The term Sciatica is used to describe leg pain, tingling, numbness or weakness that travels down the low back via the sciatic nerve to the back of leg. Sciatic nerve arises from each side of lower spine and passes deep in the buttock along the back of thigh and legs. The pain of Sciatica may be irregular/ infrequent or persistent causing severe agony to the patients. The pain of Sciatica may be confined to low back or hips or may extend up to toes. The pain of Sciatica can be excruciating and "not relieved by painkillers".

What causes Sciatica?

Pain in Sciatica is due to irritation or pinching of Sciatic nerve within the spine. This occurs most commonly due to prolapsed intervertebral disc (slip disc) causing nerve compression resulting in pain.

Is surgery the only treatment for Sciatica?

Most patients can be managed with medication/exercises. So surgery is not the only way out. Patients who have severe pain can also benefit from "Epidural Steroid Injection". This treatment has proven to be effective in avoiding spine surgery in such patients.

What is Epidural Steroid Injection?

Epidural Steroid Injection is a procedure done by a Specialist (Interventional Pain) in an Operation Theatre using X-Ray (Image Intensifier) to locate exact level of injection. A drug mixture consisting of Steroid with Local Anaesthetic is injected at the epidural space of affected nerve root. The steroid washes away inflammatory mediators from the epidural space which decreases the pain. Steroid also decreases the inflammatory response of body to the prolapsed disc. As a result the pain arising from nerve inflammation is decreased. This is a day care procedure i.e. the patients are discharged the same day.

How is the possibility of surgery ruled out?

Epidural Steroid Injection is a proven, safe and an effective treatment that works on the concept of Interventional pain management - to provide relief from persistent and chronic pain of Sciatica. Generally, a single injection is sufficient to relieve patients of the pain. The procedure can be repeated for a maximum 3 times in a year, depending on the patient's response. With effective pain relief, surgery is negated.

Non-Surgical Treatment For Sciatica

The sciatic nerve is the longest nerve in the human body. It runs from the lower back, through the buttocks, your hamstrings and into the lower leg. Sciatica means pain in the leg, numbness or any kind of weakness in the lower back. There can be many reasons for a leg pain such as an injury to the leg or it can be due to the main nerve which travels in the lower back. Many times, it is not diagnosed properly and hence it will take a lot of time to respond to the treatment or in some cases, it may not respond at all. 

Symptoms of Sciatica: 

You will experience pain in the lower back only on one side of the body. 
The pain continues from the lower back to the sciatic nerve. 
Rarely, you will see the pain on both sides of the body or buttocks. 
The pain is very sharp. 
In some cases, the patient may experience a needles or pins sensation in the leg and in some cases, it is weakness or numbness in the lower back. 
The pain gets so severe that you will not be able to walk or even stand. 
If you have lower back pain combined with leg pain, then lower back pain is not going to be as severe as the leg pain. With the help of the symptoms, your doctor will be able to diagnose sciatica but in order to know the exact cause and origin of this pain, you will have to undergo other tests and examinations. 
Physiotherapy for Sciatica: 
There are many surgical treatments available for sciatica, but it is always good to go for non-surgical treatments. So you can opt for physiotherapy. You will be able to see better and long lasting results with this treatment. As it involves a thorough assessment of it on which the treatment protocol is laid. 

Physiotherapy involves four phases: 

Pain relief 
Restoration of normal flexibility 
Restoration of full functionality 
Prevention of recurrence 
In sciatica, it is due to unbearable pain, you seek treatment. So that has to be treated initially. When you can see that the pain is under control, then the physiotherapist will start working on the range of motion for your joints. The muscle tension will be reduced and muscle strength will be improved. In the third stage, your physiotherapist will start working on restoring the normal function of your body, especially your legs and your lower back. In the last stage, the physiotherapist will help you with some exercises that will stop its recurrence. Usually, sciatica will return after some time but taking a little care at the early stage can prevent it.

Physiotherapy For Sciatica - Why Is It The Best Treatment Option?

Gridhrasi is what Sciatica is known as in Ayurveda. It is the disorder that causes mild to agonizing pain in the sciatic nerve or neuralgia. These nerves, emerging from the pelvis, run along the hamstring and may cause intense pain in one or both the legs when a person suffers from Sciatica. Sciatic pains fill your life with misery as the simplest of daily activities cause sudden and excruciating pain. There are two types of sciatica i.e. true sciatica and pseudo sciatica. Sciatica may be caused due to bulging disc or herniated disc, degenerative disc disease, piriformis syndrome, pregnancy or trauma etc. 

According to Ayurveda, Sciatica is caused due to impairment in Vata i.e. the dosha responsible for the functional ability and movement of the body and also in some cases due to impairment in the Kapha i.e. the dosha that is responsible for body fluids and lubrication. Ayurvedic herbs that improve the symptoms of Sciatica are:

1. Babunah is also known as Bitter Chamomile. Not only is it used to relieve and reduce the pain faced by a sciatica patient, but it is also used for treating problems such as rheumatism due to the advancement of age. Compressed bitter chamomile flowers are prescribed for sciatica.
2. Guggul is also known as Indian Bdellium. Since guggulu is well known for its anti-inflammatory properties, it relaxes the sciatic nerves.
3. Rasna is also known as Vanda Orchid. Intense or agonizing pain due to the sciatic nerve issues can be reduced by this ayurvedic herb due to its anti-inflammatory properties. 
4. Juniper oil is extremely helpful when massaged onto the thigh muscles with firm strokes or pressure. It is used extensively in massage therapy for treating sciatica since the extent of reduction in sciatic nerve pain is tremendous. 
5. Jaiphal is also known as Nutmeg. After being mixed with sesame seeds oil, nutmeg is coarsely powdered and then fried till it turns brown. This is then applied to those areas where the sciatic pain is intense for instant relief.
6. Kumari is also known as Indian Aloe. Properties of Indian Aloe are extremely helpful in treating lower back ailments such as sciatica and lumbago.
7. Shallaki is also known as Boswellia or Frankincense. Containing anti-inflammatory properties, shallaki is applied externally to get relief from sciatic nerve pain. 

Ayurvedic preparations such as yogaraja guggulu, Vataganjakusha, Saindhavadi taila are also very useful in treating Sciatica.

Ayurvedic Treatment of Sciatica

The sciatic nerve is one of the largest nerves in the body. It goes from the lower back all the way down to the base of the leg. When there is a disorder associated with the sciatic nerve, it is known as Sciatica. 

Sciatica, however, does not necessarily need a surgery or a very elaborate procedure to fix the problem. Most commonly, it is treated simply by practicing a number of simple exercises. Here are some of the most common exercises prescribed to treat Sciatica:

1. Reclining Pigeon Pose:
There are three main forms of the pigeon pose. These are sitting, reclining and then forwarding. It is recommended that if you have very recently started your treatment for Sciatica, then certainly you should go for the reclining pose. In this pose, you are supposed to hold your left leg in the air at a right angle to your back. Then, hold your ankle against the knee. Finally, repeat this stretch with the right leg as well.

2. Knee to Opposite Shoulder:
In this stretch, the starting position is on your back side. You have to have your legs out and feet upwards. From this position, try to bring your right leg towards your left shoulder. Hold this for 30 seconds and then release and relax. Repeat this activity three times and repeat the whole procedure with your other leg. Only take your leg as far as it goes.

3. Sitting Spinal Stretch:
At the start of this exercise, sit on the ground with your legs going straight outwards and your feet flexed in the upward direction. Pull your left knee and put it on the outside of your right knee. Finally, place your right elbow on the left knee, so that your body turns to the left. Hold for 30 seconds and then relax. Repeat the procedure with the other knee.

4. Standing Hamstring Stretch:
Put your foot on an elevated surface such that it is above the floor, but not above hip level. Flex your toes forward such that your feet and legs are nearly in a straight line. Bend as far towards the foot as possible. However, do not stretch so far that you feel pain. Finally, repeat this procedure on the other side after release.

Exercises For Sciatica

While it may be obvious that no form of pain is welcome, it can be said that pain which is felt on account of being affected by sciatica is especially unwelcome. Taking that into due account, the good news is that physiotherapy can go a long way in helping by improving this sort of pain.

The longest nerve in the whole human body is the sciatic nerve, so it can be expected that when there is trouble with this nerve, the pain would be pretty significant. The leg pain which is caused to a person when this nerve happens to be getting pinched is known as sciatica.

There is a range of treatments when it comes to how something as painful as sciatica is to be solved. Now, while it is true that a solution such as making sure there is an amount of bed rest which is sufficient is very important, to say the very least, it is often the case that the person with sciatica would like his or her recovery to be hastened.

In order to make sure that this is the case, physiotherapy is quite useful. There are various forms of physiotherapy which can be made use of, and the decision as to which sort of physiotherapy a person would be best suited to would obviously be part of the subjective assessment of the person by a practitioner who is well qualified and experienced.

Some of the solutions when it comes to physiotherapy being used in order to treat sciatica are quite innovative, to say the very least. For example, there is physiotherapy instrument mobilisation, which is also known as PIM. What this entails is that a mechanical spring-loaded instrument is used in the process which serves the purpose of mobilising the spinal cord of a person along with his or her peripheral joints.

One form of physiotherapy oriented treatment which is used to address the issue of sciatica is real-time ultrasound physiotherapy. It can be said that this is not close to as cutting edge as physiotherapy instrument mobilisation is but it does serve as a rather dependable and useful way to battle sciatic pain. This form of physiotherapy makes use of ultrasound technology to analyse how the muscles function and then using that as a basis to create a list of physiotherapy exercises to be done by the person who is having sciatica. Rather than medicines, physiotherapy improves sciatica by getting a person to use oneself!

How Can Physiotherapy Help With Sciatica Pain?

Sciatica is a neurological condition that mainly arises due to problems in the sciatic nerve. The sciatic nerve is believed to be the largest nerve originating from the spinal nerves L4 to S3. It extends downward from the lower spine into the back of each leg (thighs) right down to the foot. The sciatic nerve acts as a connecting link between the spinal cord and the foot and the leg muscles. People with sciatica often experience a tingling sensation along with a shooting pain radiates downwards from the lower back (mostly the lumbar region) to the back of one of the legs. Some may also experience the sciatic pain down both the legs (rare).

Types of Sciatic Pain:

Sciatica that affects a person can be of two types depending on the severity of the associated symptoms

Acute sciatic pain: In this case, a person experiences a sudden radiating pain which often heals by itself within a week or two. More than often, the pain is triggered by an injury to the spinal joints, nerves, or the disc.
Chronic sciatic pain: This is a more serious condition where the pain may linger for long, often more than three months. The chronic sciatic pain may affect a person with severe Arthritis and nerve injury and damage.
Symptoms associated with Sciatica:

One of the characteristic symptoms of Sciatica is a shooting pain that radiates from the lower back (often the lumbar) to the back of one (or both) of the legs.
In some, the sciatic pain may result in weakness and a tingling sensation down the affected leg.
A person with sciatica may find it difficult to move his/her foot and legs (restricts their movement).
Some people may experience a shooting pain even while they are in a sitting position. In some others, the pain may be at its worst when a person is in a standing position.
Sciatica can also trigger a hip pain.
What triggers sciatica and the associated symptoms?

The disc is a protective shield that prevents any damage or injury to the vertebrae. A degenerative disc problem can interfere with the normal functioning of the disc triggering sciatica.
Spondylolisthesis: In Spondylolisthesis, also known as a Slip Disc, a bone (mostly in the lumbar region) slips over the bone which is located just below it. People with prolonged and untreated spondylolisthesis are often known to suffer from sciatica.
The sciatic pain can also affect a woman during her pregnancy.
Lumbar spinal stenosis: This condition is is characterized by the spinal canal narrowing down in the lumbar region. Lumbar spinal stenosis exerts pressure on the sciatic nerve, giving rise to sciatica.
A muscular strain or spasm in the buttocks can also be a contributing factor.
Proper management and prevention for sciatica are possible. One should be alert and consult a doctor in case they experience the associated symptoms or any discomfort.

Sciatica Pain - What Can Trigger It?

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