Sciatica - What it is and what to do about it.
Sciatica is a very common condition that affects many of us at some point in our life. Sciatic pain is typically a sharp electrical pain or dull ache that radiates down either one or both legs. The more swollen and irritated the nerve is, the further down the leg the pain goes. Typically the pain is felt in the lower back, buttock and leg, though some only feel pain in their buttock and/or leg. The sciatic nerve is the largest and longest nerve in the body. It is made up of nerves from the 4-5th lumbar, and 1st-3rd sacral nerve roots. Nerves are normally able to handle compression and stretching that is part of day to day living without causing problems. Due to some traumatic event, or an unusual or prolonged activity, i.e. bending and twisting in the garden all weekend, or a long drive, the nerve can becomes swollen (inflammation). Sciatic pain is often associated with changes to the structure of the spine, i.e. degenerative changes such as degenerative disc disease, disc bulging and herniated discs, etc. Though it is important to understand that these degenerative changes are not always the cause, many of us have herniated discs and will never know it! The degenerative changes themselves are typically not enough to create the sciatic pain. It is the overdoing what are body can handle that causes the problem. The swelling is a signal for the brain to protect the area causing the back and/or leg to become painful and sensitiized. The swelling and sensiitization can then make movements and postures of the back and leg very uncomfortable.
Sciatic pain is usually worse with either sitting or walking/standing. Sometimes the pain is worse with both. Sciatic pain can come on very suddenly or can be gradual in nature. Sciatic pain maybe also present in signs of nerve compression like pins and needles, loss of feeling or loss of strength in the leg muscles.
Sciatic pain can typically be managed very well with a combination of manual physical therapy, activity/posture modification, time and medication.
The manual physical therapy first starts with a history taking to identify where the pain is, what has caused or is causing the problem, what you have found worsens or eases the pain, any other past medical history, medications, hobbies, sports, work, etc.
The physical exam will involve:
- Looking at your mobility to see if particular motions increase or decrease the pain.
- Testing the physical health of your nervous system.
- Palpation and mobility testing of the vertebrae.
- Testing movement and/or positions to determine which relieve or aggravate the leg pain.
Once the physical exam is completed treatment can be undertaken. There is good evidence that Manual Physical Therapy will get you better more quickly. Treatment can consist of:
- Manual therapy techniques directed at improving vertebral mobility to open the space or take pressure off the nerve.
- Exercises designed to improve mobility, open the space for nerve and/or reduce tension on the nerve.
- Education on pain management strategies, postures, sleeping position and activities to help reduce the pain.
- Physiotherapy modalities such as electrical stimulation, heat and ice to help with pain.
- Lumbar traction can be performed in a variety of positions to help reduce pain.
At home it is important to:
- Be patient and relax. There are lots of scary stories and words associated with sciatica i.e. 'slipped discs', 'pinched nerves', etc. Our body does an amazing job in dealing with the stress and strains we put it through. Our body and nervous system does well dealing with the natural wear and tear we go through as we age. Sometimes we over do it, then we need some treatment and need to let things settle down. The more stressed and anxious you are, the worse the pain will be. Deep breathing and progressive muscle relaxation exercises can really help.
- Find and use the positions and postures your manual physical therapist has suggested.
- Try to remain as active as the pain will allow. Some discomfort with moving around is normal. Research has proven that keeping active i.e. puttering around (stand a little, sit a little, walk a little) will allow you to get better quicker.
- Find and use sleeping positions that will help alleviate the pain.
- Use ice and/or heat. If the pain is less than 48 hours old use ice. Use heat if the pain has been present for more than 48 hours. Heat can be in the form of hot showers, an electric heating pad, a microwaveable pad or hot water bottle.
- If the pain is constant you may benefit from anti-inflammatory medication. If the pain is keeping you from sleeping you might consider a muscle relaxant. If the pain is unbearable then you might consider a pain reliever. It is best to discuss this with your physician.