I see many patients with sciatica in my Southampton clinic. Sciatica symptoms are quite easy to recognize. When sciatica hits, one can hardly move. The pain can be excruciating but different people will experience it in different ways. Most sufferers recover within 6 weeks, but pain may take even longer to resolve. Sciatica affects between 10% to 40% of the population. People around the age of 40 years are more at risk. Around 33% of people, may have persistent symptoms up to 12 months. Sciatica affects people in certain types of occupation where physically strenuous positions are used. Repetitive movements, especially when handling heavy items may be risky in long term. This is why it is important for employers to understand that. You should have your workplace assessed and adapted to your needs, not the other way round.
What is sciatica?
It is all to do with the irritated, compressed, or inflamed sciatic nerve. The sciatic nerve comprises spinal roots from spinal segments L4 and S3 (bottom end of your spine). It is a bulky type of nerve, up to 2cm in diameter. It leaves the pelvis through the greater sciatic foramen where it runs under the piriformis muscle (a very common site for nerve entrapment). The nerve then runs along the back of the thigh, into the leg, and finally terminates in the foot.
Sciatica is not a medical diagnosis. It is a term used to describe a set of symptoms usually caused by an underlying medical condition. For example, you may have sciatica as a result of
- disc herniation
- lumbar stenosis
- degenerative disc disease
- muscle spasm
- sacroiliac joint disfunction
What I stress to patients is that what they do outside the clinic room is very important. Here are some key tips I give to my sciatica patients:
- Check bed mattress – is it firm enough? Contact me should you need further advice on this
- Have you noticed what activities cause you more pain? Is there any chance to do them differently? Triggering pain is making rehabilitation and recovery difficult hence we need to avoid triggers by modifying or avoiding certain activities. This we oftentimes cover in the clinic
- Do you use lumbar support in your car or whilst sitting? Supporting your back in the first days of sciatica onset is critical
- Bed transfers – do you know how to get up without triggering the pain?
- How do you transfer from sitting to standing?
- Do you sleep well? In what position? Sleeping on the side with adequate support in the form of a pillow between your legs and under your back is important.
Assessment starts from the moment patient enters the clinic room. Sciatica usually affects the way patients walk, breathe, position their torso. In the bid to avoid pain patients often remain in an antalgic position (side bent position). Forward bending in most cases will be painful. There are several tests that can help with the diagnosis with the slump test, straight leg raise tests, being frequently used in physiotherapy clinics. To rule out other conditions physiotherapists should carry out also other tests. For instance, the involvement of the sacroiliac joint should be excluded
Symptoms of sciatica
- One-sided pain spreading from the lower back down the leg It may affect your buttock, back of your thigh, calf, and reach the foot.
- Pain is likely to be very intensive and disabling. Patients often can’t move and decide to rest in bed instead.
- Muscles around the injury go into spasm in a protective mechanism. They will feel very tight and can make the pain even worse.
- Patients may feel a burning sensation around the low back and buttock
- Patients may remain in the position that offloads the spine hence avoiding the pain. Leaning to one side, away from the pain, is common
- Driving a car may not be possible due to pain for a few days, or sometimes longer
- Walking may be very painful
- Small movements of your head, torso, upper and lower limbs can trigger the pain
- Flexing the spine may bring temporary relief
- There may be a loss of muscles strength and function
- Pins and needles
- Stress, anxiety, feeling tired
Sciatica exercises for sharp pain
Sciatica – like conditions
Sometimes, other conditions may mimic sciatica. For example, in the sacroiliac joint disorders, patients may have pain in the buttock, lower back, groin. Also, other spinal nerve entrapments may be similar to sciatica. Pudendal nerve, femoral nerve, or obturator nerve entrapments are frequently mistaken for sciatica. However, the pain will be affecting the front and inside of the leg, groin, and genitalia. inAppropriate testing as part of clinical examination is critical as it helps to distinguish between these conditions and choose the right therapeutic approach.
Sciatica exercises – rehabilitation at home
The acute phase requires a gentle approach. You can do a few exercises that will allow you to soothe the nervous system and relax the spinal muscles that make the pain even worse. Try these three key exercises below in the first 3-4 days of sciatica onset. Slowly but gradually the pain should start easing off and move from your leg toward the spine. Breathing slowly and deeply is key in all the below exercises. If you hold up your breath, your body will tense up, and you may not see much improvement. Actually, this can even lead to more pain.
Sciatica exercises for acute pain
Download PDF – Sciatica exercises
Sciatic nerve gliding (flossing) – exercise
The exercise below is recommended for the reduction of pain. It often forms part of the rehabilitation program patients can complete at home.
Sciatica or emergency?
Remember, sciatica related pain is likely to subside within days and become more manageable. Sometimes, if the pain does not go away after 4-6 weeks, it is advisable to see a specialist or your GP.
There are some serious symptoms that you may have back pain with. If these occur, do not ignore them, contact an emergency department right away
Inability to pass urine
Inability to stop a bowel motion or leaking
Numbness in or around your back passage, buttocks, or between your inner thighs
A change in ability to get an erection
If you have pain in both legs and/or worsening weakness in the legs
Some useful information on sciatica you can find on the NHS page.
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Chartered Physiotherapist and Master Myofascial Therapist. In the NHS since 2008; I currently work in the community as a Physiotherapy Team Lead. I also run a specialist back pain physiotherapy service in Southampton, UK. Follow me on social media.