Read on to find out more about this often difficult to manage the condition, get results fast and find out the best exercise you can do at home to easily make some changes to your nerve pain today
The sciatic nerve is the largest nerve in the human body. It starts in the lower back, passes through the buttock and along the leg and to the foot. It connects the nervous system to the skin covering the legs and the muscles of the leg, foot, and back of the thigh. Sciatic nerve pain is called sciatica, and it is experienced mostly as pain that radiates down the legs and across the buttock (Koes, van Tulder, & Peul, 2007).
Sciatic Nerve Pain Causes:
Sciatica can result from a variety of causes, though the main one is a herniated disc that compresses the nerve root; this is responsible for around 90% of all cases. Other common causes are lumbar stenosis, spondylolisthesis, arthritis, and tumors. Sciatic nerve pain can also be caused by pressure arising from a dysfunctional sacroiliac joint or the piriformis muscle. Pregnant women can also experience sciatic nerve pain.
Between 5% and 10% of people who suffer from lower back pain have sciatica. Typically, it occurs mainly in the 45 to 64 age group and its risk factors are associated with height, mental stress, and smoking. It is also more likely to occur in people who carry out frequent lifting and driving.
Typically, symptoms of sciatica include:
- Unilateral leg pain which is stronger than lower back pain
- Pain the radiates to the feet and toes
- Numbness in the above regions
- Increased pain when a leg is raised
- Only one nerve root is affected
Symptoms can also depend on the origin of the injured nerve, in other words, the spinal segment of the lower back from which it emerges.
The condition is diagnosed by physical examination and history. Physical tests such as raising the affected leg to see if it increases the pain level as usual. MRI and CT scans may be used to rule out other causes and with patients who fail to show improvement after one to two months of conservative care.
For most people, sciatic nerve pain is resolved in two or three weeks. Around half recover within 10 days, and 75% noticed an improvement after 4 weeks. However, in around 30% of patients, the condition lasts for over a year.
- Conservative treatment focusses on reducing the pain using drugs or by reducing pressure on the nerve. There is little evidence that bed rest improves the condition and usually, it is no longer recommended. Although analgesics, non-steroidal anti-inflammatory drugs (NSAIDS) muscle relaxants, and intramuscular steroid injections are often prescribed, there is no evidence that they are more effective than placebos (Vroomen , de Krom, Slofstra, & Knottnerus , 2000).
- Normally surgery is only recommended if severe leg pain has persisted for over six weeks, that it hasn’t been reduced by other treatments, and/or it is limiting your ability to engage in normal activities. Surgery generally focuses on repairing the herniated disc that is suspected of causing sciatica and will be used to remove the part of the herniated disc that is pressuring the nerve. If the pain is caused by lumbar spinal stenosis, then both bone and disc tissue may be removed.
- Physical therapy is the most effective treatment for sciatic nerve pain, and this is described in the following section.
Physical therapy and exercise for sciatica
Physical therapy exercises are considered to be the best treatment for most cases of sciatica (Emms, Gosling, Papadopoullos, & Duarte, 2015) and the long-term benefits are often better than those provided by the surgery. The approach is usually to strengthen the back muscles, stretching exercises, and aerobic exercise. Regular gentle exercise helps patients recover quickly and avoid future sciatic nerve pain. Advice is also an important element of any treatment plan.
- Strengthening exercises, a range of exercises can be used to strengthen muscles, ligaments, and tendons that support the back. As well as the lower back it is important to strengthen muscles in the abdomen, the buttocks, and the hip. Building strength in these core supporting muscles will help keep the spine in alignment and make it easier to extend and twist the spine without causing damage.
- Stretching exercises can quickly help alleviate sciatic nerve pain. Stretching the hamstring is important as a tight hamstring increases stress on the back which increases the pain.
- Low impact aerobic exercise such as swimming and walking will help your cardiovascular system supply nutrients to the injured tissues improving the natural healing process. Endorphins are also released which directly help reduce the pain
- Nerve flossing exercises are often key to getting results with this difficult to manage the condition. Watch this video
Sciatic nerve pain can be severe and debilitating, however, for most people, it will simply go away after a few weeks. In cases where it persists treatment becomes necessary. The most effective treatment for most cases is physical therapy, and although painkillers can help, there is evidence that they do no better than placebos. As most cases of sciatica are caused by a herniated disc, you can minimise your chances of sciatica by taking care of your back, for instance adopting a good posture, exercising regularly, and always lifting correctly.
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Emms, A., Gosling, L., Papadopoullos, S., & Duarte, R. (2015). Commonly Utilized Physiotherapy treatment Approaches in the Management of Sub-acute Sciatica: A Pilot Study using the Delphi Process. Musculoskelet. Res. 17, 1450017 .
Koes, B. W., van Tulder, M. W., & Peul, W. C. (2007). Diagnosis and treatment of sciatica. BMJ Jun 23; 334(7607), 1313?1317.
Vroomen , P., de Krom, M., Slofstra, P., & Knottnerus , J. (2000). Conservative treatment of sciatica: a systematic review. J Spinal Dis;13, 463-9.