Lachlan Hough
APA Titled Musculoskeletal Physiotherapist
Sciatica is a common reason for people to visit a physiotherapist, and it can be very painful and distressing to experience, but what does the word actually mean, and what do you need to know if you’re experiencing it?
Sciatica is a broad term used to describe leg pain that is coming from the spine. It is a type of referred pain, or pain felt in a certain body part but originating from elsewhere in the body. People often think that sciatica occurs due to a ‘pinched nerve’, but this is not always the case.
Sciatica may occur due to:
- Pressure or contact on a nerve
- Inflammation causing irritation of a nerve
- Or without nerve involvement at all – known as somatic referral
People with sciatica may report feeling:
- Pain in the lower back or buttock and usually down one leg (but sometimes people can have leg pain without back pain)
- Reduced or painful movement of their back
- Pins and needles or numbness
- Weakness of certain muscles or movements
What does a physiotherapist do for sciatica?
One of the most important things a physiotherapist will do when someone has sciatica is to assess what the probable source is. They will listen carefully to what you tell them about the pain, its location, and any other symptoms that you report. This gives a lot of information about the likely cause of your sciatic pain. They will then complete a thorough examination of the spine and the nerves to determine if anything is present that would suggest contact or pressure on a nerve (“a pinched nerve”). This includes things like loss of sensation, loss of muscle power, and changes in reflexes.
Treatment for sciatica is individualised to the person experiencing it, however common early treatments may include massage, joint mobilisation, taping, and exercise. Your physiotherapist can also work with your wider healthcare team if there is a need for pain relief or anti-inflammatory medication to help you recover.
As time progresses and your pain improves, it’s important to regain your strength and conditioning. Your physiotherapist may recommend strengthening or gym exercise, or other options like Pilates, as part of your rehabilitation. They will also help guide you towards returning to normal day-to-day tasks, sports, or other meaningful activities.
Are scans helpful?
Scans can play a crucial role in some cases, but they aren’t needed in most instances of back pain or sciatica. A scan only shows the structure of our spine, but it cannot show pain. Many people without pain have degenerative changes, disc bulges, and even narrowing around nerves on scans, and many people with pain have no clear cause shown on a scan.
When a scan is warranted, it is used to confirm the diagnosis, not make a diagnosis.
When is back pain or sciatica an emergency?
Most back pain is not due to serious injury or pathology. However, there are some signs you should be aware of. If your back pain is accompanied by the following, it is essential to go to the emergency department as soon as able:
- Bladder dysfunction
- unable to empty your bladder
- Bowel dysfunction
- Losing control of your bowel/incontinence
- Numbness or change in sensation in the “saddle region”
- imagine you are sitting on a horse – it’s the area of your body that would be in contact with the saddle.
- or if you can’t feel yourself wipe after going to the bathroom
- Sexual dysfunction
These symptoms are rare, but they can represent a condition called Cauda Equina Syndrome which requires urgent attention. People may not think, or may not feel comfortable, to share these things with their physiotherapist, but it is important to do so if they have occurred alongside back pain or sciatica.
Take home messages
- Sciatica is common, but usually not dangerous
- Scans are helpful in some cases, but often unnecessary
- Physiotherapy is helpful and your physio can guide you through the different stages of your rehabilitation
- Sometimes medication is needed to help pain initially
- A co-ordinated team approach with your GP will often be beneficial
The experienced physiotherapists at City Baths Spinal & Sports Medicine Clinic are equipped to help you determine the source of your sciatic pain and provide you with management and rehabilitation advice to help you get on top of your sciatica.
Book your assessment today!
