Sciatica is the term used to describe back pain which radiates down the leg and is a symptom itself rather than a specific diagnosis. Sciatic nerve pain can be caused by a number of factors although a ‘disc involvement’ is one of the most common.

Symptoms

Sciatica pain usually but not always starts with acute low back pain radiating down into the buttocks, back of the thigh and lower into the legs.

It may be sharp or acute and be accompanied by tingling, pins and needles or numbness.

Sciatic pain is often triggered by a minor movement such as bending over to pick something up.

Symptoms are often made worse by sitting, coughing or sneezing.

There may be tenderness & muscle spasm in the lower back with trigger points and tenderness in the buttock muscles.

Causes

The medical term for sciatica is acute nerve root compression or radiculopathy which is pressure on the sciatic nerve resulting in symptoms of numbness, pins and needles and pain.

Nerve Root

A prolapsed disc, herniated disc or slipped disc as it is sometimes known is not simply a disc that has slipped out of place.

Intervertebral discs separate the vertebrae, they function as shock absorbers and allow movement.

They quite happily allow forwards and backward movement, sideways movement, and twisting. However, a combination of the two can put excess stress on the spine and damage the discs.

The intervertebral discs are filled with a gelatinous substance in the middle called nucleus pulposus and when a disc prolapses this jelly-like centre squeezes out and puts pressure on the spinal cord compressing the nerve routes and causing pain.

Depending on where the sciatic nerve is pinched will determine where the pain radiates.

Radiculopathy

The sciatic nerve runs very close to this muscle and tension in the muscle can cause compression of the sciatic nerve resulting in buttock pain which radiates and down the leg.

It is sometimes difficult to distinguish between sciatic pain caused by a disc problem, or piriformis syndrome.

Generally, with piriformis syndrome, there will not be any lower back pain and there is usually a less well-defined point of injury

Anatomy

The sciatic nerve is the largest nerve in the human body and is formed by the union of 5 nerve roots from the lower spine. It passes deep in the buttock and down the back of the thigh all the way to the heel and sole of the foot. The sciatic nerve serves a vital role in connecting the spinal cord with the skin and muscles of the thigh, leg and foot.

Treatment

Treatment options really depend on the cause of the injury and the extent of the symptoms. Pain relief is the first priority.

Severe cases which are usually caused by a prolapsed or slipped disc often require surgery although conservative treatment is usually tried first.

In less severe cases and those caused by piriformis syndrome, less rest is required. Rest from activities which aggravate the condition only.

Keeping moving if possible is important.

Gently stretch the hamstrings and buttock muscles.

Apply heat therapy to help ease muscle spasm.

Sports massage usually works particularly well for piriformis syndrome.

If your sciatica is caused by a lumbar disc prolapsed then extension exercises are recommended to help reduce the compression of the disc on the nerve root.

After the acute painful phase, you will be encouraged to restore pain-free movement in your back through mobilization and stretching exercises. Re-education on posture and correct lifting techniques are learned and maintained

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