will say is that I regularly review progress to make sure things are going in the right direction. If we’re not making progress within three to six sessions, we’ll look to change the plan or consider alternative care. I don’t want you repeatedly coming back without progress being made.
Osteopathic treatment is usually not painful. Some techniques may feel firm and sometimes symptoms can temporarily flare up after treatment because of the irritation already present. I’ll work within what is comfortable for you and treatment is never compulsory. If something feels uncomfortable, you can let me know and we’ll alter what we do.
My default position is not telling you to stop doing the things you enjoy or need to do. My goal is to find a way to keep you doing the things that matter to you. Sometimes we need to modify or change things slightly while symptoms settle down. Completely stopping is a last resort and if we have to do that, it’s only ever temporary.
Recognise these symptoms?
Let’s take a proper look.
A proper assessment is the place to start, so you understand what’s going on with your sciatica and what can be done about it.