Firstly, sciatica sucks.
It is disabling, distressing and down-right awful! If you are reading this and suffering from sciatica you probably want to know what to do about it… yet struggling to get comfortable to even read this…
But before you start to panic. Sciatica is not as common as it is made out to be. This is because there are things that can ‘mimic’ the appearance of sciatica. They have similar symptoms but are not quite as bad and don’t last as long.
This is why the correct diagnosis is important…
What is it?
Broadly speaking, sciatica is when there is a ‘’combination of lower back pain WITH usually worse leg pain that travels BEYOND the knee. This may or may not include sensory or motor deficit in the leg.’’
Sciatica gets its name from the nerve commonly associated with it: The Sciatic Nerve, which supplies the back of your thigh, the calf and foot. (So if your pain is in the front of your thigh, you don’t have sciatica!)
Sciatica has been described as an umbrella term. It encompasses several potential and interweaving diagnoses. Here are some fancy words that come under that umbrella:
Radiculopathy - evidence of loss of motor/sensory function
Radicular pain - leg pain associated with the nerve root (area in the spine)
Somatic Referred pain - diffuse/bizarre sensations/pains into the back/leg
Entrapment Neuropathy
Neuropathic pain
What causes it?
Here are some common causes:
Disc herniations/bulges - these can cause nerve root irritation compressing it in the spine. But we know that these disc bulges do heal in time, usually within a similar time frame as the sciatica itself.
Muscular compressions - piriformis syndrome is a commonly discussed problem when referring to sciatica as the nerve passes through/past this muscle deep in your buttock.
Narrowing of spaces - age-related changes to your spine can narrow spaces (aka foraminal stenosis) potentially causing compression onto the nerve roots as they pass through. These changes are called spondylosis and spondyloarthrosis.
How long does it last?
Sciatica can last 3-12 months.
75% of people with sciatica will have 50% improvement within 12 weeks.
By 4 months we have ~15% of people with complete resolution of symptoms and by 12 months ~20% of people with sciatica would have complete resolution.
So unfortunately, sciatica can last a long time which makes it so awful. The reason the recovery time has such a range is probably related to the various different things (see above) that can cause sciatica.
What to do about it?
The bit you are really here for… well there is no magic wand, no magic exercise or magic potion/medicine that will cure your sciatica.
Even with scans to confirm (or refute) the presence of disc bulges/herniations sciatica can stick around for the amount of time specified above.
But there are things you can do to make your life that little bit easier: 1. Get a Proper Diagnosis - seek out a musculoskeletal professional who will take the time to listen to you properly and give you an honest diagnosis. They can be a source of reassurance and guidance during the toughest of times.
You can book here with me: www.nathanbullosteopathy.co.uk/online-booking
2. Filter the Help - from my experience, everyone has their own well-meaning suggestions about what to do for your sciatica. But that’s just it. It’s YOURS! Yours will be very different to anyone else’s. Take other people’s personal experiences and recommendations with a pinch of salt.
3. Have a Goal - Where do you want to be in 3, 6, 12 months time? Get back to Brazilian Ju-Jitsu? Get back to running? Being able to play with the grandchildren? Put your socks on yourself? Having something to aim for can provide the motivation and tenancy to keep going.
4. Exercise - you’ll find a bunch of exercises that the internet will say will ‘cure your sciatica’. But as we’ve discussed, there are other things that can mimic sciatica. So some of these exercises may well help, but perhaps not if you have ‘True Sciatica’. BUT… doing gentle exercises within a pain free(ish) range is good and should be helpful for recovery. Your therapist can help you understand what exercises might be best for you.
5. To Scan or not to Scan - MRIs are the go-to for investigating if there is a potential disc-related problem to your sciatica. But these are not necessarily the first port of call as sciatica can improve without them as treatment approaches are largely similar. However, I can and have referred people from MRI’s if we are not getting the improvement we are after.
6. Don’t panic - surgery is rarely indicated for sciatica. However, going back to point 1, seeking professional help early is important to identify if surgery is needed urgently.
Takeaways
True Sciatica is awful but can affect us in a variety of ways and intensities.
Things that mimic sciatica can also occur but generally improve a lot quicker than True Sciatica.
Surgery is not always indicated but if it is it needs to be done quickly. This is why it is important to see a professional who knows what they are talking about!
Unfortunately, there is no magic bullet for sciatica (I would share it if there was!) but there are things you can do to help yourself.
Motion Forward.
Nathan, Your Friendly Neighbourhood Osteopath