Sciatica, not just a pain in the bum.
ciatica is commonly diagnosed as hip or buttock pain radiating along an area of the leg. More often than not this is a misdiagnosis. Genuine sciatica is an impingement of the sciatic nerve which originates from spinal levels L4 to S3 and results in lower back or gluteal region pain (depending on impingment point), pain or paraesthesias (numbness or tingling) along the posterior thigh radiating down to the heel of the foot. The nerve impingement can be caused by spinal stenosis, osteophytic growns, disc herniation or in some cases around the pelvic region by a tight piriformis muscle (also known as piriformis syndrome). Other causes of lower back pains which radiate to the thigh can vary but this is for your practitioner to ascertain by examination, testing and if necessary imaging.
Spinal stenosis
Spinal stenosis is the narrowing of the spinal canal that houses the spinal cord and the nerve roots. The cause of spinal stenosis in the lumbar spine is commonly associated with aging. Areas of the vertebrae widen as they degenerate and can compress the spinal nerves as a result (Ullrich, P., 2011). Patients with spinal stenosis are generall comfortable while sitting but will experience discomfort standing due to the reduced space available in the vertebral canal and intervertebral foramen. This reduced psace affects the flow of blood to the area so while the bone itself can impinge and irritate the spinal nerves, the lack of fresh blood flow and removal of toxins will also cause aggravation to the nerves in that area. It is very rare that lumbar spinal stenosis will cause severe nerve damage.
Disc herniation or "slipped" disc
Disc herniation is another cause of sciatic nerve irritation. Where a lumbar disc herniates or prolapses and the inner gel-like interior inside a lumbar disc contains inflammatory proteins. When these proteins leak out they can aggravate your sciatic nerve roots thus resulting in sciatica symptoms (Moeller, A., 2016).  Further to this a disc herniation can disrupt the flow of blood and fluids around the nerves similar to that of spinal stenosis. Disc herniations heal over time and with the right treatment plan can be prevented from reoccuring.
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Piriformis syndrome
Piriformis syndrome is a condition in which the piriformis muscle spasms and causes buttock pain. The piriformis muscle can also irritate the nearby sciatic nerve and cause pain, numbness and tingling along the back of the leg and into the foot. The sciatic nerve can travel beneath, over or through the piriformis muscle (see diagram), this variation in position can affect a person's chances in developing piriformis related sciatica symptoms. The piriformis muscle can become tight through from muscle, spine or sacroilliac joint imbalance. When tight or in spasm, the piriformis can provoke sciatic nerve irritation and result in causing sciatica pain patterns. Osteopathic treatment can help this through rebalancing the spine and sacroiliac joints, releasing the piriformis muscle and stabilising the pelvic girdle.
How can osteopathy help sciatica?
Your osteopath will do a series of tests to ascertain the cause of the sciatica symptoms. These tests should involve a striaght leg raise test (SLRT), deep tendon reflex tests (DTR) and muscle power tests at the very least. In some cases further neurological testing is performed dependant on the results of the previous tests. 

Treatments will vary based on the examination findings but each of these causes is treatable. The aim of the treatment to reduce the pressure on the sciatic nerve through mobilisation of the spine, reduction of pressure on the spinal nerve roots, relaxing the associated muscles and realigning unbalanced joints.
Uncommon but potentially serious symptoms.
Call NHS direct on 111 if you experience symptoms such as:
  • Incontinence
  • Loss of use of one or both legs
  • Numbness around the anus or genitalia
  • Unusual rash which doesn't fade under a pressed glass
  • ​Pain worsening at night and not relieved by painkillers
To find out if osteopathy can help you or to book an appointment get in touch today!