Sciatica

Person gardening following sciatica.

Sciatica

Sciatica is an umbrella term to describe pain in the leg that is radiating or being referred from the back.

It can be extremely painful and debilitating and is caused by irritation, compression or inflammation in the nerves roots that supply the sciatic nerve ( L4-S1).

Physiotherapy is a common treatment for sciatica. Physiotherapists understand the complex interaction of the brain, tissue and nervous system and can help you regain your life again.

 

Signs An Symptoms Of Sciatica

  • Unilateral Leg pain
  • Commonly at the back of the leg (posterior) and below knee.
  • Numbness in the affected leg.
  • Neurological weakness
  • Altered reflexes
  • Positive slump test

 

What Can Cause Sciatica?

  • Disc Herniation
  • Age Related Degenerative Changes
  • Inflammation around the nerve root.

 

What Questions Do Physios Ask If You Have Sciatica?

Physiotherapists will ask you a series of questions to rule out that it is not something more serious.

This red flags which may suggest further investigations are needed are:

  • Progressive, gross weakness
  • Problems with your bowel or bladder
  • Suspicion of cancer or infection ( fever/rapid weight loss/ loss of appetite)
  • History of trauma ( fall from height/ RTC)
  • Persistent sciatica for 12 weeks + despite conservative treatment.

 

Conservative Treatment

It is important that people are educated about sciatica.

Physiotherapists work with helping people to become educated and help people build confidence that it is safe to move.

If pain is left  for a long time the brain can develop protective conditioned responses which overall increases pain and increase disability.

 

How A Cage Fighter With 7 Years Of Pain Returned To Fighting After One Session

For example a patient I saw had been experiencing back pain for 7 years.

He was originally a cage fighter and had leaned forward to put his trousers on one day and experienced severe back pain. In the following weeks of trying to manage it himself he had developed a powerful feedback loop.

It started because he was unable to put his socks on. when he tried to do this he would experience severe pain.

The next time he tried a similar activity he would ‘brace’ expecting the pain.

Initially he was only unable to put his socks on but as this feedback loop became strong any movement or even the thought of moving would make his muscles tense and he would experience pain.

 

Had Given Up Cage Fighting And Work

Slowly he became more and more debilitated and had to give up cage fighting and work. He experienced pain daily and found it difficult to find any position that was comfortable.

He started to feel less like himself, became irritated with little things and became isolated from his friends and girlfriend as he was unable to do activities with them like he had before.

After 6 month of treatment he had gone for an MRI.

 

Can Negative Doctors Words Harm?

The doctor had explained that he had a disc protrusion and that it would probably settle over time. He advised that no surgery was needed as the disc protrusion was small and the patient was not experiencing any numbness or weakness in his leg.

The patient reports over the next few years he had gained weight, felt low and completely lost his identity. He said every day he would come down and look at his MRI on his fridge and think about the life he could have had if this had never happened.

 

The Solution

When he entered my clinic I did not touch him. Everybody wants hands on treatment but as a physio it is your job to give the therapy that will work.

See the problem he is language.

Stick with me while I explain.

I showed him this video https://www.youtube.com/watch?v=dlSQLUE4brQ, particularly from 12.41.

Prof Peter O’Sullivan is a big inspiration for me.

He helped me understand that if we don’t consider perception then we will never be as effective at treating the problem. That’s not to say we don’t experience pain through noiception but just in a very different way than we first thought. To learn about noiception please click here https://www.youtube.com/watch?v=ikUzvSph7Z4

 

Who Knew One Session Could Change His Life

Physios have a huge role in helping people discover ways to break these patterns and get people back to their normal activities and work.

Once I showed my patient this video I did a few exercises with him. I reassured him that whatever had happened 7 years ago was healed.

Think about it. You don’t have a cut finger for 7 years.

I sent him away for a week and he walked back into my clinic with a huge smile.I have had no pain he told me. I can’t believe it.

Just a few strategies had given him his life back.

He returned to cage fighting and work.

Don’t waste 7 years of your life.

 

Book a discovery call with our team if you need an expert to help you.

To find out more about sciatica please click here

https://www-bmj-com.csplis.idm.oclc.org/content/367/bmj.l6273

 

 

Nicole

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