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What is it?
Sciatica is a term that is used to describe a symptom – a pain down the back of the leg (following the path of the sciatic nerve) – rather than a specific disease. There are many different causes of sciatica (see below).
Sciatic pain is often accompanied by other symptoms including numbness, weakness or tingling in the leg(s). Some patients will develop a flexed posture or a lean to one side. In more severe cases, patients may have difficulty walking due to the leg giving way or being unable to lift the foot. In rare cases patients may develop bowel or bladder symptoms such as a loss of continence (if this occurs medical care should be sought immediately).
There are many potential causes of sciatic pain including but not limited to; a bulging disc, compression of a nerve or referred pain from a muscle or joint. Sciatica may result from chronic poor posture, muscle imbalance or weakness, repetitive strain or following lower back injury (such as a fall onto the buttocks).
Testing to establish the underlying cause of the sciatic pain is essential. Assessment of the muscles, joints and nerves of the lower back and legs should be performed. This may include range of motion, palpation and neurological testing (reflexes, strength and sensation). In some cases further imaging may be required. Magnetic resonance imaging (MRI) is usually most useful in this regard as it can detect soft tissue injury such as damage to the discs or spinal cord.
The appropriate treatment will depend on the cause. In the large majority of cases sciatic pain can be successfully treated with conservative care without the need for injections or surgery. Spinal manipulation, soft tissue work, traction and exercise rehabilitation are effective options in the treatment of sciatica.
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