Sciatica

The problem

Sciatica is a pain that radiates along the sciatic nerve from either the lower back or buttock and into the leg and foot. Sciatica typically affects one side of the body but can affect both legs.

Sciatica occurs when the sciatic nerve is impinged and irritated. Most commonly this results from a herniated or bulging lumbar spinal disc pressing on a lumbar or sacral nerve root. Other spinal causes of sciatica include spondylolisthesis (the slipping of one vertebra relative to another) and spinal stenosis of the lumbar spine (the reduction of space for neural and vascular tissue in the lumbar spine as a result of narrowing of the spinal canal).

Sciatica can also have a non-spinal cause such as piriformis syndrome, pregnancy or as a complication of a medical procedure such as the fitting and wearing of a cast. Piriformis syndrome covers several conditions but is most commonly a result of trauma to the buttock muscles resulting in inflammation and muscle spasms and resulting compression of the sciatic nerve which passes close to the piriformis muscle.

Understanding your pain

As with other specific conditions that can be addressed with manual therapy, it is important to first understand the history of your sciatic pain before a diagnosis can be made. This involves asking you: to describe your symptoms; when and how your symptoms started; which activities provoke pain or dysfunction and so on.

The history you give me guides me in making an appropriate physical examination of the affected area and surrounding tissue including joints above and below the affected area especially around your lumbar spine, pelvis and hips. The examination might include observation in standing and on the treatment couch, palpation of the area as well as special tests such as the straight leg raise test.

Treatment

Treatment consists of applying appropriate manual therapy techniques such as soft tissue massage, joint mobilisation and stretches to the appropriate tissue. Sometimes this means a focus on the area of pain and sometimes this means relieving surrounding tissue that may have become painful or restricted either because of adaptations you have made to accommodate your sciatica or issues that are affecting the sciatica directly.

During the treatment we can discuss possible lifestyle adjustments you could make to relieve your symptoms and allow healing to take place these might include discussing your work place habits, your posture or how you lift, including how you lift young children if that’s relevant to you. We can also discuss whether a graded exercise programme is appropriate for you and if so I can take you through the relevant exercises after the manual therapy treatment.