I hope you enjoyed the last TOP physiotherapy blog all about desk-based postures and I hope you could put some of those tips to good use!
This blog is all about sciatica, which is probably one of the most common complaints I see at TOP Physiotherapy - Olney. Sciatica is famous for sometimes causing excruciating radiating leg pain, which usually runs down the back of both or one of your legs. The symptoms of sciatica are all very similar (radiating leg pain) however the underlying cause of the pain varies tremendously. Identifying what the underlying cause is, is what we do best here at TOP physiotherapy. What I hope you get from this blog is a bit more understanding of what sorts of structures can cause sciatica and some useful tips on how to self-manage some of the symptoms at home.
What is Sciatica?
Sciatica is caused when the sciatic nerve is agitated either by compression or tension. The sciatic nerve originates in your lower back and travels down your leg and splits into various branches just above the back of your knee. As it travels such a long distance there are many structures that can irritate it along its long and winding route. Any irritation of that nerve presents as sciatica symptoms. Trying to differentiate between which structures are causing the issue is the tricky part, especially if the sciatica is so severe that the pain is excruciating. This can only really be done in clinic by a chartered physiotherapist. So, this blog will mainly focus on improving your understanding of what kinds of structures can irritate the sciatic nerve and some tips on how to manage them at home.
What I should say before I go on is; sciatica is extremely painful and sometimes (very rarely) can be a sign of cauda equina syndrome which is a medical emergency, so coming in to see me in the clinic is the best way to understand exactly what structure is causing your radiating leg pain. If you are concerned please contact me. I can run through a range of questions over the phone and be able to assess whether I think your issues could indicate cauda equina and therefore a trip to A&E.
Discogenic Sciatica
The first structure that I will discuss that can irritate the sciatic nerve is the inter-vertebral disc. If the disc protrudes, it can narrow the whole which the nerve leaves the spinal cord and thus cause radiating leg pain.
The usual age range for an acute disc protrusion is between 21-35 years of age, however it has been known to occur out of these age ranges. Often it can come on spontaneously, however in the younger age group it is often caused by heavy lifting tasks, coupled with rotation. Anyone experiencing acute lower back and radiating leg pain which originated from a lifting or sporting injury should get checked out by someone at the clinic immediately. This is because some discogenic back pains can cause significant narrowing of the spinal cord and therefore if left untreated can cause permanent damage to that nerve. I know that sounds scary, but please be reassured, this is incredibly rare.
There is another classification of discogenic sciatica which is caused by degenerative disc disease. This is when, usually with age, the disc loses some of its height and elasticity. Because it's a little less ‘squishy’, disc protrusions are a bit more common however far less likely to be a medical emergency. That doesn’t take away from the severe pain it can still cause. For either degenerative or acute disc protrusions an exercise which is very popular is the cobra stretch. WARNING - If this stretch is painful and makes things worse please stop and phone the clinic.
What I should explain, is that over 50% of people over the age of 40 will have a disc protrusion on MRI. So if you have had an MRI and it has shown a disc issue then don’t presume that this is causing your issues. It could be an incidental finding. At TOP physiotherapy we always treat the person rather than the image, however the scan can sometimes help us create a better understanding of your condition.
.Facet Joint Sciatica
Another common structure which can cause sciatica is the facet joints which are situated either side of your vertebra, in your spine. These are two symmetrical joints, either side of each vertebra and they allow your back to move. Like most joints they have a capsule encompassing the entire joint. Therefore if there is stiffness or dysfunction of the joint, the joint capsule can swell and compress the sciatic nerve.
Facet joint dysfunction can be caused by several issues, however the most common one I see is when the joint surfaces become closer together, harder and less congruent - this is known as ‘sclerosis’. This usually presents completely out of the blue and what can sometimes help to settle them down is the right stretching program.
Some ideas can be seen below. Give them a go, if they don’t work for you then please just get in touch and we would be happy to talk through your symptoms and give you some advice – completely free.
Piriformis Syndrome (Deep Gluteal Syndrome)
The final cause of sciatica that I will write about in this blog is called - ‘piriformis syndrome’. Anything with syndrome at the end of it often sounds worse than it is but actually it just means a ‘collection of symptoms’. The piriformis is a small muscle in your buttock which your sciatic nerve passes through. As you can expect, if your piriformis muscle becomes tight this can occasionally irritate your sciatic nerve and therefore cause sciatica. This is one of many structures away from your spine that can cause sciatica. The reason I have chosen to write about the piriformis as it is one of the more common causes of sciatica.
As you can expect, piriformis syndrome often begins with buttock pain but if left alone it can worsen to cause radiating pain throughout the entire leg. It is often easy to identify whether your piriformis is tight. You can try some of the stretches below and if they cause your symptoms, your piriformis is likely to be, at the very least, contributing to your symptoms. After establishing whether the piriformis muscle is tight, it is important to understand why it is tight. Two common issues that cause piriformis syndrome is underlying osteoarthritis of the hip or weak glute muscles. Both of which we can diagnose in clinic.
I hope you found this blog interesting and useful. I empathise with those of you out there with sciatica, I understand it can be excruciatingly painful, and you can often feel completely helpless, please be reassured - WE CAN HELP.
If this sounds like you, please get in touch!! There are lots more structures which can cause sciatica that have not been mentioned, so if the stretches mentioned in this blog have not helped, don't panic there is much more we can do to help.
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