Sciatica: Understanding the Pain, Causes, and Relief with an Osteopath in Manchester
Most people will have heard of sciatica: whether you have experienced it, or know someone who has, it is a prevalent and often debilitating condition that affects millions of people worldwide. At Holland Osteopathy it is one of the most common complaints people come to see us with at our Manchester based clinic. But what actually is it? What causes it? What are the signs and symptoms? And most importantly: how can you get rid of it? This blog post will aim to answer these questions, and more, and explore how Osteopathy, as well as Physio and Chiropractic can help alleviate this excruciating pain.
What is Sciatica?
Sciatica is a condition characterised by radiating leg pain that travels along the sciatic nerve, which runs from the lower back, down the buttocks, and extends into the leg, and sometimes into the foot. As the sciatic nerve is irritated, injured, or compressed it can also cause altered sensation into the leg, such as tingling, numbness or pins and needles, as well as muscle weakness. While it can disrupt your daily life, making simple activities like walking, sitting, and standing painful and challenging, sciatica itself is a symptom of something else. So, whether you are seeing a Physio, Chiropractor or an Osteopath, they should always be looking for the cause.
The Sciatic Nerve
The sciatic nerve is the longest and widest nerve in the human body, comprising lumbosacral nerve roots (L4–S3) that originate in the lower back. It extends from the lumbar spine through the buttocks and down the back of each leg and into the foot. The sciatic nerve plays a crucial role in transmitting signals from the spinal cord to the lower body, enabling various motor (movement) and sensory functions.
Motor function: The sciatic nerve supplies the hamstring muscle group (biceps femoris, semimembranosus and semitendinosus) and the hamstring portion of the adductor magnus (groin/adductor muscle of the thigh). And then the sciatic nerve branches off as it indirectly supplies all the muscles of the lower leg and foot.
Sensory function: Indirectly supplies (via its terminal branches) the skin of the outside leg, heel, and both the top (dorsal) and bottom (plantar) surfaces of the foot.
What Causes Sciatica?
It is caused by inflammation or compression of the lumbosacral nerve roots (L4–S3) which form the sciatic nerve. Sciatica occurs when something compresses or irritates the sciatic nerve. This compression can happen for various reasons, and some of the common causes include:
1. Herniated Disc: A herniated (bulging) or ‘slipped’ disc is one of the leading causes of sciatica. When the nucleus of the disc (the soft, gel-like centre) protrudes through a tear in the outer layer, it can put pressure on the adjacent nerve roots, including the sciatic nerve. There is something about the nucleus that makes it directly irritate nerve roots, with a couple of theories suggesting this is due to inflammatory enzymes, or due to an immune reaction, so the body sees the nucleus as a foreign body.
2. Spinal Stenosis: Spinal stenosis is a condition characterized by the narrowing of the spinal canal. This narrowing can squeeze the nerve roots, leading to sciatic pain. Have a look at my blogs on arthritis of the spine and degenerative disc disease for some causes of spinal stenosis.
4. Spondylolisthesis: This condition occurs when one vertebra slips forward over another. The slippage can put pressure on the sciatic nerve roots, leading to pain and discomfort. This is often a result of trauma, such as landing on your back, or can occur with degeneration of the spine.
5. Trauma: Injuries to the lower back, such as fractures or accidents, can damage the sciatic nerve or surrounding structures, resulting in sciatica.
6. Pregnancy: Sciatica can occur in pregnancy, but it will be as a result of some of the causes described above.
7. Space occupying lesions/ growths: In very rare cases, cysts and benign and malignant tumours, can compress the nerve roots that supply the sciatic nerve.
Signs and Symptoms
Sciatica manifests in a variety of ways, and its symptoms can vary in intensity and duration. As we know the sciatic nerve controls the movement of a huge portion of our leg as well as supplying a sensory information so symptoms can cover a vast area. Symptoms can come and go and can be aggravated and relieved by changing positions or movement. Common signs and symptoms include:
1. Radiating Pain: The hallmark symptom of sciatica is radiating pain that typically begins in the lower back or buttocks and travels down one leg. The pain can range from a mild ache to a sharp, searing sensation.
2. Altered sensation: You may experience numbness or a pins-and-needles sensation in the affected leg, or a loss of sensation to touch.
3. Muscle Weakness: Weakness in the leg or foot on the affected side is common, making it challenging to move or lift the leg. See above for the muscles that are supplied by the sciatic nerve.
4. Pain While Sitting: This is often seen when herniated discs are the cause of sciatica, and often people find that sitting for extended periods exacerbates their pain. This can be especially problematic for those with desk jobs or who need to sit during daily activities.
5. Difficulty Walking: If the cause of the sciatica is related to spinal stenosis, or spondylolisthesis this is more common, particularly when weight is placed on the affected leg.
6. Worsening Symptoms with Certain Movements: Certain movements, such as coughing, sneezing, or bearing down during a bowel movement, can intensify the pain associated with sciatica. This is often a result of increase pressure within the spine aggravating the original cause of sciatica.
7. Lower Back Pain: Some individuals experience lower back pain in addition to the leg pain, especially if the root cause is related to a herniated disc or other lower back issues.
8. Cauda Equina: In severe cases there can be a loss of control (incontinence) to bowel or bladder movements, or numbness around the saddle region. THIS WOULD REQUIRE URGENT MEDICAL ATTENTION.
Diagnosing and Treating Sciatica
If you're experiencing any of the symptoms described above, it's crucial to seek professional help. Both Osteopaths, Physios and Chiropractors can diagnose and treat the causes of sciatica. Diagnosis typically involves a comprehensive evaluation, including:
1. Medical History: Your healthcare provider will ask about your medical history and any previous injuries or conditions that may be contributing to your symptoms. Factors such as your age, BMI, occupation, and mechanism of injury often enable a diagnosis to be made early on.
2. Physical Examination: A physical examination will help assess your range of motion, muscle strength, and reflexes. Your healthcare provider will also perform specific tests to identify the source of your pain. As an Osteopath we are trained to test parts of your nervous system such as reflexes, power, and sensation to help with diagnosis.
3. Imaging Studies: Imaging is often seen as a last resort and is usually not warranted, but X-rays and MRI (Magnetic Resonance Imaging) can provide detailed images of the spine and help identify structural issues that may be causing sciatica.
Once diagnosed, there are several treatment options available to manage and alleviate sciatica:
1. Conservative Measures: In many cases, sciatica can be managed with conservative treatments. These may include avoidance of aggravating factors, Osteopathic, Chiropractic or Physical therapy, ice/cold compression, and over-the-counter pain medications.
2. Medications: If over-the-counter medications aren't effective, your GP may prescribe stronger medications for neuropathic pain.
3. Epidural Steroid Injections: In severe cases, where pain is persistent and debilitating, your healthcare provider may recommend epidural steroid injections to reduce inflammation and alleviate pain.
4. Surgery: In rare cases, when conservative treatments are ineffective or if there is a structural issue that requires correction, surgical intervention may be necessary. Common surgical procedures for sciatica include discectomy (disc removal) or laminectomy (removal of the back part of the vertebra) to create space and decompress the nerve.
Osteopathic Treatment for Sciatica in Manchester
At Holland Osteopathy, we offer a holistic and non-invasive approach to managing and relieving sciatica. Osteopathy focuses first on the cause of your symptoms, followed by treatment on the musculoskeletal system and aims to offload the pain causing structures, restore balance and function in the body. Osteopaths use a variety of techniques to address sciatica, including:
1. Patient Education: This is the most important aspect of any treatment. Osteopaths, as well as Physios and Chiros can provide the best treatment in the world, but if patients continue doing everything that aggravates their symptoms it can all be for nothing. That’s why it is important that we educate patients about their condition, its causes, and how to manage and prevent future episodes of sciatica. Avoidance of aggravating factors is vital!!!
2. Manual Therapy: Osteopathic treatment often involves hands-on manipulation of the spine and surrounding tissues to improve mobility and offload pain causing structure that may put pressure on the sciatic nerve.
3. Exercise Prescription: Osteopaths can recommend targeted exercises to strengthen spine-supporting muscles and enhance posture, lowering the risk of recurring sciatica. Given the varied causes and symptoms, always consult a medical professional before undertaking an exercise program.
4. Lifestyle and Postural Advice: Osteopaths look at more than just your musculoskeletal system. Your lifestyle can play a huge role in how you experience pain. Looking at the way you sleep, stress levels and diet can all factor in how well you recover from any injury.
Preventing Sciatica
Preventing sciatica involves maintaining good spinal health and adopting healthy lifestyle habits. Here are some tips for preventing sciatica:
1. Exercise Regularly: Engaging in regular physical activity can help strengthen the core and back muscles, reducing the risk of sciatica.
2. Maintain Good Posture: Pay attention to your posture when sitting, standing, and lifting objects. Using proper body mechanics can significantly reduce the risk of back problems.
3. Use Ergonomic Furniture: If you have a desk job, invest in ergonomic office furniture to support your back and maintain a neutral spine position.
4. Lift Objects Properly: When lifting heavy objects, bend at the knees and keep the object close to your body to reduce the strain on your back.
5. Maintain a Healthy Weight: Excess weight can put additional pressure on the spine, increasing the risk of sciatica.
6. Stay Hydrated: Proper hydration supports the health of spinal discs, reducing the risk of herniated discs.
Sciatica can be a painful and debilitating condition, but with the right diagnosis and treatment, individuals can find relief and regain their quality of life. Remember, early intervention and adopting a preventive approach can go a long way in reducing the risks and maintaining a healthy, pain-free life. If you, or someone you know, is suffering from sciatica, get in touch with us at Holland Osteopathy, to explore the best course of action for your specific situation.