A Painful Introduction

Many things in life are a pain in the bum – but some more specifically than others. And if you suffer from sciatica, you’ll be aware that some pains in the bum are certainly more intense than others.

Although the pain differs for everyone, sciatica or sciatic pain can cause back pain, leg pain and buttock pain that quickly derails us from living an active and fulfilling life. So sciatic pain sucks, but how can you get back to living pain free?

We’ve dealt with literally thousands of sciatic pain patients at our clinic, and if one thing is clear it’s that proper diagnosis and correctly identifying the underlying cause is essential.  Here, we’ll break down the who, what and where of sciatica to help you understand what may be causing your sciatic pain.

What Is Sciatica/Sciatic Pain? 

The sciatic nerve runs from your lower back, through your hips and down each leg. Sciatica refers to pain felt along this nerve. Most commonly, the pain will be a numbness and tingling sensation and occur down one side of the body from the back, through the hips and down the leg.

Importantly, sciatica is not a medical condition orthotic  diagnosis in and of itself – but is simply a term used to describe a set of symptoms that might arise for a wide variety of reasons. 

What Are The Symptoms Of Sciatica/Sciatic Pain?

Because there are multiple causes of sciatica, no two sciatic pain episodes are alike. Some people will be in severe pain while others will feel much milder pain. Some people will also have the pain occur suddenly and for others it will be a gradual onset. However, there are a few key symptoms for where the pain is and what it tends to feel like: 

• Moderate to severe pain in lower back, buttock and down your leg.
• Numbness or weakness in your lower back, buttock, leg or feet.
• Pain that worsens with movement; loss of movement.
• “Pins and needles” feeling in your legs, toes or feet

Symptoms are usually most severe early on but many people make a recovery within
recovery within 6-8 weeks. A minority of people (about 20%) will become chronic or recurring suffers.

In rare cases compression of the sciatic nerve can be so severe that there is progressive weakness in the legs and/or loss of bowel and bladder function.  If you’re finding this is the case, you should seek medical attention immediately as this can signal severe nerve damage.

What Are The Different Types Of Sciatica/Sciatic Pain?

Because both the causes and symptoms of sciatica are so broad, sciatica can also be broken down further into two different types:

Neurogenic: Neurogenic sciatica occurs when the sciatic nerve gets compressed, which can happen for various reasons. This type of sciatica often comes along with leg pain that is worse than lower back pain. If you have neurogenic sciatica you might also struggle with symptoms like numbness, muscle weakness and pins and needles sensations.

Referred: Referred pain is caused by a muscle or joint problem in the spine or pelvis. It is not truly a form of sciatica, but mirrors the pain and symptoms. Pain is more likely to be dull and achy and does not include the feelings of pins and needles, hot and cold sensations or numbness. Reflex changes, objective weakness and sensory changes are also unlikely to be present.

From the above, it might seem like it’s easy to tell which type of sciatica you have, but to make things more confusing, this isn’t always true. If you’re trying to guess which type of sciatica you have you’re unlikely to have much luck without proper diagnosis.

In a 2012 study of more than 500 patients with pain radiating to the legs, no single symptom, or cluster of symptoms, was clearly linked to actual nerve root pathology. Put another way, there was no single symptom that accurately predicted whether someone’s sciatica was neurogenic or referred. So, to truly get the cause of what’s creating the pain it’s best to speak to someone who’s experienced in treating sciatic pain to help you find out what’s going on.

What Are The Causes Of Sciatica/Sciatic Pain?

Some of the most common causes of sciatica are:

Disc Injuries: The most well known cause of sciatica is a herniated disc (also known as slipped disc or disc prolapse), possibly accounting for as many as  85% of cases. This occurs when one of the soft, gel-filled discs between the vertebrae of the spine bulges or ruptures, compressing and/or irritating the sciatic nerve. The pain can often be very severe, but that doesn’t mean recovery will take longer. Many slipped discs can resolve themselves within a couple months.

Muscle spasms: Another exceptionally common cause of pain is muscle spasms – which can often lead to referred sciatica. Muscle spasms can cause sciatica by compressing the sciatic nerve as it travels through the muscles. For example, a tight or spasming piriformis muscle can irritate the nerve as it passes into the leg causing sciatic pain. This is commonly known as pririformis syndrome.

Sacroiliac joint dysfunction: The sciatic nerve runs close to the sacroiliac (SI) joint, which is located between the sacrum (the large bone at the bottom of the spine) and the pelvis and damage or inflammatory conditions affecting it can lead to sciatica. 

Spondylolisthesis: A spondylolisthesis is where one vertebra slips forward over the vertebra below. This commonly occurs in the lower back where nerve roots from the sciatic nerve leave the spine. Naturally, pressure on the nerves here can cause sciatica. 

Spinal stenosis: Spinal stenosis is a narrowing of the spaces within your spine, which can put pressure on the nerves that travel through the spine. The restricted space inside the canal can put pressure on the spinal cord, causing  sciatica. The condition can arise from multiple different causes including spinal degeneration, damage to the spinal joints between the vertebrae and cysts or tumors growing within the spinal canal.

How Can I Treat Sciatica/Sciatic Pain?

For us to fully treat your sciatica, we need to understand the exact cause of what’s causing it. It’s likely that your sciatic pain has started from some type of functional or biomechanical problem in your spine. The initial aim of your treatment is get to the bottom of exactly what this problem may be.

It is important to ensure that you don’t further aggravate your symptoms and avoid movement that’s going to increase your pain – this might include bending, lifting and prolonged sitting. For some people, lying for short periods of time will help alleviate pain, but they should aim to not lie for too long – movement has been found to be vital to recovery as is much more preferred than bed rest.

If you’re in lots of pain, you’ll likely need painkillers to help manage the pain while we deal with the underlying cause. Initially stretching exercises are also an important part of your treatment to help reduce any muscle tightness that may be present.

Once we know what the underlying cause of your sciatica is, there’s a broad range of treatment options we may use depending on what your specific needs are. Sciatica generally responds best to a combination of these treatments:

Spinal manipulation and moblisation: Both these treatments aim to restore normal balanced movement by ensuring your biomechanics are functioning as they should be, as poor mechanics are often responsible for irritating the sciatic nerve. This is usually combined with flexibility and strengthening exercises to reduce the chance that poor mechanics don’t remerge.

Myofascial Release: Deep tissue manipulation also helps with restoring normal movement of the spine by removing muscle tightness that may be restricting it. If you have piriformis syndrome you are likely to find this brings dramatic relief.

Acupuncture and dry needling: Both these techniques aim to reduce muscle tension that’s affecting spine alignment using hair thin needles that are placed into the skin at specific points.

Exercise: Exercises to help strengthen your core, improve flexibility of the spine and stretch relevant muscles are often also a part of treatment. Which ones we use will depend on the root cause of your sciatica and how much pain it’s causing you. For more information on which exercises we recommend see here. 

Other stuff: We have a heap of different ways to treat sciatic pain – many of the people who come to us for treatment of their sciatica have already tried treatments like those above without success and we are still able to find new combinations of treatments that ultimately work for them.