Patients often describe that they have “sciatica” or say their “sciatica is playing up”. So what is sciatica and what does the evidence say is the best way to manage it?
Sciatica is radiating leg pain that can cause severe discomfort and dysfunction and is caused by inflammation or compression of the sciatic nerve which is the nerve that exits the spine from the L4, L5 and S1 vertebrae. There can also be low back pain present. Between 10-40% of people will suffer from it in their lifetime.
The patient will normally describe:
- Pain that radiates below the knee.
- Leg pain that is worse than back pain.
- Feeling of numbness or pins and needles in the leg.
Upon testing there will be pain when stretching the nerve, weakness of muscles and abnormal reflexes.
What causes sciatica?
- Nerve root compression from a herniated/bulged disc is the most common cause.
- Inflammation from herniated disc irritating nerve
- Inflammation from facet joint degeneration irritating nerve
- Lumbar spinal stenosis
- Piriformis muscle syndrome can entrap the sciatic nerve
Is a scan needed?
Routine imaging is not advised and potentially harmful if not indicated.
An MRI may be considered if trauma was the reason for the onset of the sciatica, if a serious pathology is suspected or if there are progressive, worsening neurological symptoms such as weakness and worsening pain.
How long does it take to get better?
The majority of patients with sciatica will recover within 3 months. In a cohort study 87% of patients with low back pain and sciatica who received conservative, chiropractic care was resolved after 3 months and 73% after 1 year.
Most disc bulges resorb and move away from the nerve within 12 weeks.
The longer the patient has been in pain, the higher the pain is graded and unhelpful beliefs about how long it will take to heal are associated with poorer prognosis.
Some patients do not resolve within 3 months and symptoms can last for 1 year.
How is sciatica managed and treated?
Conservative management is always a first priority.
Initial treatment is targeted at managing pain, maintaining function, and decreasing inflammation. Chiropractic treatment such as soft tissue massage, gentle spinal mobilisation and treatment targeting the sacroiliac joint as a way to access and feed into the sciatic nerve are supported.
In a randomised clinical study that compared surgical outcomes to chiropractic care for sciatica, 60% of patients with sciatica who had failed other medical management benefited from spinal manipulation to the same degree as if they underwent surgical intervention.
- Exercise rehabilitation is important with the goal of maintaining postural alignment, core strength and stability and normal biomechanics of the trunk and pelvis.
- Stretching to address mobility restrictions is also especially important.
- NSAIDs can be useful for a short time if pain intensity is unmanageable.
- Spinal injections are not recommended by the Danish national guidelines due to insufficient evidence.
- Surgery is considered if pain persists past 12 weeks.
- Interestingly acupuncture is not recommended for the treatment of sciatica.
About Campbell Allport
Campbell has worked in the occupational health and safety industry as an injury management consultant allowing him to gain valuable experience and insight into office and vehicle ergonomics.
He is now solely in private practice and is a senior clinician in Melbourne and the founder of Beyond Better Health in Cheltenham, Victoria.
He has a special interest in working with sporting teams, athletes and the CrossFit community as well as working with pain sufferers of all ages and activity levels.