What is Sciatica?

Patients will often present with 'Sciatica' but Sciatica is not a diagnosis and often misused to describe lower back, buttock and leg pain. Sciatica is a symptom of an underlying cause. The sciatic nerve emerges from the spine in your lower back & pelvis, it then passes through the buttock region, into the back of the leg. Sciatica refers to irritation of the sciatic nerve.

Causes:

- Lumbar herniated disc

A herniated disc occurs when the soft inner core of the disc (nucleus pulposus) leaks out, or herniates, through the fibrous outer core (annulus) and irritates the contiguous nerve root.

A herniated disc is sometimes referred to as a slipped disc, ruptured disc, bulging disc, protruding disc, or a pinched nerve. Sciatica is the most common symptom of a lumbar herniated disc.

- Degenerative disc disease

While disc degeneration is a natural process that occurs with aging, for some people one or more degenerated discs in the lower back can also irritate a nerve root and cause sciatica. Degenerative disc disease is diagnosed when a weakened disc results in excessive micro-motion at that spinal level, and inflammatory proteins from inside the disc become exposed and irritate the nerve root(s) in the area.

- Isthmic spondylolisthesis

This condition occurs when a small stress fracture allows one vertebral body to slip forward on another; for example, if the the L5 vertebra slips forward over the S1 vertebra. With a combination of disc space collapse, the fracture, and the vertebral body slipping forward, the nerve can get pinched and cause sciatica.

- Lumbar Spine Stenosis

This condition commonly causes sciatica due to a narrowing of the spinal canal. Lumbar spinal stenosis is related to natural aging in the spine and is relatively common in adults over age 60. The condition typically results from a combination of one or more of the following: enlarged facet joints, overgrowth of soft tissue, and a bulging disc placing pressure on the nerve roots, causing sciatica pain.

- Piriformis syndrome

The sciatic nerve can get irritated as it runs under the piriformis muscle in the buttock. If the piriformis muscle irritates or pinches a nerve root that comprises the sciatic nerve, it can cause sciatica-type pain. This is not a true radiculopathy (the clinical definition of sciatica), but the leg pain can feel the same as sciatica caused by a nerve irritation.

- Sacroiliac joint dysfunction

Irritation of the sacroiliac joint—located at the bottom of the spine—can also irritate the L5 nerve, which lies on top of the sacroiliac joint, causing sciatica-type pain. The leg pain can feel the same as sciatica caused by a nerve irritation.

Symptoms

Usually, sciatica only affects one side of the lower body and the pain often radiates from the lower back all the way through the back of the thigh and down through the leg. Some combination of the following symptoms is most common:

• Lower back pain, if experienced at all, is not as severe as leg pain

• Constant pain in only one side of the buttock or leg, but rarely both the right and left sides

• Pain that originates in the low back or buttock and continues along the path of the sciatic nerve - down the back of the thigh and into the lower leg and foot

• Pain that feels better when patients lie down or are walking, but worsens when standing or sitting

• Pain that is typically described as sharp or searing, rather than dull

• Some experience a "pins-and-needles" sensation, numbness or weakness, or a prickling sensation down the leg

• Weakness or numbness when moving the leg or foot

• Severe or shooting pain in one leg that may make it difficult to stand up or walk

• Depending on where the sciatic nerve is affected, the pain and other symptoms may also include foot pain or pain in the toes.

How Osteopathic treatment can help Sciatica

Osteopaths commonly treat 'Sciatica' and its associated causes. Your osteopath will work on any tight muscles, compressing the sciatic nerve, the joints in the lower back and pelvis that are not moving well and give advice on any stretches or exercises that can be done to relieve the pain.