The sciatic nerve is the longest nerve in your body. It runs from the back of your pelvis, through your buttocks, and all the way down both legs, ending at your feet. 
 
Sciatica is the name given to any sort of pain that is caused by irritation or compression of the sciatic nerve. When something compresses or irritates the sciatic nerve, it can cause a pain, often the pain extends from the lower back all the way through the back of the thigh and down through the leg. Depending on where the sciatic nerve is affected, the pain may also extend to the foot or toes. 
Sciatic pain can range from being mild to very painfulI. It consists of leg pain, which might feel like a bad leg cramp, or it can be excruciating, shooting pain that makes standing or sitting nearly impossible. Sciatica usually affects only one side of the lower body. For some people, the pain from sciatica can be severe and debilitating. For others, the pain from sciatica might be infrequent and irritating, but has the potential to get worse. 
 
Seek immediate medical attention with any symptoms of progressive lower extremity weakness and/or loss of bladder or bowel control. 
 
The pain might be worse when you sit, sneeze, or cough. Sciatica can occur suddenly or it can develop gradually. You might also feel weakness, numbness, or a burning or tingling ("pins and needles") sensation down your leg, possibly even in your toes. 
 
Causes of sciatica 
 
A herniated or prolapsed disc that causes pressure on a nerve root — this is the most common cause of sciatica. 
Piriformis syndrome — this develops when the piriformis muscle, a small muscle that lies deep in the buttocks, becomes tight or spasms, which can put pressure on and irritate the sciatic nerve 
 
Spinal stenosis — this condition results from narrowing of the spinal canal with pressure on the nerves. 
Spondylolisthesis — this is a slippage of one vertebra so that it is out of line with the one above it, narrowing the opening through which the nerve exits 
A prolapsed disc is the most common identified cause of sciatica, but in some cases there is no obvious cause. 
 
Treating sciatica 
A combination of things you can do at home, such as taking over-the-counter painkillers, exercise and hot or cold packs can usually relieve the symptoms. 
 
Treatment for sciatica focuses on relieving pressure and inflammation. Typical sciatica treatments include: 
 
Medical treatments 
Anti-inflammatory drugs such as non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, or oral steroids, to relieve inflammation. 
 
Physiotherapy 
Your physiotherapist will be able to help you achieve a pain-free state quickly. Your physiotherapist will use a variety of treatment modalities to reduce your pain and inflammation. These may include: ice, acupuncture, de-loading taping techniques, joint mobilisations and exercise. The initial aim is to try and centralise the pain, taking the pain out of the leg. 
 
This treatment helps to prevent further episodes of sciatica. In many cases of a herniated disc, the symptoms can be relieved if you get into a position of spinal extension, but if this position is painful it should be avoided. Spinal extension can be achieved by lying on the front and gently propping the shoulders up on the elbows. 
 
As the inflammation and pain reduces, your Physiotherapist will then focus on restoring your normal back joint range of motion and resting muscle tone, lower limb nerve flexibility and posture. Tight leg and back muscles may need to be released to allow full and normal movement of your legs and back. Normal muscle length and muscle strength prevents injuries. 
 
Another area that your Physiotherapist will work on is restoring good core muscle control. Research into back pain has highlighted the importance of good deep abdominal core stability to maintain a healthy back. 
 
The next stage of your rehabilitation is returning you to your normal level of fitness and daily activities. And finally preventing any further recurrence of the problem. 
 
Epidural steroid injections 
Steroids, with their strong anti-inflammatory effects, are delivered at the origin of the inflamed sciatic nerve roots. 
 
Surgery 
Surgery may be warranted if the sciatic nerve pain is severe and has not been relieved with appropriate manual or medical treatments. 
Preventing sciatica 
 
There are some steps you can take to minimise your risk of disc or back injury that could lead to sciatica. This includes: 
 
• Better posture and lifting techniques 
• Stretching before and after exercise 
• Simple, regular exercises to improve flexibility 
 
Lifting and handling 
 
One of the biggest causes of back injury, particularly at work, is people lifting or handling objects incorrectly. Learning and following the correct method for lifting and handling objects can help prevent sciatica. 
 
• Think before you lift – can you manage the lift? Are there any handling aids you can use? 
 
• Start in a good position – your feet should be apart with one leg slightly forward to maintain balance. When lifting, let your legs take the strain – bend your back, knees and hips slightly but do not stoop or squat. Tighten your stomach muscles. Do not straighten your legs before lifting as you may strain your back on the way up. 
 
• Keep the load close to your waist – keep the load as close to your body for as long as possible with the heaviest end nearest to you. 
 
• Avoid twisting your back or leaning sideways – especially when your back is bent. Your shoulders should be level and facing in the same direction as your hips. Turning by moving your feet is better than lifting and twisting at the same time. 
 
• Keep your head up – once you have the load secure look ahead, not down at the load. 
 
• Know your limits – there is a big difference between what you can lift and what you can safely lift. If in doubt, get help. 
 
• Push, do not pull – if you have to move a heavy object across the floor, it is better to push it rather than pull it. 
 
• Distribute the weight evenly – if you are carrying shopping bags or luggage, try to distribute the weight evenly on both sides of your body. 
 
 
Posture 
How you sit, stand and lie down can have an important effect on your back. The following tips should help you maintain a good posture. 
 
Standing 
Stand upright, with your head facing forward and your back straight. Balance your weight evenly on both feet and keep your legs straight. Imagine a large bunch of helium balloons attached to your head softly lengthening your spine. 
 
Sitting 
You should be able sit upright with support in the small of your back. Your knees and hips should be level and your feet should be flat on the floor (use a footstool if necessary). Some people find it useful to use a small cushion or rolled-up towel to support the small of the back. 
 
If you use a keyboard, make sure that your forearms are horizontal and your elbows are at right angles. If you are concerned regarding your work station position then seek professional advice to have it assessed properly. 
 
Driving 
Make sure that your lower back is properly supported. Your knees should not be higher than your hips so make sure the base of the car seat is correctly positioned. Foot controls should be squarely in front of your feet. If driving long distances, take regular breaks so that you can stretch your legs. 
 
Sleeping 
Your mattress should be firm enough to support your body while supporting the weight of your shoulders and buttocks, keeping your spine straight. Support your head with a pillow, but make sure that your neck is not forced up at a steep angle. 
 
Exercise 
Exercise is both an excellent way of preventing back pain and reducing any back pain you might have. However, if you have chronic back pain (pain that has lasted more than three months), consult your physiotherapist before starting any exercise programme. 
 
Exercises such as walking or swimming strengthen the muscles that support your back without putting any strain on it or subjecting it to a sudden jolt. 
 
Activities such as Pilates or Yoga can improve the flexibility and the strength of your back muscles. It is important that you carry out these activities under the guidance of a properly qualified instructor. 
 
There are also a number of simple exercises you can do in your own home to help prevent or relieve back pain. Your Physiotherapist will be able to advise you on the correct exercises to carry out. 
 
If you would like any advice or further information on the above information then please do not hesitate to contact us on 01206 844410 
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