Sciatica is a symptom rather than a specific diagnosis. Available evidence from basic science and clinical research indicates that both inflammation and compression are important in order for the nerve root to be symptomatic.
Although the term sciatica is simple and easy to use, it is, in fact, an archaic and confusing term. For most researchers and clinicians, it refers to a radiculopathy (pinched nerve in the spine), involving one of the lower extremities, and related to disc herniation. As such, the term ‘sciatica’ is too restrictive as nerve roots from L1 to L4 may also be involved in the same process. However, even more confusing is the fact that patients, and many clinicians alike, use sciatica to describe any pain arising from the lower back and radiating down to the leg. The majority of the time, this painful sensation is referred pain from the lower back and is neither related to disc herniation nor does it result from nerve-root compression.
Some interesting facts research based:
- Most patients with acute sciatica have a favourable prognosis but about 20%-30% have persisting problems after one or two years
- The diagnosis is based on history taking and physical examination
- Imaging is indicated only in patients with “red flag” conditions or in whom disc surgery is considered
- Passive (bed rest) treatments have been replaced with more active treatments
- Consensus is that initial treatment is conservative for about 6-8 weeks
- Disc surgery may provide quicker relief of leg pain than conservative care but no clear differences have been found after one or two years
If you suffer from this back injury we suggest you to see a doctor. If he recommends exercise for rehabilitation you should consider:
- Active techniques over passive techniques;
- Identify muscle imbalances and correct any movement asymmetries;
- Strengthening weaker or key muscles;
- Avoid any pain during exercise;
- Slow progression toward more intense activities;
- Use a specialist to guide and help you (at least during the initial phase).
Things you should know:
If you have a bulged disc is very unlikely that this structural problem will change but a lot of people can live pain free even with several disc bulges and so can you;
Pain is a defence mechanism. As long as your brain perceives instability, lack of control or weakness you will feel pain regardless having a structural injury or not;
Exploring safe movement, correcting muscle imbalances and getting stronger will decrease pain;
Surgery should always be a last resource.
Any kind of analgesic or anti inflammatory won’t correct the problem.
Exercises for sciatica pain:
Everyone has a different body, biomechanics and injury past therefore would be irresponsible to suggest one size fit all battery of exercises. Assessment is key to define the recovery process and exercise selection for sciatica pain.
Sources:
Diagnosis and treatment of sciatica, BW Koes, MW Van Tulder, WC Peul – Bmj, 2007
Sciatica, Jean-PierreValat MD PhD, Stéphane Genevay MD, Marc Marty MD, Sylvie Rozenberg MD, BartKoes PhD
