Sciatica, or L5 radiculopathy, is a condition characterized by pain or sharp sensation that radiates along the path of the sciatic nerve, which runs from the lower back, down the hamstring and inside the side of the lower leg and ending in the forefoot and toes.
This condition is often caused by compression or irritation of the sciatic nerve at its origin (known as the nerve root) as it exits from the lumbar spine. This nerve root irritation leads to symptoms such as sharp pain, tingling or numbness and potentially loss of muscle function in the muscle innervated by the sciatic nerve (like your toes muscles, some ankle muscles, your calf complex and your hamstrings). However, it is important to note that not all sciatic nerve irritations are at the nerve root (or origin) and the nerve can be under compression further down its pathway through the leg. These other regions can be through the glute region, hamstring origin and around the knee.
Therefore, the diagnosis and management of sciatica involves a comprehensive approach aimed at firstly understanding where the nerve is becoming irritable, as well as alleviating pain, reducing inflammation, and improving overall functionality.
Assessment of this condition needs to be a thorough testing process. It involved an in-depth understanding of each client’s story (when the back AND leg pain started, how it responds to different movements, how it changes in the day, your overall health and many more variables). Then we would move onto a physical examination, whereby an OHL Physiotherapist would perform a neurological examination (to understand the current function of the nerve) and palpate your spine. We’d also be keen to better understand your body’s response to different movements, thus spinal movements and functional activities like sit-to-stand and walking may be assessed as well. It is only after a full assessment would an OHL Physiotherapist be able to answer your question of whether any imaging (CT, MRI or x-ray) is beneficial in this case.
Once an assessment is complete, a working diagnosis would be presented by your trusty OHL Physio – who is also ready with a plan fit for you. This play may include manual therapy and massage, movement therapy, strength training, pacing planning, pain management strategies and referral into our OHL Group Physio class program. The ratio and timeframe of each intervention is purely based of your individualised symptoms, but most notably your neurological assessment.
If your OHL Physio is feeling like conservative therapy is not likely to be successful in isolation, we may refer you to see your GP, a pain specialist or a sports physician to gain a medication approach to also help settle your nerve irritation at a chemical level (whilst physiotherapy helps to address the biomechanical irritations, which can worsen the local chemical irritability). These medications may include tablets like anti-inflammatories (Nurofen to Mobic to Prednisolone), pain relief (Panadol osteo to Panadeine forte to Targin) and occasionally short use of neurogenic drugs like Lyrica. Medication decisions are made in consultation with your medico, related to many health and nerve severity factors, and they will continue to liaise with yourself and your trusted Physiotherapist throughout the rehabilitation process.
In some cases, epidural steroid injections may be recommended to deliver anti-inflammatory medication directly to the affected area, providing more targeted relief. However, these interventions are typically reserved for more severe or persistent cases and require medical supervision. Lastly, while conservative approaches are most often effective, surgical intervention may be considered in cases of severe or persistent sciatica that do not respond to other treatments or if it has lead to a significant loss of leg muscle strength or any changes to bladder and bowl function. Surgical options aim to relieve pressure on the sciatic nerve, addressing the underlying irritation on the nerve itself. Post-op care after these surgeries is a passionate area for OHL Physios and we’d be with your all the way through!
In some cases, an OHL Physiotherapist will design a customized exercise program based on the individual's specific symptoms and needs. This could range from exercises to increase mobility of the joints or promote nerve movement, increasing muscle strength or building back towards work and sport activities. It is important you are assessed thoroughly to recommend the best exercise and treatment options as sciatica is not a one size fits all diagnosis.
Maintaining a healthy lifestyle is essential for managing sciatica. Regular exercise, such as swimming or walking, helps maintain good general heath and promote movement through the back and hips, reducing the risk of future flare-ups. Additionally, being aware of activities and posture that irritate the back or nerve so they can be modified to be more tolerable is important to reduce risks of flare ups.
In summary, clients experiencing sciatica should consult with an OHL Physiotherapist ASAP. Getting a personalized management plan tailored to their specific needs is paramount to getting better as quick as possible. Book today via 9431 5955 or you can book online via the Client Portal on our website.
