Sciatica is actually the term that we use to describe any pain or symptoms, such as tingling or numbness that travel down the path of the sciatic nerve. Just like the word “headache” it is not an actual diagnosis of your problems, just an accurate description of the location of your pain.

Sciatic pain can be anything from a mild to severe ache or pain of such severe intensity simple tasks such as walking, bending, sitting or even just standing up can be difficult and in some cases impossible.

There are two types of sciatica:

- Neurogenic

- Referred

In Neurogenic sciatica the pain is caused by compression of the sciatic nerve or smaller nerve roots that form it, symptoms can vary in severity due to the amount of pressure on the nerve. This can be caused by a variety of problems, from bulging discs to tight muscles.

The discs between the vertebra can bulge, herniate or sequestrate (burst) causing direct pressure on the nerves leaving the spine. Pressure directly onto the spinal cord from within the spine can also compromise the function of the sciatic nerve. Tight muscles through the buttocks and top of the legs can also irritate and put pressure on the sciatic nerve.

In most of these cases the leg pain is worse than the back pain and described as a sharp, burning, shooting pain. It is often associated with a feeling of numbness, pins and needles, hot and cold sensation and muscle weakness.

With neurogenic sciatica there are usually abnormal neurological exam findings such as a loss the normal reflexes, muscle weakness and sensory changes.

DISC BULGE OR HERNIATION

The intervertebral disc is constructed of outer rings of cartilage, inside of which there is a soft centre called the nucleus pulposus. When the disc bulges (prolapses), the nucleus pulposus has shifted with the disc but remains contained within the outer cartilage rings. A bulging disc is very common in patients over 40 years of age.

When the disc herniates (sequestration), this soft material escapes out of the disc through tears that occur in the outer fibers of the cartilage, called annular tears.

The nerve roots are extremely sensitive, and the subsequent sciatic pain is caused by irritation of the spinal nerve roots, inflammation caused by proteins contained in disc material, or a combination of both.

They are caused by:

- Pre-existing weakness in the annulus

- A sudden increase in pressure through the disc

- Poor posture over time damaging the discs

- A sudden unexpected load

- A motor vehicle accident

Other causes of sciatica include:

- SPINAL STENOSIS

- ABNORMAL SPINAL MOVEMENT

- SACROILIAC JOINT DYSFUNCTION

- PIRIFORMIS SYNDROME

- SPONDYLOLISTHESIS

- PREGNANCY

- MUSCLE STRAIN

- TUMORS, FRACTURES, INFECTION

- ANKYLOSING SPONDYLITIS

A physiotherapist will assess sciatica through:

- Patient History

Understanding how and when the pain started, what makes it better or worse.

- Postural & Movement Check

Looking at posture, walking, and any movement restrictions.

- Palpation

Feeling for tight or tender areas in the lower back and legs.

- Neurological Testing

Checking reflexes, muscle strength, and sensation in the legs.

- Orthopaedic Tests

Tests like the Straight Leg Raise or Slump Test to reproduce sciatic symptoms.

- Range of Motion

Measuring flexibility and movement in the spine and hips.

- Referral (if needed)

May refer for imaging like MRI if serious pathology is suspected.

This helps identify the cause of your sciatica and guides your treatment plan.

At Integrate Physiotherapy our physiotherapists are well trained with latest evidence based practice methods and we will ensure you get the best possible care and management for sciatica.Many people who experience sciatica get better within a few weeks or months using a functional approach to treatment without surgery.

If you suffer from sciatica its most likely started from a functional, mechanical problem in your spine. The initial aim of your treatment is to remove the irritation of the nerve, reduce inflammation in the area and improve the movement in your spine.

It is important to stop you aggravating the problem further by avoiding activities such as bending, lifting and prolonged sitting. In severe cases you will need painkillers and anti-inflammatory medication to help control the symptoms while the cause is removed.

Initially stretching exercises are also an important part of your treatment.

The most important thing is that once your condition has stabilised your health care practitioner designs an individual treatment program and exercise regime to prevent recurrence.