In my Bracknell area osteopathy clinic I see many people with the same set of conditions over and over again. Sciatica is one of the most common conditions I see in both clinics. Sometimes it can come on suddenly, and sometimes it develops slowly over time.
What causes sciatica pain?
Sciatica is not a diagnosis but a description of leg pain and other symptoms you can feel in your buttock or leg, and sometimes alongside back pain. Sciatica is a word that describes the back pain, buttock pain and leg pain that is caused by pressure on the sciatic nerve. This is a symptom, rather than a condition simply because many things can cause this feeling – anatomical variations, arterial problems, even a rare form of gout! You may also hear “sciatica” used to describe leg numbness, tingling or other odd sensations like hot water being poured onto your foot.
Sciatica pain can be very debilitating. The most common cause of sciatica is a disc herniation, where a bit of the disc tissue between the spinal vertebrae pokes out beyond where it should. This is not the only cause, however – there are many potential causes including muscle compressing the sciatic nerve is it runs through the buttock, or nerve root irritation caused by facet joint inflammation. Essentially anything that can annoy the nerve at some point near where the nerve roots leave the area of the spine can cause what we call sciatic pain.
What causes sciatica?
Disc Prolapse or Herniation
The most common cause of sciatica is a disc herniation. But don’t despair! Did you know that a huge percentage of men over the age of 50 with no back pain — something on the order of 78% — have been found to have disc prolapses? There are many studies like it, but this particular one was a study on hips, and as part of the process they had to review hip and low back MRIs of men without back pain (as it could have confused the results). On reviewing these MRIs, 78% of them had disc prolapses. (This is one reason why we don’t routinely do imaging – results are often misleading. You can read the NICE Guidelines for more information.) Having a disc prolapse does NOT mean you are going to have sciatica, and sciatica can be caused by other things.
This doesn’t mean that the men in that study always had a disc prolapse. Discs usually heal within 8 to 12 weeks. Herniations also tend to recede/pull back inside as we get older and are less likely to prolapse when older – so in older people who have a sudden onset of sciatic pain we are sometimes looking for a different cause. The sciatic nerve can become irritated as it passes between the joints in the back, as well – and often in older people there’s a little bit of wear and repair process going on in the low back. Occasionally, in some people,, this wear and repair process can irritate nerve roots.
Much more rarely, tight muscles in the buttock area (piriformis) can be a cause of sciatica. Piriformis is often blamed for sciatica but actually that muscle is only a real problem in about 5% of cases. Those people frequently will have an anatomical variation where the nerve runs through the muscle instead of underneath it, which in some people makes it more susceptible to irritation.
A muscular cause of sciatica can occur at any age, however, the herniated discs causing sciatic pain are more common in younger people. Occasionally, an older person with spondylosis can have sciatic pain.
What can I do to prevent sciatica pain?
Some of the things that cause sciatic pain can be minimized by being at a healthy weight and maintaining an active lifestyle. Sitting posture changes can be key in reducing sciatic pain, as more pressure is placed through intervertebral discs when sitting than in any other position – and when seated the hip is bent forward which stretches the nerve in the back of the leg.
Sciatic pain can also be generated by stress – when we have had an old injury, even if it’s healed, stress can flare up the pain again. This is a result of what we call ‘central sensitisation’. It is an extremely common cause of longstanding chronic pain.
There are many potential causes of sciatic pain and it’s important to get this kind of pain checked out by a qualified person. If the sciatica is mechanically generated, then it can be helped by very gentle manual therapy to reduce some of the associated spasm and compensation, exercise rehabilitation to create extra space between the joints and get things working well again, and neural flossing in order to help desensitise the nerve.
In very rare instances, sciatica will need immediate medical attention. If you have pain all the way down both legs and difficulty controlling your urine or bowel, or feel numbness in your saddle area and genitals, this could indicate a very serious condition that requires immediate medical treatment. If this sounds like you, go to A/E.
Rehabilitation and Treatment of Sciatica
Sciatica pain is treated as the symptom of whatever the underlying cause is suspected to be. As sciatica is often in part generated from the back, approaches using manual therapy, strengthening and movement rehabilitation for the trunk, back, gluteals and lower limbs is often undertaken. Home exercise is extremely important, as often a person’s pain over time can cause them to be conditioned or to ‘get out of shape’. Treatment will usually resolve most sciatica but if conservative care doesn’t work or if new or unusual symptoms develop you might be sent for additional screening tests.
Pain education in sciatica
In longstanding sciatica pain, one of the most important interventions with sciatica is approaching the sciatic pain from a cognitive-behavioural point of view. Understanding the pain, and what contributes to it in your life, is proven to help with the pain all on it’s own. When you understand what’s causing your pain and you understand what is exacerbating your pain, it can make you less afraid, and it makes you more likely to think positively about your outcome. The number one predictor of long-term chronic pain development is fear and fear avoidance, and this is why I always include time for pain education in my work with people with longer-standing pain.
If you’ve got pain, please do book in with me either at the North Ascot clinic. I would be happy to help