Odds are you have or have known someone with sciatica or sciatic pain. So what is it? 

Sciatica is a symptom not a diagnosis. Sciatica is the sensation of a ‘pinched’ nerve, whether it be physical compression, or a result of inflammation over exciting the nerve. It is an unusual feeling resulting in nerve-like sensation through the buttock and down the posterior thigh (hamstring) to the back of the knee. This nerve pain is often represented as pins and needles or a dull burning pain but can also feel like electric shocks.

Where is it and what does it do?

The sciatic nerve begins in the lower section of your lumbar spine. It is formed by a combination of 5 nerves L4/5 and S1/2/3 found at the bottom of your lumbar spine and your sacrum (tailbone). These nerve fibres are controlling the movement and sensations of the lower limbs. Messages pass from the brain to initiate movement and sensory information from the legs travel back upward to give the brain all kinds of information. These nerves bunch together in the buttock near the piriformis muscle and at its thickest point is 2cm in diameter! 

The sciatic nerve travels though the thigh surrounded by a fatty sheath for protection and insulation, at the knee the nerve splits into small branches to innervate different muscles of the feet and calves. 

What is true sciatica?

Amongst health professionals what’s known as ‘true sciatica’ is when the sciatic nerves are being aggravated at the level of the spine. This can be due to – 

• Some narrowing around the spinal cord – known as canal stenosis
• Central disc bulging/herniation
• Osteophytes – Bony growths
• Pregnancy
• Muscle spasm (in the back or buttocks)
• Some cases of severe disc degeneration 
• Previous surgeries around the lumbar spine

So I mentioned this being ‘true sciatica’ which implies there is a ‘fake or faux’ sciatica. This is where the sciatic nerve is aggravated at another level of the nerve other than the spine, such as the pelvis. Stay tuned for our next blog for more information!

What are some factors that predispose the injury?

• An injury/Mechanical event – Disc bulges/herniation can be caused by a multitude of things, lifting and twisting, prolonged poor posture, undertaking new activities when deconditioned
• Weight – Being overweight greatly increases your chance of injury’

• Age – Degeneration and osteophyte growths can impinge the nerve.

Can it be serious?

There are some signs and symptoms that can indicate a medical emergency in regard to sciatic pain. This is known as Cauda Equina syndrome. This is a rare condition where the nerve roots at the bottom of the spine are compressed, these nerves control your lower limb but also organs such as your bowel and bladder. This will often be rushed into surgery to prevent permanent paralysis or organ control. 

So what are the signs for this?

• Severe back pain that is unrelenting 
• Numbness tingling or nerve pain down the back of one or both legs 
• Saddle paraesthesia – not being able to feel your buttocks or groin
• Incontinence – this is a big sign of an emergency as you have lost the ability to control your bodily functions

Common causes of this

• Severe accidents that result in spinal trauma
• Tumours and malignancies 
• Gunshots and stabbings
• Severe stenosis
• Some birth defects. 

In the clinic

During the consultation firstly our Osteopaths will assess the pain with thorough questioning and case history before physically examination where we will endeavor to differentiate if the pain is coming from the spine itself or if nerve compression is occurring elsewhere. Occasionally imaging may be required to confirm or rule out diagnoses. 

Your management plan will then be developed based on the working diagnosis and severity of pain. Usually treatment will involve trying to decrease muscle spasm and tension to try to enable better range of motion through the lumbar spine, hips and pelvis. As pain decreases over treatments and functionality has returned a strengthening and home exercise program will be developed to help the patient return to work or hobbies and reduce the risk for future re-aggravation. 

Read more about Sciatica and what we can do to help it here.