Referred Sciatica is pain due to a muscle and joint problem in the spine and pelvis, it can mimic sciatica and it is important to determine the cause of your pain. Referred pain is usually dull and achy but can also be sharp in nature. It does not usually cause a feeling of ‘pins and needles’, hot and cold sensation, numbness or muscle weakness.

In some cases the pain is worse in the back than it is in the leg and doesn’t usually have a shooting quality to it.  Abnormal neurological findings, such as reflex changes, objective weakness and sensory changes, are unlikely to be present.

When there is degeneration (arthritis) in the spine and the intervertebral discs the spaces between the vertebra are narrowed. This can lead to nerve root irritation and sciatic pain in one or both legs. If the disc is damaged severely inflammatory proteins from inside the centre of the disc can irritate the nerve root causing sciatic pain.

The spinal canal is pathway the spinal cord passes through as it travels down inside the spine. In the case of spinal stenosis  the canal has become narrowed and the restricted space inside the canal can put pressure on the spinal chord cause sciatica.

There are many different causes of spinal stenosis including spinal degeneration, damage to the spinal joints between the vertebra and cysts or tumors growing within the spinal canal.

When the lumbar spine has a restricted or abnormal movement range there is often associated irritation of the joints between the vertebra, localised inflammation and muscle spasm and tightness. These changes can lead to irritation of the sciatic nerve and subsequent sciatica.  These changes can be from poor posture past trauma to the spine and poor work and home environments placing stress on the spine.

The sacroiliac (SI) joint is located between the sacrum (the large bone at the bottom of the spine) and the pelvis. The sciatic nerves run close to the SI joint as it exits the pelvis and damage or inflammatory condition affecting the joint can cuase irritation of the nerve and sciatica.

The sciatic nerve runs below or through the piriformis muscle as it exits the spine. A tight or spasming piriformis muscle can irritate the nerve as it passes into the leg causing sciatic pain. Most patients with sciatica will have a tight piriformis muscle as the this muscle is plays a part in the stabilisation of the low back. When a patient is experiencing sciatica this muscle will tighten up as part of the natural protection mechanism of the body. It is rare however that the tight piriformis is the only cause of the sciatica.

A spondylolisthesis is where one vertebra slips forward over the vertebra below. There is usually an association with a loss of disc height and narrowing of the spaces where the spinal nerves exit. The most common site for a spondylolisthesis is the lower lumbar spine where the nerve roots that form the sciatic nerve exit from the spine. Pressure on the nerves at this level can cause radiating sciatic pain.

The most common causes of a spondylolisthesis are trauma to the spine, arthritis and degeneration, pathology (such as cancer or infection), and previous surgical procedures to the spine.

During a pregnancy the mother’s centre of gravity will move forward as the baby increases in size and weight. This causes an increase in the curve of the lower back and can lead to irritation of the spinal nerves in this area. In some cases this will lead to sciatic pain in one or both legs. The position of the baby can also lead to an irritation of the sciatic nerve and sciatica. Often spinal problems that were present before the pregnancy will worsen during this period.

Severe damage to the muscles surrounding the spine can cause irritation of the nerve roots as they exit the spine. When there is an injury to the spine one of the first mechanisms that your body will do to protect itself from further injury is to tighten the muscles surrounding the spine to try to prevent futher aggravation of the injury. It is rare for muscles to be the cause of sciaica in most cases the muscle tightness and spasm is secondary to the sciatica or spinal injury.

Damage to the structure of the spine from cancer, trauma or infections can cause pressure or impingement on the nerve roots in the lower back and subsequent sciatica.  While this is a very uncommon cause of sciatica, it is vitally important that these potential causes are ruled out before any treatment is started.

This is an uncommon type of arthritis that effects the spine and pelvis. The chronic inflammation that occurs in and around the spine with this disease can cause symptoms such as sciatica.

Once the history is completed a physical examination will be performed to help find any underlying causes of your sciatica. This will involve a thorough assessment of your posture, spinal range of motion, physical condition and balance. During this assessment what movements relieve or aggravate the sciatica is carefully monitored.  In the physical exam, your doctor will observe your posture, spinal range of motion, muscle spasm and physical condition, noting any movement that causes you pain.

During this part of the examination your reflexes in your knees and ankles are tested. The strength of the muscles supplied by the sciatic nerve and ability to feel touch along the sciatic nerve is also assessed. These tests are very good indicators of the presence and location of specific nerve root irritation or injury.

During this examination the joints of the spine and pelvis, the muscles and nerves are put under a mild physical stress. During this assessment which tests relieve or aggravate the sciatic pain is carefully monitored.  The results give valuable information about the cause of the sciatica.

What tests are performed depends on which specific disease, illness or injury are suspected to be causing the sciatica.

The most common tests include:

• X-rays
• Computer Tomography (CT scan)
• Magnetic Resonance Imaging (MRI)
• Blood tests

These tests help find the cause and also rule out any other pathologies as the cause of your symptoms so the most appropriate treatment can be given.

Over-the-counter nonsteroidal anti-inflammatory drugs such as ibuprofen or stronger prescription medications are often used to reduce the inflammation that is associated with the irritation of the sciatic nerve. These drugs do not treat the cause however they can be effective at reducing or relieving sciatica pain. When combined with effective treatments to remove the cause such as spinal manipulation they can help provide fast effective treatment of sciatic pain. Muscle Relaxants or narcotic medications may also be prescribed for the short term (a few days and up to 2 weeks) to alleviate pain in severe cases.

Massage therapy aims to increase blood circulation,  relax muscles  and release of endorphins which are the body’s natural pain relievers. Massage therapists believe that reducing muscle tightness and will allow the restoration of normal movement of the spine and remove the irritation of the sciatic nerve.

A range of different exercises can used to help strengthening your core, improving the flexibility of your lower spine or stretching muscles through the area. Which exercises are recommended for will vary dependent on the cause of your sciatica and  the severity of your condition.

These are used to help reduce inflammation and pain due to sciatic nerve irritation. This is usually used in conjunction with exercises for flexibility and strength of the lower back.

For acute sciatic pain, heat and/or ice packs can help alleviate the leg pain, especially in the initial phase. Usually ice or heat is applied for approximately 20 minutes, and repeated every two hours. Most people use ice first, but some find more relief with heat. The two may be alternated. It is best to apply ice with a cloth or towel placed between the ice and skin to avoid an ice burn. Ask your health care practitioner

Epidural steroid injections are used to reduce the inflammation in the spine when the patients pain is severe. The injection goes directly into the inflamed area around the sciatic nerve.  The effects tend to be temporary and do not address he underlying functional issues that created the problems.  Importantly, it can provide sufficient relief to allow a patient to progress with a conditioning and exercise program.

These two techniques are very similar, hair-thin needles are placed into the skin at specific points. Acupuncture aims to restore well-being by altering  energy flow in the body while dry needling aims to remove trigger points contained overactive muscles.  Both of these techniques have shown good results in reducing sciatica pain however neither technique addresses the most common causes of sciatica such as disc damage and poor biomechanical damage.

In this surgery, the small portion of the bone and/or disc material that is pinching the nerve root is removed. This allows for extra space within the vertebrae and the pressure on the nerve is reduced.

This type of surgery is performed for severe disc injuries. The vertebra above and below the injured disc are fused together to prevent movement. Short term this surgery can have a good result however the increased stress to the areas above and below the surgery can lead to long term problems at different levels.

The injured disc is replaced with an artificial disc usually made of metal. It is similar to a hip or knee replacement. This is relatively new surgery and its long term results are unknown at this stage.

Your doctor may suggest Over-the-counter pain medications such as ibuprofen or codeine or stronger prescription drugs such as stronger narcotics for a short time. They can also use Nerve pain medications and Muscle relaxants to control symptoms. In severe cases Cortisone injections can be  given  into the area around the spinal nerves.  Your doctor may recommend a chiropractor masseur or physiotherapist to help remove the underlying cause of the sciatica or refer you to a specialist for a further opinion.

Physiotherapy treatment for sciatica usually involves massage, dry needling, TENS machine, exercises or taping. Physiotherapists use similar exercise techniques to those used by chiropractors to improve spinal movement and strengthen spinal muscles.

Massage aims to increase blood circulation, relax muscles  and release of endorphins which are the body’s natural pain relievers. Masseurs believe that reducing muscle tightness and will allow the restoration of normal movement of the spine and remove the irritation of the sciatic nerve.