Sciatica

The back of a shirtless man holding his back in pain. His spinal cord is showing through his skin and is highlighted red and yellow signifying pain.

What is sciatica?

Sciatica is pain due to an impingement or irritation related to the sciatic nerve or nerve root. The sciatic nerve is a large nerve formed from nerve roots that originate from the spinal cord. These nerve roots pass out between the disc spaces and join up to form the sciatic nerve.

Sciatica is a very broad term to describe ongoing lower back and leg pain, particularly affecting the buttock area. You may experience symptoms from your lower back all the way down to your feet.

The sciatic nerve that joins into the bones of the pelvis is experiencing sciatica pain

Causes

Sciatica occurs when the nerve roots in your lower back become compressed, pinched or irritated, resulting in varying levels of pain. This could be caused by a number of reasons:

  • Herniated disc or bulging lumbar intervertebral disc
  • Spondylolisthesis - a spinal condition that causes one of the lower vertebrae to slip forward onto the bone beneath it resulting in the nerve roots being compressed. 
  • Piriformis syndrome - although uncommon, the piriformis muscle in your buttocks lies directly above the sciatic nerve. If the muscle becomes tight, swollen or spasms, then it can compress the sciatic nerve beneath it.
  • Lumbar spinal stenosis - when the space available for the nerves in the spine narrows, it can put pressure on the nerves in this area. 
  • Leg length difference that changes the way you move
  • Degenerative disc disease which can occur with ageing. 
  • Poor strength and mobility in lower limbs
  • Trauma from a car accident, falling down or contact sports (i.e. rugby) can place external forces on the nerve roots and injure or compress the nerves.

Who's at risk 

There are a number of factors that can put you at a higher risk of developing sciatica:

  • Age: Usually the middle aged or older population is more affected, as the discs in the spine change and weaken with age.
  • Occupation: Jobs that require prolonged periods of sitting or awkward positions, or require you to carry heavy loads could have an impact.  
  • Sedentary lifestyle: Inactive people with poor strength and mobility. 
  • Obesity: Excess body weight can increase the stress placed on the spine.
  • Muscle imbalances and dysfunction
  • Walking and running patterns that overtime may affect and tighten the piriformis muscle. 
  • Diabetes: People with diabetes have an increased risk of nerve damage. 
  • Pregnancy: Hormonal changes, the position of the baby and the extra stress placed on the back during pregnancy can greatly increase your risk. 

Symptoms

With sciatica, you will most likely experience shooting pains or constant pain that starts in your lower spine, then radiates through your buttocks and down the back of your leg.

Other common sciatica symptoms include:

  • Muscle weakness 
  • Altered walking and running patterns with poor hip stability 
  • Poor balance 
  • Paresthesia - abnormal sensation of the skin (tingling, chilling, burning or numbness) with no apparent physical cause. 
  • Pain worsens with prolonged sitting and occasionally standing. 
  • You may experience some numbness or tingling in your buttocks, legs and feet.
  • It is usually a burning, tingling or sharp pain, as opposed to a dull ache. If it is a dull ache it may indicate it is more related to your muscle rather than nerve. 
Woman holding her back in pain from sciatica

It's important to note, that sciatica can vary in severity, so two people could experience very different symptoms. One may have a dull ache, numbness or tingling, and another could have a burning or stabbing pain that prevents them from walking or standing. 

Diagnosis

The signs and symptoms of sciatica closely resemble those of other lower back and hip conditions, hence why it is important for one of our podiatrists to diagnose your condition and formulate a treatment pathway. We may require a second opinion or aid from another allied health professional to enable the most effective treatment pathway.

Treatment

Generally avoiding aggravating activities will settle the symptoms and applying a gentle heat pack can help relax and soothe the area. 

If the pain has not subsided after a few days, we recommend seeking medical attention from one of our podiatrists to see if we can help you. 

    When treating sciatica, we often suggest an individualised combination of treatments to allow you to achieve the fastest and most effective recovery.

    • Strengthening and stretching exercises, in conjunction with foot mobilisation techniques (FMT)
    • Appropriate, supportive footwear
    • Pain-relieving and anti-inflammatory medication
    • Custom prescribed foot orthotics may be recommended if you have a difference in leg length
    • Foot and ankle strapping may be beneficial
    • Dry needling of surrounding soft tissue structure to help relieve tension on the muscles

    Depending on your condition, our podiatrists may recommend conjunctive treatment with another health professional.

    Below, we have outlined some of the stretches you can do to help your condition. However, we recommend consulting with our podiatrists to get a personalised treatment plan to ensure they are going to be effective for you. 

    Stretches

    1. Lie on your back with both knees bent and your feet on the ground. Pull one knee to your chest, and hold this position for five to ten seconds. Repeat on the other side. Do five to ten times with each leg.
    2. Lie on your back with your knees bent and your feet on the ground. Pull both knees to your chest and hold this position for five to ten seconds. Rest and repeat. Do five to ten times.
    3. Lie on your back with your knees bent, and put your hands behind your head or stretch your arms to the side. Flatten your lower back to the floor. Hold this position for five to ten seconds. Rest and repeat. Do five to ten times.

    What can happen if I ignore sciatica?

    Although rare, if you ignore sciatica pain, you could experience some of the following complications:

    • Permanent damage to the sciatic nerve, due to constant compression of the nerve. 
    • Loss of motor control and sensation in the affected leg.
    • Numbness, tingling and some muscle weakness in the affected leg.
    • Prolonged periods of severe pain.

    Prevention

    Although sciatica is not preventable in all cases (e.g. from degenerative disc disease, an accidental fall etc.), there are a number of approaches that you can take to protect your back and prevent the condition.

    • Exercise regularly to strengthen the muscles in your back and core, that work to support your spine.
    • Use ergonomic lifting techniques to decrease the strain placed on your back and spine.
    • Use good ergonomic posture while sitting or standing, especially at your job. 
    • Avoid sitting for long periods of time. 

    FAQs

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