Sciatica, in the majority of cases, is not as scary as people may fear. We regularly help people rid themselves of sciatica at the clinic with our sciatica physiotherapy treatment. Firstly we need to screen thoroughly for anything that could be serious. If you can’t feel the seat you’re sitting on or if it’s affecting your ability to go to the toilet please stop reading this and go to A&E!
Formalities done, let’s focus in the type of sciatica we can help with. There’s understandable fear of sciatica. Fear of what’s causing it. Fear that it will never go away. For the majority of cases however that fear is thankfully unfounded.
On this page we’ll talk about what sciatica is and what you can do to go about getting it sorted.
What Is Sciatica?
Technically it is increased sensitisation of the sciatic nerve which can cause pain along any of the sciatic dermatomes (skin sensation of the nerves), namely L4, L5, S1, S2 and S3. These are all the lower vertebras in the back. Check the picture below to see if your pain matches any of the outlines below for those nerves. Roughly speaking any nerve type sensation down the back of the leg, in the shin or foot is due to the sensitisation of the sciatic nerve.
Click to view larger image
Your pain can be along any of those lines in the leg. It can be mild or severe. Nerve type sensations can be deep seated pain, pins and needles, numbness or just a heavy back ground ache. It may, or may not be accompanied by back pain as well.
What Causes The Sciatica Pain?
We like to categorise sciatic pain into two categories those with a mechanical cause and those without. In many cases it is a combination of the two. It’s important to understand that it is possible to have sciatica without anything actually being structurally wrong with you. Equally it is reassuring that you can have an actual feature (as we like to call them) on your scans which don’t mean you must be in pain.
Wikipedia summarises the physical factors. In traditional physiotherapy sciatica treatment terms the following are thought to be the most common causes of sciatica:
- Slipped/Herniated/Prolapsed Disc
- Spinal Stenosis
- Spondylolithesis
- Whiplash
- Piriformis Syndrome
- Pregnancy
Pregnancy aside, all these conditions sound scary. But they needn’t be. We have many clients who are now pain free with all of the conditions above. Yet no pain. So long as we check for the most severe of symptoms most sciatica can relieved without the need for surgery. All of the conditions above are thought to increase the sensitivity of the sciatic nerve. As to how is unclear.
It can be direct contact with the nerve. Especially in cases of slipped discs. But that doesn’t necessarily mean pain. Many of our clients have discovered they have some of these issue in their back as part of a routine check without any symptoms at all. Of course, the more severe the disc bulge you have, the more likely you are to feel pain from it. But it’s not guaranteed.
This may sound confusing. And it is. There really is that je ne sais quoi about pain and who feels it and who doesn’t. Our holistic approach attempts to deal with all possible causes. We’ll start with biomechanics.
In short tension in muscles such as hip flexors, glutes, hamstrings and calves will increase tension on the sciatic nerve and in so doing increase its sensitisation. We often find that if we can release these muscles we release the pain in the sciatic nerve. I talk about this in the video below:
We can go further. If we consider the picture below showing the Anatomy Trains superficial back line you can see how the back muscles ad hamstrings are continuous all the way up the neck. We have seen many times sciatic pain eased by releasing the back of the neck!
Then there’s the psychological part of the condition. It’s very unusual to have any kind of injury without any psychological component at all. We are, after all, human. Things like fearing what it could be and fearing what it could mean to your life if it doesn’t go away are issues we regularly discuss with our clients.
The more we worry about these things the more tense we hold ourselves and the more it will hurt. A lot of pain is about protection. Protection equals tension and tension leads to pain. This protection can be conscious or subconscious. Either way it needs to be addressed. But of course to give you the confidence to believe in this it’s so important we screen for more serious underlying conditions.
This is where sometimes imaging can be useful to rule out anything bad to give us the confidence to let go. Conversely however, scan results can be scary. There’s a lot of Latin in there and many minor findings can lead to a lot of trepidation, understandably so. We often help clients cut through the jargon to understand how much they need to be concerned by their scan results. We talk more about this in our article about MRI Scans and X-Rays.
The final piece of our work is to help you to find ways to calm your nervous system. Are there some easy wins and life tweaks to help you feel more relaxed in general. A calmer nervous system will simply feel less pain.
Many clients are understandably sceptical at the outset. But the proof is in the pudding. If we can do something in our sessions to make you start to feel better it helps you to believe you can exist in a better place.
It’s important to remember that if you haven’t had a major accident then likely nothing has changed in your body and so your body, with all its imperfections, has existed in a pain free state before the sciatica started.
So our approach looks to remove the causes of the tension through the body that is causing the increased sensitisation on the sciatic nerve. Whether these causes are physical or emotional. Usually both. This approach means that we don’t have to press the bits that hurt until they are ready to let go. Which makes for more enjoyable and less scary treatment sessions for everyone involved!
If you’ve been struggling with sciatica recently or have had it in the past and would like to prevent a re-occurrence then please fill out the form here to arrange for us to give you a call to discuss how we might be able to help. We’d love to help you improve the quality of your life.
