Sciatica is pain from your lower back extending down the back of the leg to the calf / ankle. The sciatic nerve is travels from your lower back to your knee where it splits into the tibial and common peroneal nerves. When the nerve itself is irritated by inflammatory chemicals or direct pressure from another tissue, the feeling of intense sharp or burning pain and tingling / numbness are often reported in the regions that the nerve supplies. Sometimes weakness in the muscles of the leg also occurs. Sciatica is therefore the description of the pain rather than the problem itself. The cause can be a herniated disc; joint / bone osteophytes (growths relating to degeneration of the joints / spine); sponylolisthesis (forwards slip of a vertebra); or sometimes a muscle in the hip (piriformis muscle) can pressure the nerve.
Diagnosis of sciatica:
Sciatica is often misdiagnosed because there can be many causes of pain in the back of the leg. Understanding the cause or where the pain is coming from is important to determining the best treatment. A thorough examination is important for a clinical diagnosis. If the pain is true sciatica coming from the lower back then investigations are often recommended. Your physiotherapist will test muscle strength, skin sensation and tendon reflexes. Referral to a medical practitioner or specialist is usually recommended if these tests are positive. Xray, CT scan and MRI are the most common investigations to help confirm the clinical diagnosis and understand if and where the nerve is being irritated / compressed and what the best course of treatment is.
Treatment of sciatica:
Treatment is dependent on the clinical findings and investigations. Managing the pain and inflammation via medications is recommended and your GP is most helpful to advise you on what to take. Once severe pain settles improvements can be managed by changes to posture and movement habits. Restoring mobility and strength is introduced once there is no increase in symptoms associated with exercise. Water based exercise can be helpful in getting you moving whilst the pain is present.
Surgery for sciatica:
Surgery is sometimes recommended if the conservative treatment (non-operative) approach doesn’t help or if there is the risk of permanent nerve damage. Bowel or bladder dysfunction associated with low back pain or sciatica symptoms or extreme muscle weakness in the leg(s) requires urgent medical assessment and may require emergency surgery.