Sciatica can be severe and debilitating. In this article, we take a look at sciatica and its causes and symptoms. We cover some danger signs to watch out for. We then talk about how osteopathic treatment for sciatica can help.
What is sciatica?
Your sciatic nerves are your body’s largest – around 2cm thick at their widest point. No wonder they can cause such a lot of pain!
The sciatic nerve starts out as a grouping of nerve roots that exit from the spinal column in the lower back. The nerve then works its way through the buttock and down the back of the leg. Near the back of the knee, it splits to form two nerves that pass into the lower leg and foot.
That’s why irritation of a sciatic nerve can give symptoms in the buttock, leg and even the foot.
It’s important to note that sciatica is just a symptom, it’s not a condition in itself. A painful nerve is telling you that it’s being compressed or irritated by something else in the body. The key is to find the cause.
The first sign of an unhappy sciatic nerve might be a tingling sensation, usually under your foot. If the nerve continues to inflame, you’ll get sharp, shooting pains. You might feel these from buttock to thigh, and sometimes into the side of the lower leg or foot. You might also start to notice areas of numbness. If things progress, you can have weakness in the leg or foot. You might notice this if you repeatedly stumble or find it harder to walk up stairs than normal.
These symptoms will usually fully resolve once the problem is dealt with, but the sooner you seek treatment, the better the outcome.
Many issues can provoke sciatica. Most of them are not concerning (even though they’re painful!) but a few need urgent attention. Here are some things to watch out for:
- Severe pain that isn’t eased by rest, or that’s worse at night
- Sciatica accompanied by fever, nausea or a loss of appetite
- Sciatica that started with a bad fall, accident or injury
- Progressive neurological signs – tingling, numbness or weakness that continues to worsen over time
In addition, the following three signs can be indicators of Cauda Equina Syndrome, which is rare but needs urgent medical attention:
- Loss of normal control when urinating or defaecating – that might be difficulty starting or stopping, or not feeling the need to go
- Lack of sensation in the perineal area (that’s the area between your thighs, including genitalia, urinary tract and rectum)
- Pain in both legs
If you have any of these, get checked by your doctor!
Causes of sciatica
As we said earlier, sciatica is a symptom. The most common underlying cause is compression of the nerve in the low back, often from a protruding disc. You may have felt your back ‘go’, or you may also have low back pain if this is the case.
The sciatic nerve can also sometimes be compressed in the buttock, where it passes through the deep buttock muscles. Spasm of these muscles can cause sciatica. It’s often misdiagnosed as a disc bulge, so be sure to get it properly checked. Mention if you have buttock pain or you’ve had a fall onto the buttock.
Sciatica can also be caused by other problems in the spine. The changes that happen to the bones, joints and ligaments of the spine as part of ageing can trigger sciatica. Or a condition called ‘spondylolisthesis’, where one vertebra becomes displaced on top of another, can compress the exiting nerve roots.
There are some medical conditions that cause sciatica-like symptoms, too. Your osteopath or GP will be able to tell if there’s an underlying medical issue and refer you appropriately when necessary.
Osteopathic treatment for sciatica
Most cases of sciatica respond well to manual therapy and self-help measures over a few weeks to months. Osteopaths can diagnose and treat the cause of your sciatica. They can also ease the symptoms and give you advice on what to do at home – and what to avoid doing!
Your osteopath will ask a lot of questions about your sciatica, how and when it started,and what worsens or eases it. They’ll also want to know about your general health and medical history.
Then your osteopath will examine you to find out how your sciatica is affecting you. what structures in your body are involved. This includes testing your tendon reflexes, muscle strength and sensation to understand how well your nerve is functioning. They’ll keep an eye on that over the course of a few weeks to make sure it isn’t worsening.
Next comes the treatment itself. This usually includes soft tissue massage for tight, painful muscles and joint mobilisation in your spine, hips and legs. You might benefit from mobilisation in your upper body too, as poor mobility here can add stress to your lower back. The osteopath may work to ease the path of the sciatic nerve, which should be able to slide and glide as it passes through the muscles and connective tissue of the body. There are many techniques in the osteopathic toolbox – your osteopath will tailor the treatment for your sciatica to your particular needs and preferences.
After that, the osteopath will discuss how you can manage your symptoms at home. You might need some advice on comfortable sleeping positions or supports that can make driving easier. Perhaps you want to know whether a warm cushion or an ice-pack will help. Maybe you just want to know how soon you can get back to the golf course. You may have a lot of questions – feel free to ask!
How many treatments will I need?
Without wishing to be evasive – it depends! As we said earlier, there are many causes of sciatica, and so treatment for sciatica varies too. Most people see an improvement in their symptoms within two to three treatments. Getting back to full function can take six to eight weeks. But if the cause is straightforward, you might find you’re pain-free much sooner.