What is it? Do you have it? Should you be worried?
A while back on our social media pages we broke down sciatica in terms of what it is, how to treat it, and busted some common myths and misconceptions around this particular condition. We figured we could add to that content with this blog post to revisit that same content and perhaps give some more nuance and direction to help everyone out!
What is Sciatica?
Nerve related symptoms under the umbrella of a location-based description. This location are the many innervations of the sciatic nerve. The sciatic nerve goes from the lower back, to back of the leg, then branches into the foot. Although the branches differ in name, it’s all the same structure which is why pain can be in different areas. Sciatic nerve symptoms are not unique as compared to symptoms from other neuropathic issues. This means “sciatic nerve pain/symptoms” could be mimicked by various other nerves, even in the upper body.
So what can you expect, if you suspect that you have sciatica?
Paresthesia, or, in other words, nerve related symptoms. This can present itself in many different ways such as: tingling, numbness, crawling skin, small sensations causing irritation (such as fabric like your bed sheets touching the affected area), burning hot sensation, stabbing pain, or even temperature changes in the affected limb.
Migration or moving of symptoms. As we mentioned before the sciatic nerve innervates many areas all along the leg and foot. If the sciatic nerve is affected then it’s not a surprise that symptoms for that affected area will travel. This is not necessarily an indication that things are worse for you, it just means the symptoms are referring in a different way on that particular day.
Good and bad days with mornings typically being the time of day where symptoms are at their worst. Again, symptoms being worse in the mornings is normal for sciatica and not an indication that you have done something wrong or a sign you are getting worse.
TL;DR: Sciatica is complex and basically is nerve related symptoms located somewhere along the sciatic nerve innervations along the leg and foot. Typically worse in the mornings, and responds to a variety of factors.
Okay so, if there is a number of symptoms, a number of locations, and a number of different factors that is attributed to sciatica, how can we even treat it? Or better yet, can we prevent it from happening?
Let’s start with prevention! Can we prevent sciatica entirely? …Nope.
…Okay so maybe we can’t prevent it, but can we reduce the risk of having it? Yes, actually.
Modifiable risk factors for sciatica include
Smoking
Obesity
Exercise
Sleep
Psychosocial Stress
(Cook et al. 2014, Parreira et al. 2018)
Basically, all the usual suspects for most musculoskeletal conditions! If you want to reduce the risk of sciatica, don’t smoke, improve nutrition, adopt an active lifestyle, stay hydrated, increase sleep quality, and reduce weight if overweight. Let’s say you suspect that you already have sciatica, what does treatment look like?
Once sciatica is suspected/diagnosed treatment will revolve around a few different things.
Modification to sensitive movements: To reduce flare-ups we will seek to identify specific movements that are unique to your sciatica presentation, and modify how you perform those movements in the short-term as they remain sensitive. This allows you to have less frequent interruptions to your daily routine, as well as help to reduce the sensitivity coming from the sciatic nerve.
Incorporate rehab movements: These are movements that are used, not necessarily to increase strength and performance metrics, but to reduce pain and increase total tolerance to stimuli in currently affected areas. This can be anything from lower limb strengthening such as deadlifts, repeated movements such as lumbar extension/flexion, nerve glides for the sciatic nerve, and even just general movement such as regular walking. The key with this is that there needs to be some form of progression. Doing the same activity, the same way, forever ad nauseum is not realistic or expected. As we expose ourselves to a particular dose of stimulus, we will adapt to it as long as we are living organic beings therefor, we will need planned progressions to that same stimulus to get continued benefit from it.
Pain Modulation: These are the classic passive interventions such as massage therapy that assists in interfering with pain processing. This is less about breaking down various types of tissues and more about providing information to your brain, and body as a whole integrated system that we could use less protection (pain/symptoms) to a particular area of the body. This also does not have to be backbreakingly painful either!
These three factors form a cohesive treatment that looks at you as a whole instead of just constantly chasing pain around, which is just unproductive as sciatic pain is finnicky and can have flare-ups for no one individual cause.
Top tips: Be patient and don’t go searching for one magic exercise. This stuff does not go away overnight, expect some level of ups and downs. Just as long as the ups outweigh the downs we are doing well.
Now for the juice: Myth busting!
Leg pain is not always sciatica. You can have pain in the back of your leg and it be just that. Pain in the back of your leg. Suspected sciatica is based on the symptoms as a whole and not just pain in the back of the leg. Your experience may not reflect your MRI. We see this time and time again, imaging results being used as an exact cause of symptoms. Big problem with that, MRI results for pain related disability is unreliable outside of outlier cases like fracture, spinal tumors, etc. Even disc bulges, disc degeneration, and similar findings have more in common with age than pain due to a linear increase in these findings and age in asymptomatic populations. When we get older we get wrinkles, well these are your wrinkles on the inside.
Common “causes” you will hear about sciatica are grossly inaccurate. Think of: weak glutes, core instability, leg length discrepancies. There is no evidence that these are causes of even pain, let alone a specific subset of pain such as sciatica. In fact, there is actual evidence that directly contradicts these common claims! (Lederman, 2014)
Surgery is not a necessity, and in our opinion, should be a last resort. Studies have looked at surgical vs conservative intervention results and there is not much difference long-term. You can always do more rehab but you can never undo surgical interventions. (Peul et al. 2007, Fernandez et al. 2016)
NSAIDS (Advil, Tylenol, Ibuprofen) typically do not help with nerve pain. In many cases you will have better results exploring different positions and moving to get reductions in pain, even if all you can manage is small movements like moving your foot.
Long story short: sciatica sucks and can be an extremely frustrating and painful experience to deal with. The honest truth is there is no magic exercise that is bar-none better than others, nor are there any quick fixes as even with surgical interventions there is still an active rehab component. Movement is inevitable and a part of the process. Accepting that can be uncomfortable, but that is also part of the process. Having a plan in place that is curated to fit your lifestyle and unique presentation of sciatica is a valuable asset, and it adds tools to your own toolbox should you experience sciatica in the future.
You got this.
Matt
RMT, CCPC