In this section:
- What is sciatica?
- What causes sciatica?
- Treatment for sciatica
- Conditions that mimic sciatica
- Piriformis Syndrome
What is sciatica?
Sciatica refers to pain felt in the buttock or down the back of the leg as result of irritation or compression of the sciatic nerve or its nerve roots. As well as pain other symptoms can include tingling and, in more severe cases, total numbness or even weakness in parts of the leg. This weakness can get so severe that a patient can lose all power to the affected muscle groups to the extent that they lose the ability to pull their foot up towards their shin or stand on tiptoes.
The sciatic nerve starts around the lower back, passes through the buttock and then down the back of the thigh to the knee, where it divides into two branches which supply the lower leg and foot. Sciatica can originate from damage or pressure on any part of the sciatic nerve but the nerve is most commonly irritated where it begins in the lower back.
What causes sciatica?
In early adulthood to middle age, the most common cause of irritation in the lower back is from a bulging intervertebral disc. After middle age it is more likely to be from degenerative changes or osteoarthritic changes of the spine. Other causes include a spondylolisthesis, which is when one vertebral segment of the spine slips forward in relation to the one below it.
Treatment for sciatica
Most of these types of lower back problems can be helped by lifestyle changes and physical therapy, including IDD Spinal Decompression Therapy, as well as education on posture and corrective exercises. At Spine Plus we are at the forefront of providing such treatment and have a comprehensive rehabilition programme.
Most cases do not require spinal surgery but persistent or severe cases may do so to relieve pressure on the nerve. In the few severe cases where symptoms include severe numbness or weakness in the leg, tingling or numbness around the genitals or loss of bladder or bowel control, urgent surgery may be required to prevent permanent nerve damage.
For isolated disc bulges, some spinal surgeons use microdiscectomy techniques in which just the bulging part of the disc is removed. This procedure involves the use of a microscope, which enables a smaller incision to be made; this causes less damage to the muscles and soft tissues around the spine, therefore enabling a quicker recovery than with larger incisions without the use of a microscope. The limitation of microdiscectomy is that access to the spine is limited and the surgeon may not be able to view all of the affected disc.
Conditions that mimic sciatica
Occasionally patients who have sciatic pain will undergo investigations, such as MRI scans, of their lower back to look for the cause of their sciatica and a cause will not be identified. There can be various explanations for this, for example pain may be “referred” from the hip joint, the sacro-iliac joints or referred from taut bands of muscle called “trigger points” in the lower back and buttock muscles. Alternatively, the irritation to the sciatic nerve may be in a part of the sciatic nerve below the lower back that was not imaged in the original scan; an example of this would be “Piriformis Syndrome”.
Piriformis is the name of a muscle in the buttock. In approximately 10 – 20% of people the sciatic nerve goes directly through the middle of the piriformis muscle. If this muscle goes into spasm, becomes tight or fibrous, this can pinch on the sciatic nerve and produce a form of sciatica. This condition occurs when the piriformis muscle irritates or causes compression of the sciatic nerve.
Diagnosing Pirifromis Syndrome
Since the sciatic nerve can be compressed due to various conditions, such as a herniated disc, lumbar muscle strain, spinal stenosis and facet arthropathy, these conditions often co-exist and may cause the piriformis to tighten. Diagnosis of isolated piriformis syndrome can therefore be challenging. Various diagnostic procedures such as CT scans, MRI and EMG are used to exclude the possibility of other causes that can result in the compression of the sciatic nerve.
Symptoms that could indicate the presence of the disorder include numbness in the buttocks, pain while ascending or descending stairs, tingling in the legs, and pain while sitting for long periods. The patient’s history of pain and symptoms are taken into account, along with a physical examination to check for a contracted piriformis muscle. The patient is made to undergo various movements with their legs and hips, which cause compression of the piriformis muscle. If these movements result in pain, the diagnosis of piriformis syndrome can be made.
Treating Piriformis Syndrome
Piriformis Syndrome can be treated in the following ways
- Stretching the piriformis muscle 3 to 4 times a day
- Deep Massage and dry needling into the muscle can be very effective
- Strengthening and muscle balancing exercises: Various exercises that help to strength the core as well as the piriformis and other muscles around the hip can be done to treat the syndrome.
- Avoiding certain actions: If particular activities such as climbing stairs or running result in excessive pain, these should be avoided till the pain is under control or has been treated effectively.