We can talk about sciatica when we experience tingling pains and, in severe cases, muscular paresis in the back of the buttock, thigh and leg down to the foot.
It is sometimes associated with lower back pain, creating a lumbosciatica. Usually the problem is unilateral, but there are also bilateral sciatica pictures.
Statistics reveal sciatica is more frequent in men between 40 and 50 years of age.
Contrary to popular belief, the term sciatica does not define a true diagnosis but a set of symptoms. This clarification is important because the treatment may be different depending on the cause of the symptoms. For example, in some cases the pain may worsen in an upright position, or sitting and walking; if it is a problem of the disc the pain disappears when lying down. Coughing or sneezing often increase symptoms.
Analyzing which movements or positions increase or alleviate the symptoms is a fundamental step to identify the origin of the disorder and in Nervenia we give extreme attention to the evaluation moment to not only treat the symptoms, but also and above all the causes of sciatica.
The most common sciatica symptoms are:
- back pain that radiates to the leg,
- tingling and numbness in the leg and foot,
- weakness of the calf and foot muscles.
Sciatica is caused by the compression or irritation of the sciatic nerve or a lumbar root.
One of the causes of sciatica is the herniated disc disturbing a nerve. The vertebral disc is composed of a series of concentric rings that contain a gelatinous nucleus, called pulposus nucleus. The disks separate the vertebrae and, therefore, allow the existence of a space, the intervertebral foramen, which allows the nerve roots to exit from the vertebral canal and form the sciatic nerve that heads towards the lower limb. The disks are shock absorbers for the spine, but they are also considered weak spots as they suffer from the pressure of daily movements. The compression of the sciatic nerve from a herniated disc occurs when the liquid center of the disc protrudes externally and causes an inflammatory reaction on the nerve root, thus causing sciatica.
Sciatica can also occur during late pregnancy, primarily as a result of compression exerted by the uterus on the sciatic plexus, and secondarily, due to muscle tension or vertebral compression resulting in having to constantly endure the extra weight constituted by the fetus, in addition to its own posture of advanced pregnancy.
It is also possible to have compressions of peripheral sections of the sciatic nerve, usually due to tissue tension exerted by the muscles of the pelvis or thigh. A possible cause of this is the so-called piriformis syndrome. In this condition, the piriformis muscle, which is located under gluteal muscles, contracts and compresses the sciatic nerve that runs through the muscle.
Another cause of sciatic symptoms is dysfunction of the sacro-iliac joint, often evaluated during manual therapy.
Unhealthy postural habits, prolonged sitting posture and poor physical activity can lead to both vertebral and tissue problems that are often associated with sciatica.
Another cause may be the activation of trigger points that are felt when the muscles undergo ischemia, low blood supply, injury, strain or chronic muscle contraction.
Also the stenosis of the vertebral canal, a condition in which the vertebral canal narrows and compresses the spinal cord or the roots of the cauda equina, the complex of nerves running inside the vertebral canal, can be a cause of sciatica. The narrowing of the vertebral canal can decrease the space available for the sciatic nerve and prevent it from coming out correctly, squeezing and irritating it.
Normally, the diagnosis of sciatica is clinical through the patient’s simptoms and through physical tests.
The Lasègue sign, or Straight Leg Raise test, can be used for diagnosis and is usually positive in the lumbar disc herniation and entrapment of the sciatic nerve, where this movement causes pain.
Tests such as computed tomography (CT) or magnetic resonance imaging (MRI) can help in the diagnosis of lumbar disc herniation. On the other hand, they will hardly be positive in the event of pinching or nervous entrapment of another origin. Therefore the negativity of these tests does not exclude the involvement of the sciatic nerve.
Electromyography typically shows signs of chronic or acute neurogenic distress in the muscles affected by the sciatic nerve and its derivations.
Cures and remedies
Finding out the cause is essential for setting specific treatment. Let’s start with the diagnosis and the doctor’s instructions and we will investigate the entire course of the sciatic nerve to find out where the irritation is hidden.
Often the compressions that cause sciatica are multiple and must be discovered and treated in order to have a truly effective treatment. At Nervenia we are specialized in this type of approach.
The mobility of the sciatic nerve is restored through a particular type of passive mobilization called neurodynamics. The irritation of the sciatic nerve is instead treated through neuromodulation and deep nerve stimulation (DNS) which uses a particular type of current specific to nerve tissue.
The therapy is non-invasive and painless. The protocol also includes the treatment of inflamed or painful tissues surrounding the sciatic nerve.
An important application of this treatment occurs in the post-surgical phase, where it is essential to prevent the formation of adherences that could entrap again the sciatic nerve. creating further disturbances and relapses.