What is Sciatica?
Sciatica is a term used to describe pain that radiates down the back of the leg from the lower back or buttock and may extend as far as the calf or foot.
Sciatic pain can sometimes be associated with pins and needles, numbness, weakness in the leg or foot and other altered sensations such as burning.
Unfortunately, the term sciatica is often used to describe pain which radiates down any part of the leg, which can lead to some confusion.
Although sciatica can be incredibly painful, it is rarely serious. Most cases will resolve either on their own, given enough time, or can be effectively treated using conservative treatment such as pain-killers, exercises and manual therapy.
Sciatica usually only affects one leg but can affect both, and may or may not be associated with pain, stiffness or discomfort in the lower back.
The Sciatic Nerve
The sciatic nerve is made up of nerve roots (the name we give the nerves as they exit the spine) from several levels of the lower back.
From here they form a bundle of nerves called your sacral plexus which sit deep in the pelvis.
This plexus then forms branches to supply the leg, one of which is the sciatic nerve, which then passes out of the pelvis, down the back of your thigh to just above the knee where it splits in to branches that supply your lower leg.
What is Causing my Sciatica?
The most common cause of sciatica is a bulging disc in your lower back – this can compress the nerve as it leaves the spine, causing irritation which leads to symptoms.
However, the presence of a disc bulge does not automatically mean you will get symptoms, as disc bulges have been shown to be present in around 20% of young adults and >75% of those over 70 years of age with no associated symptoms.
Other common causes of sciatica include muscular tension, particularly in the muscles of the buttock and at the top of the thigh, a direct blow to the nerve such as in a fall or a rugby tackle and changes to the function of the pelvic girdle during pregnancy.
There are also numerous conditions that mimic sciatica. These include irritation of the sacroiliac joint (the joint between your spine and your pelvis), trigger point (knots in muscles) referral from the muscles around the buttocks and pelvis and hamstring injuries.
Your chiropractor will be able to use a combination of orthopaedic and neurological examination to determine the most likely source of your symptoms.
Can Sciatica be Serious?
Most cases of sciatica are not serious, however there are a few signs and symptoms that indicate that the cause of your sciatic pain may need to be investigated more urgently.
If you get any of the following symptoms, it is wise to contact your GP urgently, or if it is out of hours, use the 111 service:
- Sudden onset of severe pain, pins and needles and weakness in both legs
- Recent onset of bowel or bladder incontinence
- Recent onset of an inability or reduced ability to feel that you need to go to the toilet, start or stop the flow of urine
- Numbness or reduced sensation in the areas of your body that would contact a saddle
- Severe back pain associated with signs of infection such as a fever, sweats, chills or flu-like symptoms
- If your back pain is associated with recent, significant and unintentional weight loss
Do I Need a Scan for Sciatica?
Most cases of sciatica do not require any imaging. This is because in most cases, imaging would not change the way that your sciatica is treated.
There is also a poor correlation between the presence of findings on scans or x-rays and the severity of your symptoms, as a lot of the things found on these images are very common in people with no symptoms.
Imaging is usually only required if you have any of the above indications of a more serious cause for your pain, or if extensive conservative treatment, such as exercises and manual therapy, have been unsuccessful.
A thorough physical and neurological exam will almost always be the best way to diagnose sciatica. The advantage of this approach is that the function of the sciatic nerve can be tested, giving an indication of how long recovery will take.
Self Help for Sciatica
Because most cases of sciatica are not serious and are related to irritation, rather than damage, one of the most helpful things you can do is stay mobile and try to maintain your normal levels of activity, including working and gentle exercise.
This may require some modification, particularly if the pain is severe, but bed rest and prolonged sitting are not advised, as they tend to ‘seize you up’ and make symptoms worse.
There does need to be an element of caution and sensibility in applying this – although some pain and discomfort is fine, and may actually desensitise you in the long run, pushing through the pain barrier is not helpful.
A good rule of thumb is that discomfort up to about a 3/10 pain is ok to continue through. Beyond this you should try to modify the activity in some way, be that doing it for less time, more slowly or in a different way, in order to make it more comfortable.
Other things that may be helpful include the use of a cold pack (a bag of frozen peas or rice wrapped in a tea towel works well) or heat (such as a hot water bottle or microwaveable wheat bag) for 15-20 minutes.
Over the counter anti-inflammatories such as ibuprofen can be useful. If you are taking any other prescribed medications or have any pre-existing medical conditions, please check with your GP or pharmacist before taking these medications.
Seeing a Chiropractor for Sciatica
Diagnosis of the most likely cause of your sciatica and the best way to manage it requires a detailed approach.
Chiropractors who are registered with the General Chiropractic Council undertake a 5-year full-time degree including a year of supervised practice in order to ensure that they are experts in diagnosing and treating conditions such as sciatica.
Your chiropractor will take a full history, both of your current episode of sciatica and any previous episodes you’ve had. They will also ask you questions about your medical history to determine if there are any other health factors that could influence your sciatica.
After discussing your symptoms with you, a chiropractor will conduct a thorough neurological and orthopaedic examination.
Neurological and orthopaedic tests help pinpoint the exact reason for your symptoms, informing the type of treatment that is likely to be most effective for you.
After physical examination, your chiropractor will provide you with a detailed explanation of the most likely causes of your sciatica, before advising your how you can manage it at home and your options for treatment, both short and longer term. You will have chance to ask any questions you have about your symptoms.
At Worcester Chiropractic Clinic treatment is usually carried out on your first appointment so that you can start to get some relief as soon as possible.
What are my Treatment Options for Sciatica?
In addition to the self help measures outlined above, there are numerous treatment options for sciatica. These can be broadly categorised in to Conservative or ‘non-invasive’ and Invasive approaches.
Because sciatica is rarely serious, all conservative management options should be exhausted before more invasive options are considered.
Manual therapy, such as chiropractic care, has been shown to be a very effective way to manage sciatica, especially when it is used in combination with home exercises and lifestyle advice.
Manual therapy may include spinal manipulation, joint mobilisation, massage, dry needling (a western medical form of acupuncture) and kinesio-taping.
Your chiropractor will discuss the types of manual therapy with you and decide, based on your pain, medical history and personal preferences, what types of treatment would be best suited to you.
Current guidance suggests up to 12 sessions of manual therapy, including chiropractic manipulation, for treating sciatica. A recent clinical audit at Worcester Chiropractic Clinic suggests that the majority of sciatica patients get better within half this number of sessions.
Home exercise is an important aspect of treating sciatica. Core stability exercises help to take pressure away from your spine and can prevent recurrence of sciatica.
Chiropractors can guide you through the best exercises for your symptoms, based on the findings of physical examination.
Some prescription medications can be useful in the management of sciatica, including weak opioids such as codeine, and some medications aimed at targeting nerve pain. You would need to discuss these options with your GP.
Invasive treatment should only be used if all conservative management options have been ineffective and patients have strictly adhered to a regime of home exercises for around 3 months. This is typically the point at which imaging such as an MRI scan may be considered.
The first line option of invasive treatment is usually a form of injection – this is either an epidural injection, which targets the sac encasing the spinal cord, or a nerve root injection which targets the nerve as it exits the spinal column between the vertebrae.
Both types of injection use a mix of anaesthetic and corticosteroid (a strong anti-inflammatory drug) to provide pain relief and to calm down any inflammation present.
It is important that injections are combined with spinal rehabilitation as there is a finite number of times injection therapy can be used before the risk of side-effects becomes too great.
There are now very few surgical options offered for sciatica as the benefit is frequently minimal for the risks of the procedure.
The most common surgeries used are spinal decompression surgery, which involves shaving away bits of bone that are causing compression around a nerve, or a microdiscectomy, which involves removing part of a bulging disc.
Again, spinal rehabilitation is an essential step for resolving sciatica even if surgery is required.
Book an Appointment
You can book an appointment to have a chiropractor assess your sciatica by filling in the form below.
Will Sciatica Get Better?
Almost certainly yes, with the correct management, sciatica will go away. If you do nothing, there is a chance that sciatica will get better on its own, but this tends to take a long time and the sciatica is more likely to recur.
Why is Sciatica Worse in the Mornings?
It isn’t always the case, but often sciatica is worse in the morning. The reason mornings are worse is because of inflammation. Inflammation, caused by irritation to the sciatic nerve and day to day activity, can be thought of as an accumulation of fluid. When you are moving around, this fluid gets pushed about, preventing it from accumulating. When you are stationary for a time, such as overnight, the fluid accumulates and exerts pressure on the sciatic nerve. This causes more severe pain for a while, until you have moved around enough to disperse the fluid.
Why Does Sciatica Occur During Pregnancy?
Pregnancy-related sciatica is fairly common. There are two main reasons for sciatica to occur during pregnancy. Firstly, there is an increase in the mechanical load on the lower back, aggravating previous disc bulging. Secondly, a woman’s body retains fluid during pregnancy, meaning tissues swell and can exert pressure on nerves more easily. Pregnancy-related sciatica is usually easily treated, and our chiropractors have additional training in the care of pregnant patients.
What Does Sciatica Feel Like?
This is a difficult question to answer, since everybody’s experience of pain is individual. Sciatica can vary from a mild tightness in the back of the leg, right through to the most severe, unbearable pain imaginable. Sciatica always affects the back of the thigh and can travel through the buttock and into the lower leg and foot. You do not have to have back pain with sciatica. Sciatica can also cause numbness and pins and needles. Interestingly, there is no relationship between the severity of pain and the amount of pressure on the sciatica nerve. Some people can have huge amounts of pain from a very mild squeeze of the sciatic nerve, and others have almost no symptoms despite massive compression of the sciatic nerve.