"Are you suffering from lower back related leg pain?"
"Been told, or think you may have SCIATICA?"
Read below from our Musculoskeletal Physiotherapist Reuben Fox
An incredible blogpost on sciatica perfectly explained the symptoms many clients experience. I wanted to share some of the insights from this brilliant article and encourage you to also read it (bottom of page for reference) if you'd like to learn more about this condition.
**particularly if you are a physiotherapist, but it may also be useful if you're suffering from symptoms of sciatica
Often times buttock pain and leg pain can originate from the lower back. This was demonstrated in 1968, when a surgeon wrapped a nylon thread around the nerve root of a lucid patient and slowly pulled the thread, placing pressure on the nerve. Lo and behold, the vast majority of patients reported intense pain into the buttock and into the lower lateral leg! Please see image below for where the nerve root is located:
Ref: https://www.mountnittany.org/krames-images/357001.jpg
Ref: https://lambertiphysiotherapy.co.za/wp-content/uploads/2021/04/Lumbar-1.jpg
Back in 2020 when I was completing anatomy labs as part of my masters, we were viewing cadavers and looking specifically at the nerves, I remember being amazed at just how large the sciatic nerve was (just think the circumference of your thumb) and thinking that it's no wonder it can be a significant generator of discomfort. You can see just how large the sciatic nerve is on the above image (on the left).
Typically we see a collection of symptoms which describe this sciatic pain, but just remember there is an enormous 'grey zone' with regards to symptoms, you may have some of these symptoms, but there are no hard and fast rules with regards to pain. I've seen many patients with the same injury and an incredibly diverse array of symptoms. With that caveat, these are some typical symptoms of sciatica.
Symptoms of Sciatica
-
Leg pain is worse than back pain - as mentioned above, this isn't a hard and fast rule, but we tend to see that symptoms can be more painful further down the leg. If symptoms are particularly painful below the knee, this is more indicative of sciatica.
-
Pain is bad (like really really bad!) - true sciatica is often excruciating, people often don't realise how bad it can be. However, it's best to remember that symptoms can be horrible in the first few days, but tend to improve as the weeks progress.
-
There are often other weird sensations - Pins and needles, ants-crawling up the leg, buzzing are all common symptoms of this condition. These symptoms are often unpredictable and generally occur because the brain cannot interpret/understand all of the signals that are arriving from the affected area.
-
Often a generalised loss of strength - Due to the pain and lack of limb use, it can be quite common to find a generalised loss of strength in the leg.
Treatment of sciatica often centres around calming the original symptoms with massage, gentle movement, and graduated loading. I often recommend taking a course of anti-inflammatories to try settling the symptoms.
And it's worth noting again that symptoms will often be worst in the first week, but will tend to progressively improve over the following few weeks. If conservative is unsuccessful over the first 6 weeks, or if pain is particularly high for a significant period there may be a consideration for a cortisone injection to calm the inflammation around the nerve (which is the cause of the irritation).
Once symptoms have settled, you'll often need to spend a number of weeks regaining your lost strength, the timeframe really depends on how long the sciatic episode was, and how much strength was lost.
However before making any decisions around your buttock/leg pain, please ensure that you consult a Physiotherapist or GP who has experience in managing sciatica.
If you are having trouble with symptoms and would like clarity around the diagnosis and treatment of this condition, please get in touch!
References
-
https://www.physio-network.com/blog/sciatica-signs/ (author: Tom Jesson)
