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Sciatica S.O.S.: What a pain in the butt!

Updated: Aug 16, 2023


Sciatica is a common condition that affects millions of people worldwide. However do you really know what sciatica is and why it is often referred to as a pain in the butt?





Sciatica describes pain that radiates along the sciatic nerve. The sciatic nerve is made up of nerves from the spinal segments of L4-S3. These spinal segments are located in your lower back. Once these nerve roots exit the spinal column in the lower back they join together to create the sciatic nerve. The sciatic nerve then travels through the bottom, into the hamstring (back of the thigh) to the back of the knee. Here the sciatic nerve splits into two branches which then continue down through the back of the calf and into the foot.


The sciatic nerve can therefore be impinged at any point along its course. The most common places however are at the origin of the spinal nerves, in the lumbar spine, or in the buttock where the sciatic nerve is formed.






Causes of Sciatica:

The most common causes of sciatica are:

  1. Herniated Disc: A herniated, bulged, or ruptured disc in the lumbar spine, particularly at the levels of L3-S3, can result in an increased pressure on the spinal nerve resulting in pain along with sensory changes, such as numbness and tingling or even weakness along the pathway of the nerve

  2. Spinal Stenosis: This condition occurs when the spinal canal narrows, putting pressure on the spinal nerves as they are exiting the spinal canal

  3. Degenerative Disc Disease: As we age, the discs in our spine can deteriorate, causing pain and discomfort. This can also result in increased pressure being put on the spinal nerves

  4. Spondylolisthesis: This condition occurs when one vertebra is unstable and slips on the vertebra below which could result in it pressing against the spinal nerve.

  5. Piriformis Syndrome: This condition occurs when the piriformis muscle in the buttocks compresses the sciatic nerve.



Symptoms of Sciatica:

The most common symptom of sciatica is pain that radiates from the lower back to the buttocks and down the leg. The pain can be severe, and is often described as a shooting pain, it may be accompanied by numbness, tingling, or weakness in the affected leg. Some people may also experience lower back pain. The pain is often made worse by prolonged periods of sitting or standing and can be quite debilitating.


  • Pain in the lower back or buttocks that radiates down the back of one or both legs

  • Sharp, shooting pain that feels like an electric shock

  • Tingling or burning sensation in the legs or feet

  • Numbness or weakness in the legs or feet

  • Difficulty standing up or walking due to pain

  • Worsening of pain after prolonged sitting or standing

  • Pain that is worse on one side of the body





Treatment of Sciatica:

The treatment of sciatica depends on the underlying cause of the condition. In most cases, the pain can be managed with non-surgical treatments, such as:

  1. Manual Therapy: Osteopaths, Physiotherapists, Chiropractors and RMT can help relieve current pain by relaxing tightened muscles, increasing joint range of motion and prescribing an at home exercise program focused on strengthening and stretching around the sciatic nerve

  2. Medications: Pain relievers, anti-inflammatory drugs, and muscle relaxants may be prescribed to relieve pain and inflammation. These are helpful in an acute flare up but should not be used as the only method of treatment. Appropriate exercise prescription is a must for any long term relief

  3. Heat and Ice: Applying heat or ice to the affected area can provide temporary relief from acute pain.

  4. Injections: Corticosteroid injections may be recommended to reduce inflammation and relieve pain. This method should be tried once manual therapy has been tried

  5. Surgery: may be necessary in some cases, such as when the compression is caused by a herniated disc or spinal stenosis. Surgery is the last treatment option that may be necessary once all conservative treatment options have failed. It is important to note that it is important that an exercise program and lifestyle modifications have been discussed and not to solely rely on surgery.



How can Manual Therapy help?

Manual therapy techniques such as osteopathy and massage therapy can also be beneficial in treating sciatica.

Osteopathy is a type of manual therapy that focuses on the musculoskeletal system and the body's natural ability to heal itself. Osteopaths use gentle manipulations and movements to treat a variety of conditions, including sciatica. Osteopathic treatment aims to improve the alignment and mobility of the spine, reduce inflammation, and improve circulation. Osteopaths may also provide strengthening or stretching exercises and advice to help manage pain and prevent further episodes of sciatica.


Massage therapy is another manual therapy technique that can be helpful in treating sciatica. Massage therapists use various techniques to manipulate the soft tissues of the body, including the muscles, tendons, and ligaments. Massage can help to reduce muscle tension, improve circulation, and promote relaxation. Deep tissue massage, trigger point therapy, and myofascial release are all techniques that can be used to treat sciatica. Massage therapy can also be combined with other non-surgical treatments, such as physical therapy and medications, to provide a comprehensive approach to pain management.


It is important to note that manual therapy techniques such as osteopathy and massage therapy should only be performed by trained and licensed practitioners.


In addition to manual therapy and other non-surgical treatments, making lifestyle changes can also help to manage sciatica symptoms.


Maintaining good posture, engaging in regular exercise, and avoiding activities that exacerbate pain can all help to prevent further episodes of sciatica.



Sciatica is a common condition that can be managed with a variety of non-surgical treatments, including manual therapy, medications, heat and ice, exercise prescription and lifestyle modifications. Manual therapy techniques can be beneficial in reducing pain and improving mobility, and can be combined with other treatments for a comprehensive approach to pain management.


If you are experiencing symptoms of sciatica, contact us today to see how osteopathy could help and find out about the best treatment options for your specific condition and start feeling better today.



By Sarah Nugent, Registered Osteopath,

Treating the cause, not just the symptoms


References:

  1. Internal and external references including but not limited to:

  2. Mayo Clinic Staff. (2021). Sciatica. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/sciatica/symptoms-causes/syc-20377435

  3. NHS. (2021). Sciatica. NHS. https://www.nhs.uk/conditions/sciatica/

  4. Chou, R., Fu, R., Carrino, J. A., Deyo, R. A., & Imaging Professional Quality Assurance Subcommittee of the American College of Radiology Appropriateness Criteria Expert Panel on Spine. (2009). Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet (London, England), 373(9662), 463–472. https://doi.org/10.1016/s0140-6736(09)60172-0

  5. Cohen, S. P., Larkin, T. M., Chang, A. S., Stojanovic, M. P., Christo, P. J., & Wilsey, B. (2009). Systematic review of diagnostic utility and therapeutic effectiveness of cervical facet joint interventions. Pain Physician, 12(2), 323–344. PMID: 19305485

  6. Lee, J. H., Kim, S. K., Lee, S. H., & Kim, Y. H. (2019). Treatment of Sciatica: A Narrative Review. Journal of back and musculoskeletal rehabilitation, 32(3), 315–324. https://doi.org/10.3233/BMR-181298

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