What is sciatica and how do I get rid of it?

What is sciatica?

Sciatica is a collective name for a range of symptoms in different parts of the body. It mainly affects the back and legs because that’s where the nerve fibres that form the sciatic nerve converge. The pain can present across the lumbar and lower back, through your buttocks and down into the foot. The typical signs that sciatica is starting or confirmed are stabbing, aching, throbbing, cutting or radiating pain in the back and/or leg (often affecting only one leg). Numbness, tingling and muscle weakness are also common. It is worth mentioning that sciatica is a symptom rather than a diagnosis and can be treated. The vast majority of people with sciatica improve within 2–4 weeks if they do something about it. 

The most important thing to do with sciatica is to find the source of the problem. Once you know that, you know at which end of the rehabilitation process you should start. The main reason sciatica occurs is because a disc in the lumbar spine has been damaged. This in turn creates pressure against the nerve roots. An injury further away from the spine, such as in the leg, can also cause pressure. Diseases that have some kind of nerve impact can also be factors contributing to the pain.

When should I seek treatment?

To get the right help, it can be a good idea to make an appointment with someone who has advanced training in clinical diagnosis and orthopaedic medicine at an early stage. The earlier treatment starts, the sooner the problem will ease. If you do not feel the need to urinate and/or have a sensation of numbness in the abdomen and rectum, you should seek emergency treatment as there may be major nerve damage which requires surgery.

Diagnosis methods can vary but the most common is to examine reflex, sensation and strength. Other tests, such as MRI (magnetic resonance imaging), CT (computed tomography) and EMG (electromyography), are seen as supplementary diagnosis tools and are only used following a referral. Further investigations become necessary when symptoms have arisen after a trauma and in cases of long-term nerve root pain, marked impairment of nerve conduction or suspicion of serious disease.

What is false sciatica? 

False sciatica manifests itself in the same way as true sciatica, the only difference being that the pain emanates from the muscles and joints rather than the discs. As a result, the pain tends to be less intense and to have less impact on the rest of the body.

How do I treat sciatica? 

There are different ways of treating sciatica depending on the cause of the symptoms.

General advice:

• Seek help from specialists in the field (back-related disorders)
• Learn to understand your spine, where the pain occurs and biomechanics
• Think about your posture and positioning
• Keep active (walking is recommended)

Common treatment methods:

• Mechanical diagnosis and therapy (McKenzie method)
• Core training
• Mobilisation and manipulation
• Soft tissue therapy
• Acupuncture
• Injection therapy
• Back support aids

As with most injuries, there are different phases. In this case, the phases are divided into the acute, sub-acute and healing/prevention phases.

Acute

As the pain can be very intense, many people’s instinct is to lie flat in bed and wait for it to pass. Unfortunately, it doesn’t work that way. This is not to say that you should force yourself through the pain, but it is good to try to keep active as much as possible.

• Stay as active as possible. Walks are recommended.
• Avoid activities that you feel increase your back pain.
• Make movements in the opposite direction to the one that aggravates the pain (for example, bending your back backwards).
• Support your lower back by holding a pillow against your lower back when sitting.

Subacute

• Continue to be active and move around
• Avoid straining your back and try not to bend forward more than absolutely necessary.
• Continue to do exercises that reduce pain and symptoms. 

Healing/prevention

It might sound like nagging, but keep exercising. It is not uncommon for sciatica to recur, so it is important to continue to treat it yourself. To ensure your discs are strong enough to last a long time, you need to strengthen your core, hips, thighs and back properly. It is a good idea to supplement strength training with some form of load-compensating exercises, such as different variations of back bends.

Can I massage away the pain?

Massage can be very helpful for sciatica because it reduces stiffness and therefore the worst of the pain. Flowgun and/or Flowpillow Heat can be used to complement your stretching and mobility exercises.