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Sciatica

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Introduction

Sciatica is a common term that is used to describe radiating pain in the back of the leg. It is usually caused by either compression or inflammation of the sciatic nerve roots. The sciatic nerve roots leave (or exit) the spinal column from the lowest part of your low back and then travel into the back of the leg and down to the foot.

Signs & Symptoms

People with sciatica often describe sharp or shooting pain down the back of the leg which is often felt in the buttock, hamstring or calf. This may be accompanied by low back pain. The patient may also report pins and needles, tingling, altered sensation or a feeling of weakness in the affected leg.

 

The pain may have a sudden onset or be more gradual in nature, and the severity varies from person to person. Some patients complain of mild episodes of pain whereas others complain of severe pain that significantly impacts on their life.

Causes

Sciatica, which may also be known as radicular pain, is caused by inflammation of the sciatic nerve roots in the lumbar spine. The cause of inflammation may be direct compression of the sciatic nerve from one of the lumbar spine discs, or inflammation of structures that surround the sciatic nerve such as the intervertebral joints or spinal ligaments/muscles.

 

Inflammation of the nerve root causes sensitivity and referred pain, which follows the distribution of the nerve into the leg. The inflammation and sensitivity of the sciatic nerve may be accompanied by other symptoms, such as pins and needles, numbness or the sensation of weakness in some areas of the leg.

Assessment & Diagnosis

Sciatica is normally diagnosed based on what the patient tells their healthcare professional and a physical examination. Your specialist Physiotherapist can give you a definitive diagnosis so that the most effective treatment and management can quickly begin. They will work with you to create goals tailored to what it most important to you. We provide regular re-assessment to track your progress and make any necessary adjustments to your management to help achieve the best possible outcomes.

 

An MRI scan is rarely needed to diagnose sciatica and should only be reserved for specific cases that present with additional, rare or worrying features which are explained in detail here.

Self-Management

Most patients improve well over time with conservative care and rarely require any further treatment. In a recent study within UK primary care over 55% of patients with sciatica improved well with conservative care, including physiotherapy. Only 11% of patients required any additional input. It is important to note that symptoms may persist for some weeks and adherence to exercises is important over the long term.

 

Your Physiotherapist will educate you on the condition and provide you with useful strategies to help address your symptoms at home. Initial management is aimed at controlling pain and improving function whilst inflammation and pain settles and improves. Patients may be prescribed pain relief to manage pain, anti-inflammatory medication to reduce inflammation of the nerve or specific pain medication aimed at reducing the nerve sensitivity. These medications may often be prescribed short term to enable you to get moving and engage with any rehabilitation or exercises.

 

Your Physiotherapist may also discuss ways in which you can change the way you perform your usual activities so that you can remain functional and continue to work. Activity modification and pacing strategies are useful tools that may be suggested.

Physiotherapy

physiotherapist helping a patient with back pain by treating Lumbar spineExercise and manual therapy are recommended within guidelines for the management of sciatica and your Physiotherapist can guide you on the most appropriate exercises.

 

Manual therapy techniques include soft tissue mobilisation, deep tissue massage and joint mobilisations which can be useful in reducing pain and improving range of motion, assisting in keeping you functional.

 

The role of exercise is to mobilise, stretch or strengthen the low back and other exercises may help to mobilise the sciatic nerve. Exercises may need to be done for several weeks to ensure maximum benefit. The Physiotherapist will give you guidance on whether pain is allowed during the exercises and how frequently these should be performed. They will prescribe you with a tailored exercise plan that will be altered in line with your progress and will eventually be geared towards strengthening and preventing re-occurrence, alongside the ongoing advice and support that you will be given.

Escalation of Treatment

In persistent and severe cases, you may be referred to see a specialist who may suggest an injection of a pain-relieving substance around the sciatic nerve. This is a specialist service and should only be offered to patients who have not responded to conservative treatment over several weeks or months.

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