The Truth About Sciatica
Sciatica is a term that most people are familiar with even if they have never experienced it themselves. Most people who begin to feel pain in the back of their leg will automatically attribute it to ‘sciatica’, even if they’ve had no history of sciatica before. Over the years, sciatica has become a buzzword used loosely by most people to describe pain in the back of their legs.
But not all leg pain is caused by sciatica as there are several potential causes for pain in the legs. The goals of this article are to help differentiate between ‘true sciatica’ and other causes of leg pain, as well as discuss the recommended treatment strategies for recovery.
What is sciatica?
True sciatica refers to a radiculopathy, commonly referred to as a pinched nerve, involving one of the lower extremities and is most seen in people with a disc herniation, disc degeneration or other type of trauma. Approximately two thirds of people with low back pain also report leg pain. (Stynes S et al)
Symptoms related to true sciatica include:
Sensory changes (e.g. numbness or tingling in the involved lower limb)
Reported pain below the knee
Leg pain that is worse than back pain
Neurological deficits (e.g. strength, reflex, or sensory deficit in the involved lower limb)
Another potential cause for pain in the back of the leg is referred pain coming from the low back. In these cases, back pain is often worse than the leg, pain may be felt in the gluteal or thigh region and is rarely experienced past the knee. Sensory changes like numbness or tingling and other neurological deficits are uncommon in people with referred leg pain.
The sciatic nerve can also be impinged or irritated at another site along the path of the nerve away from the low back. Localized inflammation, tight muscles in the hip or thigh, and things like sitting on a fat wallet can potentially cause the sciatic nerve to become irritated and cause some of the symptoms listed above.
Will I need any scans or surgery?
Proper diagnosis at onset of symptoms is key for best management. Most people do not require any imaging scans for their sciatica and most cases of sciatica respond well to conservative care including manual therapy, exercise, and other self-management strategies. Steroids or epidurals may be recommended early in the recovery process based on severity of symptoms and response to conservative treatment.
Early surgical intervention is often only recommended in cases where worsening neurological deficits are a concern (muscle weakness, loss of sensation, etc.) and the reponse to conservative care was poor. The current research recommends a minimum of 6-8wks of conservative care before considering surgery although some experts recommend significantly longer.
Complete resolution of symptoms with or without surgery cannot be completely guaranteed. Data does show a generally positive prognosis for sciatica treatment both operatively and non-operatively but recurrences are still common. It’s important to shift focus away from complete symptom resolution and focus more on restoration of function and gradual return to meaningful activities and hobbies.
How can Chiropractic care help?
Determining the true cause of your leg pain is the most important step to take as it will help guide treatment and prognosis. With a proper diagnosis, your Chiropractor will develop a treatment plan based around strategies to help you return to activity as quickly as possible.
Treatment focused on rehabilitation and gradual exposure to strengthening exercise to increase the body’s tolerance to stress is can be helpful for those dealing with new or chronic sciatica. Exercise is not only safe but is highly recommended and encouraged early on in the recovery process based on current literature. Manual therapies such as active release and joint manipulation can be helpful for decreasing pain and improving function early on in recovery.
There are no “three best” exercises for sciatica that make it go away forever. But with proper understanding of the condition, setting expectations, and developing a plan that promotes early return to activity, the outcomes are generally favorable.
