Is my sciatic nerve causing my back pain and can my Osteopath help?
Hello! Is your back sore? Do you have some leg pain as well? Perhaps some pins and needles? Or just a dull ache? I’m guessing both of these things are true if you’re searching for information on low back and sciatic nerve pain.
Fortunately you’ve come to the right place! I’m going to run you through all things sciatica and will hopefully give you some answers about what’s going on with your body. I’ll also let you know whether osteopathic treatment can help (spoiler alert, it almost definitely can!).
Ready? Grab a heat pack and let’s get started.
Get this lady a heat pack!
When it comes to low back, hip and leg pain, sciatica is one of the terms most commonly thrown around and it’s one that we hear in the clinic all of the time. It’s also a term that is not well understood and our poor old sciatic nerve gets blamed for so much back pain when often it’s not the sole perpetrator.
It’s important that we talk about and understand low back and leg pain, because in terms of prevalence, low back pain is reported to be as high as 79.2% in Australian adults and 84% in adolescents. Additionally, one in ten people, unfortunately, experience significant activity limitations.
The prevalence of sciatica itself varies wildly in literature and this is because the term is often used as a catchall for any kind of low back and leg pain, especially if there are pins and needles associated with it. That being said, one study estimated the incidence to be as high as 5 per 1000 in Western countries.
Understanding the source of back pain, how to help prevent it and what to do when it comes on is hugely important in reducing the impact of back pain on your life.
Let’s talk about the sciatic nerve
We can’t really get started until I tell you all about the sciatic nerve. As far as nerves go, your sciatic nerves (you have two) are a big deal. These two are the only nerves in your body to have their own dedicated blood supply. You know you’ve made it as a nerve when you have your own artery!
As shown in the image below, this major nerve is formed by the joining of existing nerve roots from lumbar and sacral spinal cord segments L4-S3. These nerve roots come together and create the sciatic nerve, which then goes on to supply the muscles throughout the back of your thigh and indirectly in your lower leg and foot.
Source: Up To Date Anatomy 2020
What actually IS sciatica and what are sciatica symptoms?
The reason why sciatica as a term is so poorly understood is due to the variability in symptoms and because it is a term that is often used to describe any kind of low back or leg pain. We will define sciatic nerve pain as any kind of pain radiating from the buttock along the course of the sciatic nerve or lumbosacral nerve roots associated with it.
This pain presents when pressure is put on the nerve fibres and since this is such a big nerve (about the size of your little finger), this results in a huge array of symptoms. You can feel pain along any point along the pathway of the sciatic nerve, from your bum to your foot, including your calf and the back of your thigh.
The pain can vary from a deep or dull ache or throbbing heat, to electric shock type nerve pain. You can also experience numbness, tingling, pins and needles or weakness. It can feel like a pressure pain or be sharp and no two episodes of this kind of pain tend to be the same.
Additionally because there are multiple causes (see below), it can also present with other symptoms that have nothing to do with the nerve itself. When something is irritating your sciatic nerve, your body tends to respond by trying to take pressure off the nerve. This can result in muscle spasm, joint restriction in the lower back and other compensatory patterns that can cause pain or dysfunction in other areas.
Not to jump ahead of myself, but one of the things osteopaths are great at is helping to look up and down your biomechanical chain and identifying and reducing these compensatory patterns, which could be contributing to your pain.
What causes sciatic nerve pain?
There are many causes of this type of leg pain. Most involve direct pressure or compression on the nerve or nerve roots such as a disc herniation or bony growths resulting from age-related spinal changes or degeneration.
There are rare causes in this category such as malignancy, narrowing of the spinal cord or exiting nerve root passages or vertebral fracture.
Some evidence suggests that the pain related to sciatica is not wholly due to this pressure, but is also contributed to by the inflammatory and immunological processes that are associated with the neural compression.
How is sciatica treated?
Treatment for sciatica largely depends on levels of pain, associated symptoms and how long it’s been going on for. It’s also largely dependent on the cause because the treatment for pain resulting from a disc bulge will be different to that caused by a fracture.
In early acute phases we tend to treat this type of sciatica symptom with:
- Gentle, controlled, slow movements targeting your low back and hips
- Heat or ice depending on what feels better
- Non-steroidal anti-inflammatories (as prescribed by your GP or pharmacist)
- Osteopathic treatment coupled with specific rehabilitation targeted at the cause of the pain
When pain has persisted or is unbearable, we look to more invasive and drastic treatment options such as:
- Injections targeted at pain relief
- Medications targeting nerve pain as prescribed by your GP
Can osteopathic treatment help my pain?
In our clinics we see many people with low back, hip and leg pain. As Osteopaths we will assess your pain and function and try to establish and then treat the root cause of the issue. We do this with a variety of treatment techniques and styles, including hands on soft tissue or massage work, joint articulation, manipulation and dry needling. We also prescribe rehabilitation and try to educate you to understand your pain and to help you to manage it yourself.
Our goal is for you not to need us, which is a terrible business model, but empowering people to have control of their health is our passion. Ensuring you leave us moving and feeling better is always our main focus.
At our four clinics across Melbourne, our osteopaths work collaboratively with our physiotherapists, myotherapists, podiatrists, and exercise physiologists to help all sorts of people move through life. Around 8 in 10 Australians have back pain at some point in their life and whether you’re young or old, a desk worker, mechanic, triathlete, or couch warrior, we’re here to help!
As always I am personally here to help, so if you have any more questions, you can email me directly at firstname.lastname@example.org to chat all things sciatic nerve and back pain or anything else you might have questions about.
Frequently Asked Questions
Is the sciatic nerve on the left or the right?
Both! You have two, one on each side.
What should I avoid if I have sciatica?
Avoid any heavy loaded activities or high intensity exercise until you’ve had a health professional assess you.
How long will sciatica take to heal?
It largely depends on the cause and prognosis times can vary from a week to 8+ months.
Is an osteopath or a chiropractor better for sciatica?
I’m pretty biased on this one, but the truth is that every practitioner and every patient is different and usually it doesn’t matter what type of practitioner you see as long as you can see progress in your treatment plan.
What is one exercise that could help my low back pain?
Glad you asked! Try this one but keep it within a pain free range and start slowly and with a reduced range and gently increase the movement as you get more comfortable: