Sciatica is a term usually given to describe any kind of leg pain. However, true sciatica symptoms involve the sciatic nerve which causes radiating pain downwards from the buttocks along the course of the lumbosacral nerve root (posterior leg).
Sciatica can be caused by a herniated lumbar disc where the nerve root is compressed by the disc material that has ruptured through its surrounding annulus. Other causes can be but not limited to spondylolisthesis, steno sis or malignancy. The common theme in them all is that the sciatic nerve root is being compressed. The current evidence suggests that is it not the compression directly that is causing the sciatic symptoms, but a combination of pressure related inflammatory and immunological processes.
A thorough assessment involving taking injury history as well as completing a movement assessment is used to determine the structures involved in causing the sciatica symptoms. The likeliness of a nerve root compression is increased if there is a gradual onset rather than a sudden onset.
The first line of management for sciatica is conservative management, this involves education, exercises therapy, spinal manual therapy and medication. We will discuss each below:
It is nout routine to scan for sciatica, this is due to differing reporting standards employed by radiologists but a study showed that there is negative psychological impact on patients where the authors assessed whether knowing the outcome of a diagnostic scan would improve outcome. It proved the opposite and the patients who didn’t know the outcome of their scan showed more improvement in their general health.
Staying active is advised rather than bed rest. Supervised exercise was advised to include nerve mobilisations, motor control exercises, directional exercise and strength exercises. The type of exercise given should be specific to the patient and their symptoms.
Spinal manual therapy
The term is used to describe a variety of techniques where a manual technique moves one or more joints within normal ranges of motion with the aim of improving spinal joint motion or function. Manipulations consist of a high-velocity, small or large amplitude passive movement technique at or near the end of the passive or physiological range of motion. In general, the effects of spinal manual therapy are short term.
In acute sciatica, cortico-steroids improved pain in the short term and some non-steroidal anti-inflammatory drugs have also been seen to give benefit. It is unclear within the evidence what medication gives the best results.
Remember, sciatica is a symptom, not a diagnosis. It is more important to get to the bottom of why the sciatica is present.