Sciatic Nerve Pain
Sciatic nerve pain is the acute nerve root compression of the sciatic nerve which runs through the spinal column, starting in the lower back / lumbar region and down the legs. Sciatic nerve pain is a condition that can be very painful and debilitating to those who suffer with it, but with proper diagnosis and treatment it can be managed and resolved.
At Ace Physio, our Physiotherapists work one-on-one with patients to not only ease their pain but to provide guidance and education to prevent further pain long term. The clinic is easily accessible to all patients, located in downtown Toronto Physiotherapy clinic at Yonge and College.
What is sciatica and where does sciatic nerve pain originate?
Sciatica is the pain felt in the lumbar region and down the legs. It can be caused by a variety of factors, however the most common causes are:
- Intervertebral disc degeneration (due to wear and tear);
- Spinal Stenosis
- Muscle tension of the piriformis muscle also known as Piriformis Syndrome; or
- A prolapsed disc or slipped intervertebral disc.
More so, the origin of sciatic nerve compression, most commonly at the L5-S1 point of the spinal column, dictates where the pain will radiate in the body and therefore is an important factor in alleviating the pain fast and effectively.
Symptoms of sciatica:
- Sharp pain in the lower back that radiates down the leg.
- Feelings of tingling, numbness and pins and needles down the leg.
In sciatica that is due to muscle tension of the piriformis muscle compressing the sciatic nerve, there is usually no lower back pain, subsequently allowing the physician to better differentiate between neural and muscular origins of the acute sciatic nerve root compression.
How does sciatica and sciatic nerve pain develop?
This condition can be caused by variety of factors, however in most cases, it can be prevented with correct posture and lifting techniques.
- Prolapsed or Slipped Disc: Often opccurs through shear stress movements (a bend with a twist), such as bending over to pick up an object, and twisting the body on the way up. Other common causes includes; falls, sports injuries, and car accidents. These movements happening simultaneously in both planes can put an excessive amount of stress on the spinal column, therefore resulting in a prolapse of the fluid of the intervertebral disc. This fluid, medically known as pulposus, acts primarily as a shock absorber between the bones of the spinal column and when prolapsed, places compression on the nerves that run through the spinal column, such as the sciatic nerve.
- Disc Degeneration: Incorrect lifting techniques as described above, especially when lifting heavy loads or doing so in a frequent manner, can also result in disc degeneration, leading to compression of the nerves that run through the spinal column. Disc degeneration occurs as part of the normal process of wear and tear. Techniques and treatments to ease the lower back symptoms, as well as a combination of exercises and stretches taught by a Physiotherapist for Lower Back Pain often is the optimal solution.
- Piriformis Syndrome: The appearance of sciatica is caused by the increased tension of the piriformis muscle located deep in the gluteus, which the sciatic nerve is located very close to and subsequently can sometimes compress the sciatic nerve. Cause of this tension resulting in soft tissue inflammation and muscle spasms is usually due to microtrauma experienced to the area.
Initial at Home Treatment of Sciatic Nerve Pain or Sciatica:
- Initial Protocol: Rest is initially the best treatment to aid in relieving pain and inflammation of the area. In those who suffer from sciatica due to a tense piriformis muscle, less bed rest is required, however the patient is advised to avoid all activities that aggravate their condition. In this time, your Sports Medicine Doctor may also prescribe you anti-inflammatory and pain relief medication if required in collaboration with self treatment techniques to ease inflammation and better assist the recovery, such as hot and cold therapy. Heat therapy should be applied after the initial 48 hours and can be beneficial in the relief of muscle spasms.
- Short Term: Diagnosis of the cause of sciatica in the patient can be assessed by a physiotherapist using tests to differentiate between a neural or muscular origin. Your physiotherapist may advise the use of a back brace to give support to the lower back, or sports massage in the case of piriformis syndrome alleviating any unnecessary stress.
Physiotherapy treatment for sciatica and sciatic nerve pain:
- Stretching exercises and mobilization techniques will be prescribed, dependent on the patient’s current level of pain, to alleviate the root cause of the pain experienced.
- Physiotherapy treatments may also include Spinal Decompression, which uses a Spinal Decompression Machine to stretch and elongate the spine, thereby relieving compression of the intervertebral disc and associated nerve roots.
- Acupuncture or dry needling techniques may be used to reduce inflammation and connective tissue tightness around the nerves, as well as to release tight or spastic muscles providing relief from pain.
- They may also provide electrical stimulation treatment, such as the transcutaneous electrical nerve stimulation (TENS) machine, to enhance recovery and ease pain by stimulating the mechanoreceptors which respond to touch, overriding the currently over sensitive pain nerve fibres, therefore initiating the pain gateway mechanism .
- Long term, Physiotherapy to strengthen the core muscles, re-education of correct posture and lifting techniques are employed to prevent further injury.