The sciatic nerve is the longest and thickest nerve in the body. Nerves roots exit the spine from the levels L4-S3 and join together to form the sciatic nerve. It supplies the sensation and muscles of the leg. Sciatic pain can come in many forms. It can cause excruciating pain deep in the buttock, down the back of the leg, the ankle, the foot. It can cause pins and needles, numbness and weakness in the leg and the foot.
It's said that around 40% of people will suffer from sciatica once in their life time. Sciatica simply means pain in the sciatic nerve. There can however, be a few causes of pain which normally arise because the sciatic nerve is compressed by the structures it lies next to, or pierces through.
Prolapsed disc - AKA herniated disc or disc bulge
A disc can bulge and press onto the sciatic nerve. This is very painful indeed. Symptoms can include pain that is worsened with coughing, sneezing, blowing your nose. Sitting and bending is unbearable. Herniated discs can improve but occasionally surgical intervention is needed to solve them.
***Symptoms that require urgent medical attention***: numbness in the 'saddle' area in between the legs; from the genitals to the anus, difficulty passing urine and loss of control of bowel movements, severe pain and symptoms of numbness down both legs at the same time. These symtoms are a sign of cauda equina syndrome and could require urgent surgery to prevent long term damage to these areas.
Facet (spinal) joint and sacroiliac joint inflammation
These joints are formed at the back of the spinal column and pelvis, close to where the nerve roots exit the spine. Dysfunction and inflammation of one of these joints can irritate the nerve and cause pain.
A very common is piriformis syndrome. This muscle in the back of the hip/deep buttock can spasm/tighten or become strained- often due to repetitive pressure from sitting, or for example a fall which then can irritate the nerve. In some people the nerve runs through the muscle, so when it goes into spasm it clamps around the nerve! You can imagine how painful that can be!
When degeneration of the spine has become so severe, the joints and discs deform and start to impinge on the nerves before they exit the spine. It gets worse with walking, but the pain is greatly relieved by walking with a shopping trolley - or when cutting the grass! The stooped forward posture takes the pressure off the nerves by opening the worn joints.
Like with any pain, the cause can be from other pathology including cancer. Red Flags for this include unremitting pain, which is worse at night and not aggravated or relieved by movement. Other symptoms: night sweats, loss of appetite, unexplained weight loss, change in bladder or bowel pattern and general feeling of malaise. It goes without saying that a visit to your GP is highly important if you are experiencing this.
How can an Osteopath Help?
When you visit us for an appointment we ask a load of questions, perform movement and orthopaedic tests to find out where your sciatica is coming from, and to check the level of compression of the nerve. We then treat accordingly and give you exercises to help continue the healing process. We explain what we've found and what we will do. Treatments include massage, mobilisations and if certain criteria fits we might manipulate too. It really depends on what we find on the day.
If you have sciatica and want it diagnosed and fixed, come in and see one of our osteopaths or our sports therapist today. Call or book online.