What is sciatica?

Sciatica is a symptom, not a disorder. The radiating pain of sciatica is referred pain from another problem at the level of the spine and involving the nerve. A herniated disc may cause sciatic, as can spinal stenosis and osteoarthritis. Depending on the cause, the pain of acute sciatica — which may be quite uncomfortable — usually goes away with proper treatment and proper changes in lifestyle within a month. Physiotherapists and Massage therapists are educated in joint mechanics, in the physiology and mechanics of the nervous tissues and in human motions. Your physiotherapist will be able to provide you with a physiotherapy diagnosis. With the added information from MRI’s and X-rays, your physiotherapist can help you with lifestyle changes and provide you with advice about what you can do at home to settle the nerve irritation down.    

What are the common causes of sciatica?

Your sciatic nerve branches from your spinal cord through your hips and buttocks and down the back of each leg. This nerve controls many of the muscles in your lower legs and provides feeling to your thighs, legs and feet. Sciatica may develop when a nerve root is compressed in your lower (lumbar) spine — often as a result of a herniated disk in your lower back.Discs are pads of cartilage that separate the bones (vertebrae) in your spine. Filled with a gel-like substance, they keep your spine flexible and act as shock absorbers to cushion the vertebrae when you move. If the outer covering of a disk tears (herniates), gel may seep out and press on a nerve root, causing pain in your back, leg or both. If the damaged disk is in the lower part of your back, you may also experience numbness, tingling or weakness in your buttock, leg or foot. Although a herniated disk is a common cause of sciatic nerve pain, other conditions also can put pressure on your sciatic nerve, including:
  • Lumbar spinal stenosis. Spinal stenosis is a narrowing of one or more areas in your spine — most often in your upper or lower back. When the narrowing occurs in the lower spine, the lumbar and sacral nerve roots may be affected.
  • Spondylolisthesis. This condition, often the result of degenerative disk disease, occurs when one vertebra slips slightly forward over another vertebra. The displaced bone may pinch the sciatic nerve where it leaves your spine.
  • Piriformis syndrome. The piriformis muscle starts at your lower spine and connects to each thighbone (femur). Piriformis syndrome occurs when the muscle becomes tight or goes into spasms, putting pressure on the sciatic nerve. Prolonged sitting, car accidents and falls can contribute to piriformis syndrome.
  • Spinal tumors. In the spine, tumors can occur inside the spinal cord, within the membranes (meninges) that cover the spinal cord, or in the space between the spinal cord and the vertebrae. As it grows, a tumor compresses the cord itself or the nerve roots.
  • Trauma. A car accident, fall or blow to your spine can injure the lumbar or sacral nerve roots.
  • Sciatic nerve tumor or injury. Sometimes, the sciatic nerve itself may be affected by a tumor or injury.
  • Other causes. In some cases, your doctor may not be able to find a cause for your sciatica. A number of problems can affect your bones, joints and muscles, all of which could potentially result in sciatic pain.

What are the risk factors for sciatica?

Risk factors for sciatica include health problems, lifestyle choices and inherent qualities, such as age or race, make it more likely you'll develop a particular condition. Major risk factors for sciatica include:
  • Age. Age-related changes in the spine are a common cause of sciatica. You're likely to have some deterioration in the disks in your back by the time you're 40.
  • Occupation. A job that requires you to twist your back, carry heavy loads or drive a motor vehicle for long periods makes you more prone to develop sciatica.
  • Prolonged sitting. People who sit for prolonged periods or have a sedentary lifestyle are more likely to develop sciatica than active people are.
  • Diabetes. This condition, which affects the way your body uses blood sugar, increases your risk of nerve damage.

What is the prognosis of sciatica?

Although most people recover fully from sciatica, often without any specific treatment, or any effort to minimize the pain and compression, sciatica can potentially cause permanent nerve damage. Depending on what's causing the nerve to be compressed, other complications may occur, including loss of feeling in the affected leg, loss of movement in the affected leg, loss of bowel or bladder function. If pain persists and or becomes constant with accompanying neurologic signs, medical attention is required.  Immediately seek emergency medical attention if you experience:
  • Worsening symptoms. Pain, numbness or weakness may increase to the point that you can't perform your usual daily activities.
  • Bladder or bowel dysfunction. People who have the cauda equina syndrome may become incontinent or have difficulty urinating even with a full bladder.
  • Saddle anesthesia. This progressive loss of sensation affects the areas that would touch a saddle — the inner thighs, back of legs and the area around the rectum.

How can physiotherapy and massage therapy help sciatica?

Manual Physiotherapy

Manual therapy for sciatica will depend largely on the assessment's findings of the cause of your symptoms. If stenosis is the cause, traction techniques will be performed acutely for pain relief, followed by mobilization to many of the surrounding vertebrae to gain mobility. The piriformis muscle can also be a cause, so manual treatment here will be focused on soft tissue release of the muscle, as well as joint mobilization in the ball and socket joint of the hip if there is early degenerative change there. It is important to us to also assess tension in any of the key musculature that the nerve travels through (i.e. calf and hamstring).   If you have a herniated disc causing sciatica, physiotherapy can play a vital role in your recovery. There are some very important exercises and concepts that you should know. This first aid measure requires urgent care and a commitment to the things you need to do to resolve this problem. If not, the prognosis is often poor. Once acute pain improves, your physiotherapist can design a rehabilitation program to help prevent recurrent injuries. Rehabilitation typically includes exercises to help correct your posture, strengthen the muscles supporting your back and improve your flexibility. Your doctor should have you start physiotherapy, exercise or both as early as possible. It's the cornerstone of your treatment program and should become part of your permanent routine at home. Sciatic that is caused by trauma, and/or nerve compression from a bone spur and or herniated disc is a concern and requires urgent care by a doctor.


How can exercise and physical development help with sciatica?

Rehabilitation after a Sciatica

As the pain improves, physiotherapists can educate you about the things do and to avoid doing. They can advance you to a rehabilitation program of core strength and stability to maximize your back health and help protect against future injury.  
  • Flexion Dysfunction: If the cause of sciatic was do to a flexion disorder, lumbar extension exercises create an arch or lordosis in your back, which helps to alleviate pressure as the disc and reduce the size of the bulge. Walking is an excellent for this condition once the pain reduces. Many are able to resume to their previous running activity as it is an activity that maintains the spine in good alignment. The activity that will never be good for this condition is rowing, deadlifts, deep squats, and excessive amounts of sitting, bending, lifting, sit ups, gardening, and any movements which bend the hips toward your chest and or bend your trunk to your legs.
  • Extension Dysfunction: If you sciatic was caused by an extension dysfunction, the relieving positions and postures will be towards neutral and flexion such as knees to chest and activities that bend the spine.
  Your physiotherapist can help you decide which activity is best for you at which stage in your rehab. The most important thing is to avoid or minimize these risk activities. Sciatic is a symptom that suggests nerve compression and there may be several structures that can lead to this symptom of leg pain. Your Doctor and your Physiotherapist can help determine which positions and postures are best for you.  Part of living a healthy lifestyle is to take care of your back.   A preventative program of manual therapy that is focused on maintaining spinal mobility and spinal health, and this, along with good postural habits and a balance of flexion and extension movements will also greatly reduce reoccurrence. Lifestyle change is the most critical factor in reducing the risk of re injury. Herniated discs occur in the fittest athletes, Olympians suffer from this problem even though they are very fit. Why? Because even fit individuals can have a weak trunk and core and can spend too much time sitting, bending, lifting and basically overusing their backs.


Physiotherapy and Physical Development

The final step is to establish a personal improvement health plan to continue to develop physically throughout your life. This is especially necessary after injury or an accident when you have become deconditioned. All of our staff have a combination of health sciences and sports sciences training, having dual training in both kinesiology and physiotherapy and allowing us to provide a biomechanical focus. Once you have recovered from your injuries, our therapists will perform a functional movement screen and analysis to identify individual muscle imbalances that are unique to your inherited structure, to your movement patterns, and to your goals and interests in living a healthy physical life. We develop a individualized program that focus on:
  • Your specific imbalances and movement patterns at work, home, and those evident during the activities that you participate in.
  • You structural and genetic posture and alignment characterizes and how they affect your interests to do activity etc.
  • We look at the ergonomics specific to your workplace and home

How can low intensity laser therapy help sciatica?

Low Intensity Laser Therapy (LILT) is the use of monochromatic light. Meditech Bioflex has been producing this technology for 20 years and has an extensive in house clinical lab.   The light source is placed in contact with the skin allowing the photon energy to penetrate tissue, where it interacts with various intracellular biomolecules resulting in the restoration of normal cell morphology and function. This process also enhances the body's natural healing propensities.   Low Intensity Laser Therapy does not heat or cut tissue. Unlike many pharmacological treatments that mask pain or only address the symptoms of the disease, Laser Therapy treats the underlying condition or pathology to promote healing. The technology utilizes superluminous laser diodes to irradiate diseased or traumatized tissue with photons. These particles of energy are selectively absorbed by the cell membrane and intracellular molecules, resulting in the initiation of a cascade of complex physiological reactions, leading to the restoration of normal cell structure and function.   The process is curative and therefore results in the elimination of symptoms including pain. In addition, it enhances the body’s immune system response and facilitates natural healing. The therapy is completely safe and has no adverse side effects. The technology is highly effective in the treatment of musculoskeletal conditions, arthritis, sports injuries, wound healing and a wide range of dermatological conditions. Whiplash injury typically involves injury to muscles, ligaments, and joints and typically involve several levels and a more wide spread area of injury due to the force full nature of the injury. Muscles of the neck, although short, cross over several joints and so the discomfort is generally more global initially. Laser therapy directed by multiple diodes are able to reach these tissues.


Physiological effects of Low Intensity Laser Therapy

With LILT there is an increased production and release of:  
  • Endorphins which - natural analgesics
  • Cortisol – a precursor of cortisone
  • Growth hormone – instrumental in tissue repair
  • ATP – improves and regulates cellular metabolism
  • An increase in protein synthesis – collagen, DNA, fibroblasts
  • A facilitated venous and lymphatic flow
  • Increased angiogenesis – the elevation of oxygen saturation
  • Enhanced immune response
  These responses are some of the many processes that accelerate cellular regeneration (cartilage, epithelium) and restore normal cell morphology and function. Treatments are typically 25 minutes to over 1 hour depending on the condition and area being treated   The most popular technical / clinical information requested is available on the Meditech website under Laser Reports. You may visit the Meditech website research section directly for detailed abstracts, case profiles and articles on a variety of topics relating to the use of low intensity laser therapy in the treatment of various medical conditions.  

What life style and self-care measures can you do for yourself with sciatica?

Sciatic is a symptom and not a diagnosis and there may be some serious conditions that cause this symptom. The first step is to diagnosis the problem and determine what is at the root of the problem.
  • Book an appointment with a Doctor. Seek a proper diagnosis and rule out any serious conditions.
  • Book an Appointment with a Physiotherapist. Back problems leading to leg pain is often associated with poor posture during the years where age-related wear and tear occurs. To help prevent back pain, in standing keep your head centered over your spine, in a neutral position. In sitting, keep your feet on the ground, your hips tilted forward creating an arch in your low back, keep your head in neutral such that your ear is in line with your shoulder and centered.

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