What is sciatica?
Sciatica, as the word suggests, is pain in the hip area and along the course of the sciatic nerve.
The sciatic nerve is a large nerve that extends from the lower spine to the foot, including its various branches.
Anything that presses on and injures the sciatic nerve will cause the corresponding symptoms of sciatica. However, sciatica is a general term and requires further investigation/evaluation so that a therapeutic approach can be designed that is properly directed at the cause of the problem.
Generally speaking, 9 out of 10 patients will recover conservatively, with physical therapy, medication, and therapeutic exercise.
What are the symptoms of sciatica?
Symptoms vary depending on where the sciatic nerve is compressed or injured.
The most common symptom is pain in the lower back and buttocks. Other possible symptoms include radiating pain to the lower extremities. In some cases of severe nerve pressure, neurological signs such as numbness or tingling may also occur.
Here we should clarify that back pain does not necessarily mean sciatica.
Many times a simple muscle injury or overextension can be the cause of the pain.
Sciatica “prefers” people aged 30-55, women (especially pregnant women) and those who do intense manual labor involving heavy lifting.
What causes sciatica?
The causes of this painful condition may be the following:
Spinal stenosis
This narrowing means that the diameter of the spinal canal is reduced locally and therefore the sciatic nerve is trapped and compressed at its exit from the spine.
Spinal stenosis is a condition that can be encountered either in young people with a hereditary predisposition or in older people due to natural wear and tear and degeneration.
Herniated disc
When an intervertebral disc becomes more compressed than normal, a herniation can occur. A herniation is essentially a piece of the disc that protrudes from its normal circular shape and may sometimes press on the sciatic nerve at its root. In this case, the size of the hernia but mainly the way in which the nerve is pressed will give the corresponding symptoms.
Of course, the presence of a hernia in itself does not mean anything, as there is a huge percentage of people who have asymptomatic hernias. Therefore, it is wrong to attribute sciatica to a hernia without a clinical evaluation, as the real cause may ultimately be something else.
Piriformis syndrome
The piriformis is a relatively small muscle located between deep structures in the lumbosacral region. For many years, it was not given the attention it deserved, but in recent years it has been strongly associated with sciatica, mainly due to its anatomical relationship with the sciatic nerve.
The piriformis essentially extends over the sciatic nerve. Therefore, a piriformis in muscle spasm or in an inflammatory phase can affect the sensitive nerve structure with which it comes into contact. Piriformis syndrome is more common in women, and is a diagnosis that often escapes doctors and physiotherapists.
Injury or fracture
Of course, the cause of sciatica can be simply traumatic. A sudden blow accompanied by intense contraction of the muscles in the area or a fracture can cause sciatica, which however will not persist and will resolve along with the inflammatory elements of the injury.
Neoplasm in the spinal area (tumor)
The rarest cause of sciatica is the presence of a tumor in the spinal cord, which as it grows will compress the nerve structures it borders. Here, of course, the symptoms will not go away, but on the contrary will worsen over time and eventually an MRI will reveal this rare cause.
Treatment of sciatica
The treatment of sciatica can be conservative or surgical. 90% of cases are treated conservatively and the therapeutic results last over time as long as you follow a therapeutic exercise program.
Conservative treatment is divided into immediate relief measures and a treatment plan. Naturally, every patient with sciatica first thinks about how to get rid of the pain.
The most direct way is with a cold/hot pack, acupuncture, and taking an analgesic or anti-inflammatory (always with a doctor’s prescription).
From then on, further treatment requires evaluation by a specialized physical therapist in order to identify the real causes.
A proper physiotherapeutic clinical reasoning will be followed by a series of manual therapy sessions and of course at the end of all this, therapeutic exercise and ergonomic retraining are required so that the problem is definitively a thing of the past.
If all of the above do not have the desired effect, the patient is left with 2 interventional solutions, which should be avoided. One is the injection of steroids (cortisone) locally in the area and the other is a surgical operation on the spine. Both methods only reflect 10% of cases and the patient should not be led “lightly” to the surgical bed before all other options have been exhausted.
Sciatica should normally subside to a large extent within 6 weeks of the initial onset of pain. Otherwise, it requires re-evaluation and re-determination of the treatment plan.
Of course, in manual therapy, reassessment and reevaluation are carried out with each treatment, so it is almost certain that the treatment will have the expected result.
Do you have symptoms of sciatica? Book your evaluation appointment today at 2104829303 and see all the treatment options from Bioanadrasi’s specialized musculoskeletal team.
Morochliadis Stefanos
Physiotherapist PT,MT,RFL,Formthotics specialist
