Sciatica

Sciatica is a common problem that affects half of all people at least once in their lives. It is a pain in the lower back that results from compression or irritation of the sciatic nerve – the largest nerve in our body. This pain can spread from the lower back, through the buttocks, all the way to the toes. Although sciatica often begins as a mild discomfort, it can quickly develop into severe and limiting chronic pain that makes even simple activities impossible.

What exactly is sciatica?

The sciatic nerve (nervus ischiadicus) is the longest and thickest nerve in our body, its nerve roots originate in the lumbar spine, running through the pelvis to the feet on both sides of the body.

The sciatic nerve is a sensory and motor nerve, which means that it transmits messages about sensation on the skin (the entire back of the leg, the outside of the foot, the sole of the foot) and about movement of the muscles of the lower body (hip, knee, ankle, foot). The location of the nerve compression causes sensory and motor function loss of various parts of the lower body.

Sciatica is a term for a group of symptoms caused by compression of the sciatic nerve (nervus ischiadicus).

The typical symptoms of sciatica are acute and stabbing pain that radiates from the lumbar spine through the buttocks down the back of one or both legs. Isolated pain exclusively in the leg or legs is also present. Sciatica usually affects only one side of the body.

Symptoms of sciatica and how to recognise it?

Sciatica symptoms vary in intensity depending on the location and the degree of the sciatic nerve compression. The most common sensations are:

• Sharp and burning pain that spreads through the buttocks all the way to the toes.
• The pain is occasionally present only or in isolation in a lower extremity.
• The pain typically worsens during sitting.
• A feeling of tingling and numbness (like being pricked by a thousand needles).
• Muscle weakness in the lower extremities (making it difficult to walk, stand for long periods of time, and lift objects).
• Reduced flexibility and mobility in the spine and lower body.
• Loss of sensory and/or motor reflexes in the lower body.

Weakness in the affected lower extremity and difficulty moving the leg and foot are typical symptoms, which, as mentioned above, can progress to major neurological pathologies in later stages.

Progressive forms of sciatica symptoms can lead to foot drop or loss of neurological function of the foot.

Severe compression of the sciatic nerve causes bladder problems, leading to urinary incontinence or difficulty urinating.

Did you know that sciatica rarely occurs before the age of 20, and most often occurs between the ages of 40 and 50?

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How does sciatica occur?

Sciatica occurs when the nerve roots of the sciatic nerve become compressed due to various factors:

• A herniated disc is a protrusion of the soft core of the intervertebral disc into the fibrous ring that surrounds it (the soft core) that then presses on the protruding nerve root.
• Spinal stenosis is a medical condition that causes the spinal canal (central nervous system) to narrow, which results in compression of the sciatic nerve.
• Degenerative changes in the intervertebral discs, which are most often a result of ageing, cause the vertebrae to collapse, which compresses the sciatic nerve and causes sciatica pain.
• Spondylolisthesis is the movement or slippage of a vertebra forward, which means that the alignment with the other vertebrae is disrupted. A slipped vertebra causes compression of the sciatic nerve and, as a result, sciatica pain.
• Piriformis syndrome describes the stiffness and inflammation of the piriformis muscle, which is located deep in the gluteal region. The sciatic nerve runs through or next to the piriformis muscle, and when the muscle tightens, the nerve becomes compressed, causing sciatica pain.
• A traumatic injury (fall, car accident, direct blow to the spine, sports injury) causes compression of the sciatic nerve.
• Sciatica during pregnancy is a common condition that affects pregnant women due to hormonal changes, spinal pathologies, being overweight, and rapid uterine enlargement.

The true cause of sciatica is determined during the initial diagnostic examination, which is the basis for determining an individualised treatment programme for sciatica pain.

Specialised physiotherapy for sciatica

In the acute phase of physiotherapy for sciatica, we focus on controlling symptoms, where we reduce pain, reduce inflammation, and increase range of motion and muscle strength.

Physiotherapy experts use manual therapy, joint mobilisation, trigger point therapy, and myofascial release in their work to reduce muscle tension in the spinal and gluteal musculature. This also increases range of motion and reduces sciatica pain.

Manual therapy for sciatica is performed in combination with instrumental physiotherapy for sciatica, which uses state-of-the-art devices for faster tissue healing, acceleration of cellular metabolism, and active reduction of sciatica pain. In our work we use:

• TECAR Wintecare therapy (e.g. piriformis muscle relaxation in case the cause of sciatica is piriformis syndrome)
• Summus high-energy laser (in the region of the lumbar spine and down the lower extremity – along the course of the sciatic nerve)
• HiTop high-tone electrostimulation (in the region of the lumbar spine and down the lower extremity – along the course of the sciatic nerve)
• PERISO diamagnetic therapy (reduction of sciatica pain).

We perform specialised therapeutic training for sciatica, where we activate and strengthen the deep stabilisers of the trunk, spinal muscles and the musculature around the hip.

This develops stability in the lumbar region of the spine and reduces sciatica pain in basic spinal movements. We gradually progress training with the lumbar spine flexion movement pattern, as this adapts the spine to the loads when bending the back.

We conduct special training for sciatica, strengthening spinal patterns in the direction of anti-lateroflexion and anti-rotation. We focus on increasing the load-bearing capacity of the spine.

We perform neurodynamics and neuromobilisation training to improve sciatic nerve conduction, improve mobility of the spine and lower extremities due to neurological deficits.

Our physiotherapy experts will teach you how to help yourself and how to properly modify your activity when suffering from sciatica.

DANGERS AND PITFALLS OF DELAYED REHABILITATION

 

MEDICOFIT specialists

• Pain and neurological symptoms can escalate, transforming into a chronic condition that is extremely difficult to treat.
• Inadequate rehabilitation increases the risk of permanent nerve damage, which can lead to chronic pain, numbness, or weakness in the affected extremity.
• Lack of rehabilitation leads to muscle atrophy, where muscles gradually lose strength and mass, leading to even greater spinal instability.

Inadequate or delayed rehabilitation seriously jeopardises an individual’s long-term physical health and is the main culprit for unsuccessful results and permanent movement limitations.

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Exercises for sciatica

Below, we also present some effective exercises that you can incorporate into your routine to reduce discomfort and regain flexibility and strength in your spine and lower back. Performing these exercises correctly will help you improve your quality of life and prevent further injuries.

Important notice

• The exercise can be performed in numerous modifications and different load regimens; proper execution will be prescribed by a MEDICOFIT physiotherapy specialist for low back pain rehabilitation as part of your comprehensive treatment.
• If you have hip problems, please book an diagnostic therapy appointment before performing the exercise. The exercise may also be contraindicated.
• Always do the exercise strictly according to the prescribed regimen and as demonstrated by the physiotherapy specialist for spine rehabilitation and disorders.
• We recommend the exercise as part of guided, comprehensive specialist physiotherapy for spine rehabilitation.
• If you perform the exercise independently without the supervision of a physiotherapy specialist, we are not responsible for potential symptomatic responses.

Exercise 1: Anti-extensions of the spine lying down with alternating movement of the opposite arm, leg + elastic band

Exercise 2: Single-leg knee extensions in the hip-raised position + isometric abduction

Exercise 3: Internal rotations of the hip joint with added final abduction + rotation control

Frequently asked questions about sciatica

• What kind of pain does sciatica cause?

Symptoms of sciatica or pain occur suddenly, forcefully with a specific movement, with an aggressive pain response in the back, buttocks, and legs, or gradually due to the progression of degenerative changes in the spine. Sciatica can also occur without any pathological picture, in which case the pain will decrease quickly.

• What sensation does sciatica cause?

Sciatica is caused by a severe acute irritated condition. The pain is severe and may be accompanied by neurological symptoms in the lower extremities, such as tingling, numbness in the legs and feet, and sensations of hot or cold feet. In advanced stages of sciatica, sensory and motor disorders of the legs may also occur.

Sciatica is distinguished from normal back pain in that the pain spreads to the buttocks, hips, and down one or both legs. Sciatica is characterised by occurring on only one side of the body, although it can occur bilaterally in rare cases.

• Can sciatica occur in both legs?

Sciatica can also occur in both legs, in which case it is usually a compression at the level of the lumbar spine in the form of a broad-based herniated disc or disc herniation, when the sciatic nerve roots are affected on both sides. Sciatica in both legs can occur when there are multiple associated pathologies of the lumbar spine, e.g. a herniated disc at two levels of the spine on different sides or a herniated disc with arthritic changes on different sides. It is also common to experience sciatica on both sides during an extremely severe acute condition.

• Does sciatica appear immediately or gradually?

Sciatica can occur with an “incorrectly” performed movement, even though it is not actually an incorrect movement. It involves poor activity of muscle groups at the moment of performing a movement with the probable presence of degenerative changes in the form of disc herniation or other pathologies. Often, “incorrect movement” is just the trigger for sciatica symptoms, with the problem being broader.

• How long does sciatica last?

Sciatica can go pass quickly in some cases, within one week, although in most cases, symptoms persist for several weeks. Sciatica can persist for several months or years, depending on the individual’s approach. With proper physiotherapy and kinesiology, which we recommend for all patients with sciatica, the pain usually resolves completely within a window of 6 to 12 weeks.