Sciatica  

Symptoms vary from a mild cramping or tightening sensation in the hamstring or calf muscles to a constant shooting pain in the buttock, hamstring and down to the foot.

In some instances, flexion (bending) of the lower back can increase pressure on the discs and cause prolapsed disc material to aggravate adjacent nerve roots. This means that any bending forwards, such as when putting on or taking off shoes, will typically irritate the problem and lead to a worsening of the Sciatica pain. It is not just bending forwards that can aggravate the problem. Sitting for a prolonged period can increase disc pressure and Sciatica symptoms; for example driving often cause a flare up in people with Sciatica. Lifting also typically causes irritation of the nerve roots in the lower back.

Anyone with back pain who has any of the following should consult their doctor as soon as possible:

• History of trauma – e.g. a fall or car crash
• Aged younger than 20 or older than 55 when you first experienced back pain
• Cancer in the past or present
• Unexplained weight loss
• Prolonged use of Steroid medication
• Immunosuppression / history of IV drug use
• Numbness or weakness in the legs
• Unremitting pain
• Bladder or bowel problems
• Fever

Initially

• Consult a sports injury expert
• Remain active and apply heat packs for pain relief

Progression

• Exercise to increase spine muscular stability and flexibility
• Exercise to correct effect of surrounding structures

Pain-relieving medication and heat packs are usually necessary during the first few days following a Herniated disc, but the best available evidence suggests that patients with Sciatica due to a Herniated disc should be advised to remain as active as they possibly can. This is based on the fact that research shows no significant difference between bed rest and staying active, and that there is no evidence that staying active is harmful for either severe low back pain or Sciatica.

In many cases of Herniated disc, the symptoms can be relieved if the patient gets into a position of spinal extension, but if this position is painful it should be avoided. Spinal extension can be achieved by lying on the front and gently propping the shoulders up on the elbows.

Although the symptoms of Sciatica normally settle much faster, this healing of the disc can take six to twelve weeks to completely heal and during that period the disc may be vulnerable to re-injury. For this reason, and to reduce the chances of a recurrence, the patient should follow the rehabilitation programme set by a Chartered Physiotherapist. This will involve regaining normal movement in the lumbar spine and learning how to contract the muscles that support and stabilise the back.

Research has shown that specific back exercises, known as core strengthening and stabilising exercises can be effective in relieving back pain and restoring normal function. These back exercises are most effective where the problem is caused by poor postural habits and the pain resulting from disc problems.

Manual therapy in the form of spinal manipulation has also been shown to be effective in the treatment of disc related problems and Sciatica. This can relieve nerve root compression caused by fibrous scar tissue following a disc prolapse, or the build up of gas (Nitrogen). This gas build up is a consequence of disc degeneration and tends to be more common in those aged over 40.
Most cases of Sciatica tend to settle down with physiotherapy treatment, but severe cases of Sciatica due to Herniated discs may require steroid injections or even surgery.

 

Posture plays a major role in the development of disc related Sciatica. Prolonged sitting and bending postures, where the lumbar spine is 'flexed' increase the pressure on the discs. This can lead to disc degeneration and a Herniated disc, and should therefore be avoided.

In order to avoid a recurrence of the problem it is important to take better care of back posture. An understanding of good posture is necessary to achieve this. Viewed from the side, the spine consists of a series of curves:   The curves increase the load-carrying capability of the spine compared to if the spine was just straight. The lumbar part of the spine consists of a forward curve and as long as this is maintained, posture will be reasonably good. It is important that this improved posture is maintained during all activities, particularly when sitting for long periods - slumping should be avoided.

Driving for long periods should be avoided if possible and where it is unavoidable regular breaks with stabilising exercises is a good idea. In the long term, good posture is maintained by increasing the muscular stability of the spine. This can be achieved through specific stabilising exercises.

The Core Strengthening Programme is an exercise programme that aims to improve stabilisation and support to the spine. This is achieved by re-training specific trunk muscles, which may be under used.

Once these stabilising muscles have been re-trained the muscles of the arms and legs will have a more stable base to work from. This allows you to carry out arm and leg movements with more control and is thought to improve the quality of your movement.

How will it help during sport?

• It will provide more support for your back and may reduce the risk of back injuries.
• It will provide a more stable base for arm and leg movements, improving the control and quality of your movements.
• It will improve your muscular co-ordination during movement.
• As the stabilising muscles gain more endurance you will be able to perform movements without your technique deteriorating excessively, due to fatigue.

Programme Overview

The programme is broken down into stages and must be completed step by step. You should not progress to the next stage until you have mastered the exercises of the previous stage.
The stages are:

• Stage 1
  Learn to contract the deep muscles which stabilise the spine. At first this takes quite a bit of concentration. Each individual will master this at their own pace. There is no set time, but perseverance is the key.
• Stage 2
  Increase the endurance capacity of the deep stabilising muscles of the spine, by practicing to contract them in different situations for as long as you can. This will become easier with practice.
• Stage 3
  Begin arm and leg movements whilst contracting the deep stabilising muscles of the spine.
• Stage 4
  Progress to the core strengthening exercises, while contracting the deep stabilising muscles.