Sciatica: What Causes It and How Osteopathy May Help
Sciatica can cause pain, tingling, numbness or other uncomfortable sensations that travel from the lower back or buttock into the hip, leg or foot. For some people, symptoms can make sitting, walking, exercising or even sleeping difficult.
The term sciatica is commonly used to describe symptoms associated with irritation or involvement of the sciatic nerve or its nerve roots in the lower back. The underlying cause can vary considerably between individuals, which is why a thorough assessment is important.
At Balance Osteopathy, we assess the way the lower back, pelvis, hips and legs are moving and consider how these areas may relate to your symptoms.
View this post on Instagram
What does sciatica feel like?
Unlike many types of lower back pain, sciatica can involve symptoms that extend beyond the back or buttock.
Common symptoms can include:
- Pain travelling into the buttock, thigh, calf or foot
- Tingling or pins and needles
- Numbness
- Burning or electric-type sensations
- Leg pain that may be more noticeable than the back pain
- Weakness in some cases
Symptoms can vary considerably. Some people experience relatively mild discomfort, while others may have significant pain that affects walking, sitting, sleep or exercise.
What causes sciatica?
Sciatica is not caused by one specific condition.
One common cause is irritation or compression of a nerve root in the lower spine, sometimes associated with a disc problem. Other spinal changes can also contribute to nerve-related symptoms.
Importantly, findings on scans do not always correspond directly with symptoms. Disc changes and other age-related changes can occur in people who have no pain at all.
This is why the clinical assessment matters. Understanding your symptoms, neurological function, movement and history can help determine the most appropriate approach.
Does sciatica always mean there is nerve damage?
No.
Nerve-related symptoms such as pain, tingling or altered sensation can occur when a nerve or nerve root is irritated without there necessarily being permanent nerve damage.
However, changes in strength, sensation or reflexes can be important clinical findings. Significant or progressive neurological symptoms should be assessed appropriately.
How can movement affect sciatica?
People with sciatica often notice that particular positions or movements aggravate their symptoms.
Sitting for long periods, bending, lifting, walking or certain exercise movements may increase symptoms in some people, while others may feel better with movement.
There is no single movement pattern that applies to everyone with sciatica.
Rather than avoiding all movement, it is generally useful to identify which activities are currently tolerated and gradually build capacity as symptoms allow.
This may involve modifying exercise temporarily, changing how certain activities are performed or introducing specific movements and strengthening exercises.
How can osteopathy help with sciatica?
At Balance Osteopathy, treatment begins with an individual assessment rather than assuming that every case of sciatica has the same cause.
Depending on your presentation, an assessment may consider:
- Lower back and pelvic movement
- Hip mobility and function
- Muscle and soft tissue function
- Movement patterns
- Strength and control
- Symptoms associated with particular positions or activities
- Relevant neurological signs
Where appropriate, hands-on osteopathic treatment may be used alongside exercise and rehabilitation.
Treatment may focus on improving comfortable movement, reducing muscular tension and helping you gradually return to normal activities.
The aim is not simply to treat where the pain is felt, but to understand the broader factors that may be influencing your symptoms and function.
What about nerve mobility exercises?
Nerves need to be able to move and adapt as your body moves. Specific exercises can sometimes be used to gently expose the nervous system to movement and improve tolerance.
These exercises are often referred to as nerve glides or neural mobilisation.
They are not appropriate for everyone, however, and more is not necessarily better. If a nerve-related exercise significantly increases pain, tingling or numbness, it should be reviewed rather than simply pushed through.
An individual assessment can help determine whether these exercises are appropriate and how they should be progressed.
Should you rest with sciatica?
Complete rest is rarely the goal.
While reducing activities that significantly aggravate your symptoms can be useful during an acute flare-up, prolonged inactivity can lead to reduced strength, mobility and confidence with movement.
Where appropriate, maintaining comfortable levels of activity and gradually rebuilding your normal activities can form an important part of recovery.
The right amount of activity depends on the severity and nature of your symptoms.
When should you see a doctor?
Most cases of sciatica can be managed conservatively, but some symptoms require prompt medical assessment.
Seek urgent medical attention if you develop:
- New or rapidly worsening weakness in the leg
- Significant numbness around the genitals, buttocks or inner thighs
- Difficulty controlling your bladder or bowel
- Severe symptoms affecting both legs
- Rapidly worsening neurological symptoms
These can indicate a more serious problem requiring urgent assessment.
You should also seek medical advice if symptoms are severe, persistent, worsening or not responding to appropriate management.
Getting back to movement
Sciatica can be frustrating, particularly when symptoms interfere with work, exercise, sport or everyday activities.
There is rarely a single treatment that is appropriate for everyone. A combination of education, appropriate movement, exercise, hands-on treatment and gradual rehabilitation may be useful depending on the individual presentation.
At Balance Osteopathy, we take the time to understand your symptoms, assess your movement and develop a treatment and rehabilitation approach around your needs and goals.
If you are experiencing back or leg pain that may be related to sciatica, book an assessment with Balance Osteopathy in Melbourne to discuss your symptoms and the most appropriate next steps.