What you should know about sciatica

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You may have heard people say they’ve got a really bad form of back pain called “sciatica”, maybe that person is you. Well what is it? And what can be done about managing it? In this blog I’ll go through and answer some of the common questions we get about this condition.

What is sciatica?

Sciatica refers to what’s known as bacsciaticak pain with radicular symptoms. Basically, back pain with referred symptoms into the buttock, thigh and sometimes into the lower leg. “Sciatica” is an umbrella term for any back pain that has leg symptoms.

The sciatic nerve (where the symptomatic presentation “sciatica” gets its name from) is one nerve that runs down the back of your leg. When its sensitised is can be painful. However, sciatica symptoms doesn’t necessarily mean the sciatic nerve is aggravated.

For example you may all of a sudden be lifting some boxes at work, or pulling weeds in the garden and feel a sensation of pins and needles going down your leg, or maybe some numbness secondary to a sore back.  Sciatica can develop due to a specific cause or can come on slowly over time for no apparent reason. Sound familiar?  

Different types of sciatica

Usually such symptoms respond quite well to specific movements that are identified through the guidance of physio assessment. This type of back pain responds well and recovery is much quicker.

However sometimes, this is not so easily achieved. This is a different subgroup of sciatica that is much slower to progress. In these instances, there may (but not always) be some underlying features that can cause irritation or tension on the nerves that exit the spine.

Although nerve irritation and pressure can sound scary, the majority will recover well with physio/rehab management. 80% of these unresponsive sciatica presentations recover well within 12 weeks, whilst another 10% can take up to 18 weeks. 

How do I know if I have an unresponsive bout of Sciatica? 

Seeing a Physiotherapist can help determine the nature of your back pain. Throughout a process of assessment and screening, your physio can help you identify and determine the nature of your symptoms and give you a rough expectation for how long it will take you to recover/return to pre-injury health.

Your physio may want to get imaging done in some circumstances where a response to treatment is taking longer than expected. 

What will treatment consist of? 

Once your therapist has screened and ruled out any serious pathologies and determined your episode of pain to be due to an unresponsive sciatica, a conservative approach to treatment is a general course of action. 

In the initial phase, this involves a combination of pain management strategies such as the use of medication, activity modification, spinal & neural mobility exercises which is guided by your physiotherapist uniquely to yourself. 

As symptoms of pain improve, the aim of treatment will be to progress exercise to recover mobility and strength towards pre-injury levels. 

In rarer more intense instances, symptoms aren’t improving during this phase, the option for a TESI (Transforaminal Epidural Steroid Injection) is considered to help aid recovery.  

What if my symptoms are still not improving or if they start to worsen?

If after 12 weeks of conservative management, symptoms in the leg are still not improving more time and careful observation may be indicated.

If symptoms worsen at any point through the process this can suggest it may be worth considering a surgical review with an orthopaedic specialist. Certain presentations of sciatica do well with a nerve decompression surgery. This is where the surgeon will create space (remove the pressure) between the nerve and what’s causing the pressure (commonly the intervertebral disc, scar tissue build up or bony encroachment). 

Surgery is not commonly needed for the majority of people with sciatica symptoms. So it’s always worth getting a thorough examination to determine the best path for you.

By Prash Varatharajah

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