Osteopath for Sciatic Nerve Pain

In the below article we have discussed sciatica symptoms, causes, diagnosis and treatment options.

Osteopath for Sciatic Nerve Pain?

Lumbar radiculopathy or the more commonly used term of ‘sciatica’ refers to the symptoms of pain, tingling and numbness. Which arise from nerve root compression or irritation of the sciatic nerve (NICE 2020). You will experience pain into the buttock, back of the leg and/or feet of one side. Do you suffer from a sciatica nerve problem.

Sciatica symptoms are:

Shooting, burning or stabbing type pains typically into the buttocks, the back of the thigh, leg and/or foot depending of where the sciatic nerve is being compressed or irritated. Moreover, you can experience pains all the time or occasionally depending on the severity. Tingling such as a pins & needles and feeling of numbness are commonly felt in the back of the leg. Feeling of weakness and you may experience difficultly walking.

• Moderate to severe pain in lower back, buttock and down your leg.

• Numbness or weakness in your lower back, buttock, leg or feet.

• Pain that worsens with movement; loss of movement.

• Pins and needles feeling in your legs, toes or feet.

Sciatica Pain is Typically Worse

• Prolonged sitting,

• Standing up for two long

• Turning over in bed

• Coughing

• Sneezing (This will increase pressure into your abdomen region causing pain.)

• Sometimes straining on the toilet may be difficult.

In other words sciatica will affect the majority of your day to day activities.

Will Sciatica Always Give Back Pain?

No you can experience sciatica with or without low back pain. Usually you will just experience pain into the back of one leg (not both legs). You are less likely to have sciatica if you have lower back pain with no pain referrals into your buttocks or legs.

Is There Anywhere Else I May Experience Pain From Sciatica

Yes you may experience pain on the front of your thigh or leg. Also the symptoms of sciatica could be a searing pain on the sole of your foot. There have also been cases in the web of the foot, in-between the first and second toe.

NHS Sciatica Advice (2020)

You should visit your GP or hospital if you are experiencing any of the following symptoms:

• You have sciatica on both sides

• Experience weakness or numbness in both legs that is severe or getting worse

• You have numbness around or under your genitals, or around your anus find it hard to start peeing, cannot pee or cannot control when you pee – and this is not normal for you

• Do not notice when you need to poo or cannot control when you poo – and this is not normal for you

These could be symptoms of a more serious nature which may need to be treated in hospital as soon as possible.

Common Causes of Sciatic Nerve Pain

In 90% of cases of sciatica (NICE 2020) disc herniation/s of your inter vertebral disc/s in your lower back is the cause. Intervertebral discs are between each vertebrae and their job is to act as shock absorbers and prevent rubbing of the vertebrae. The discs consist of a gel filled inner layer (nucleus pulposus) surrounded by a hard fibrous outer layer.

Therefore you can injure or strain your discs causing part of the gel filled nucleus to herniate out of the fibrous outer casing (herniated or prolapsed disc). When you have a disc herniation this may compress onto the sciatic nerve which in turns causing symptoms into the buttock, thigh, leg and/or foot.

Common causes of a disc herniation:

• Strenuous physical activity

• Heavy lifting

• Accident

• Trauma

Less Common Causes of Sciatic Nerve Pain are:

• Spinal stenosis

  • This is a narrowing of the spinal canal which is more common in the elderly.

• Spondylolisthesis

  • This is where there is vertebrae that slips forwards or backwards on another vertebrae which subsequently compressing part of the sciatic nerve. Degeneration causes abnormal bony growths to develop (osteophytes or bony spurs).

    Sometimes bony growths can impinge the sciatic nerve where the nerve exits the vertebrae irritating the nerve which causes symptoms.

• Spinal trauma or infection. 

  • Moreover spinal tumours, however sciatica caused by a spinal tumour is extremely rare.

• Piriformis Syndrome

  • The sciatic nerve travels down from your lower back through your buttocks into the leg. The sciatic nerve passes alongside the piriformis muscle. When this deep muscle of the buttock becomes really tight or spasms this can irritate the sciatic nerve which results in sciatic like symptoms.

• Poor Posture

  • Sitting incorrectly with more weight on one hip than the other can irritate or compress the sciatic nerve. Especially if this a constant long term habit.

Sciatic Nerve Pain Diagnosis

It’s not necessary to see your GP to gain a sciatica diagnosis. Manual therapists (Osteopaths, physiotherapists or chiropractors) are able to diagnose sciatica by taking a full case history.

Common Questions Asked To Diagnose Sciatica

• What is the nature of the pain?

• How long is your pain lasting?

• When did the symptoms and pain start?

• Where you doing anything particular when you first noticed the pain?

• Have you previously injured the back or hip area?

• Have you noticed any decrease in strength of the leg or foot?

After that they will perform a physical examination with testing and will then explain the cause of your pains. Sometimes imaging such as X-rays or MRI’s are required to gain further information on the exact cause of the nerve irritation.

Sciatica Treatment 

There are many treatment options available and it is up to the individual to make an informed choice as to which avenue they wish to pursue. The length of treatment depends on the cause of the sciatic pain and the patient’s ability to heal. Herniated lumbar discs account for less than five percent of all low back problems but are the most common cause of nerve root pain (‘sciatica’). Ninety percent of acute attacks of sciatica settle with non surgical management. Surgical options are considered for more rapid relief in the minority of patients whose recovery is unacceptably slow (Cochrane 2007).

Osteopath for Sciatic Nerve Pain 

An Osteopath will provide non surgical hands on treatment. Then they will address the whole posture to get other areas moving more freely (typically upper back and hips). Also to reduce pressure onto the lower back and inter vertebral discs to optimise the body’s natural healing response. Improve blood flow and circulation to the affected area which helps optimise the inflammatory processes. If the patient is experiencing alot of pain then using a more gentle approach like Cranial Osteopathy is an option we use at Wellthy Clinic.

Osteopath for Sciatica

Our Osteopath will use a combination of muscular stretching, joint articulations and joint manipulations (only when appropriate) techniques to increase movement and function. Also bespoke progressive exercises (muscular stretching and strengthening). Furthermore lifestyle and basic nutrition and hydration advice to optimise healing times to support you back into activity.

How Long Does Sciatica Last on Average? 

Typically the prognosis for patients with sciatica depends on the cause of the nerve compression and the patient’s ability to recover. For some it could be 6-8 weeks but for others it could take longer

How Long Will Sciatica Take to Heal?   

Typically the prognosis for patients with sciatica depends on the cause of the nerve compression and the patient’s ability to recover. For some it could be 6-8 weeks but for others it could take longer. Starting a structured rehabilitation plan as soon as possible is advisable to optimising your recovery.

What is the Best Pain Killer for Nerve Pain? 

If you choose to see your GP they will prescribe medications to help reduce your pains. These can be painkillers and anti inflammatory medications. Similarly muscle relaxants, antidepressants and anticonvulsants depending on the severity your symptoms.

Epidural Steroid Injections:

Your GP may refer you for a steroid injection to help you with your pain. A corticosteroid or local anaesthetic will be injected into the epidural space around your spinal cord. Consequently this may give you temporary relief from your sciatic symptoms to give you window to perform rehab exercises. This helps by reducing the inflammatory response around the sciatic nerve. Currently steroid injections are not advised as they weaken the immune system which would make you suspectible to COVID 19.

Surgical options

A small percentage of people will have surgery but this should be discussed with your GP or an consultant. The two main types are discectomy and laminectomy. A disectomy is where part or the entire damaged intervertebral disc that is compressing the sciatic nerve is removed. A laminectomy is where the back part of one or more of your lumbar spine vertebraes (lamina) are removed to create more space for the sciatic nerve. Therefore reducing the likelihood of the nerve being compressed.

How do you Treat Sciatica at Home? 

At Wellthy Clinic we are big fans of meaningful movement as it helps increase blood flow to optimise inflammatory processes. Also increase waste removal (lymphatic drainage), increase functionality of joints, strengthens muscles and self empowers you to feel a little bit better. Typically for the first 2 weeks rest is the best option, then light stretching for 2-4 weeks. After that introducing body weight strengthening exercises with stretches at 4-6 weeks. Graded exercises will be prescribed, changed and progressed accordingly by your Osteopath as part of a structured rehab plan.

Nutrition for Sciatica  

Always stay hydrated by drinking a minimum of 8 glasses of water per day (2 litres per day) little and often. Hydration status will directly affect the height of your intervertebral discs. Therefore dehydration will affect your discs and your ability to recover. Eliminate caffeine, alcohol, squash, fizzy drinks and energy drinks. As these will not help with your hydration status which is important for your recovery. Moreover adopt an anti inflammatory diet by eating more anti inflammatory foods and reduce foods high in inflammatory content is a good start.

Is Heat or Ice better for Sciatica?

At Wellthy clinic we suggest heat. Acute inflammation is a normal process therefore we want to encourage further blood flow to the region to aid and encourage the inflammatory processes. In other words we want to work with the body to optimise healing. Ice feels good short term as it reduces the inflammatory process but doesn’t address the cause of the problem. So for us we believe this isn’t the best long term solution.

Conclusion 

At Wellthy Clinic we offer an integrated approach of Osteopathy, Nutritional Therapy and Pilates to help reduce your symptoms. Interested in learning more? Book a session with our Sciatica specialists at Wellthy Clinic.

Sciatic Nerve Pain References

Cochrane Systematic Review (2007) The effects of surgical treatments for individuals with ‘slipped’ lumbar discs https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001350.pub4/full?highlightAbstract=sciatica%7Csciatic

Cochrane Systematic Review (2016) Non steroidal anti inflammatory drugs for sciatica https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012382/full?highlightAbstract=sciatica%7Csciatic

NHS (2020) Sciatica available at: https://www.nhs.uk/conditions/sciatica/

NICE (2016b) Low back pain and sciatica in over 16s: assessment and management. National Institute for Health and Care Excellence https://www.nice.org.uk/guidance/ng59

NICE Sciatica (lumbar radiculopathy) National Clinical for Health and Care Excellence https://cks.nice.org.uk/sciatica-lumbar-radiculopathy#!topicSummary

Matthew Glithero

Matthew Glithero is an Osteopath (MOsT), Sports Massage Therapist, Pilates instructor with a background in Sports Science (BSc).