What is a Sciatica or Radiculopathy?
Lumbar or cervical radiculopathy (also known as sciatica), is where the nerve is being compressed and results in a loss of the nerve function. This results in a loss of sensation, weak or absent reflexes, and muscle weakness. When this follows the path of the L4-L5 and/or L5-S1 nerve this is termed sciatica. This is not a diagnosis but rather a description of the path of the pain.
The term sciatica is very commonly used and poorly defined. There is no specific test for sciatica, but a combination of positive findings on examination increases the likelihood. The term sciatica is often confused with piriformis or gluteal syndrome. The key signs and symptoms of radiculopathy/sciatica include:
What are the Signs and Symptoms of a Sciatica or Radiculopathy?
Subjective examination:
+ Dominance of leg pain (more than back pain)
+ Location of the leg pain (below the knee)
+ Dermatomal pattern of pain
+ Sensory loss aligning with the spinal root
+ Changes in muscle strength of one limb
+ Reflex changes
+ Leg pain when coughing, sneezing, taking deep breath
+ Gradual onset
Physical examination:
+ Unilateral motor weakness (particularly dorsiflexion if L5 is affected, leading to foot drop)
+ Absent tendon reflexes
+ Positive SLR (if negative, this reduces suspicion of sciatica)
+ Increased finger-floor distance (>25cm)
If the nerve is not being pinched then it results in radicular or referred pain
Radicular pain is caused by inflammation and/or compression of the lumbosacral nerve roots (L4-S1) and results in a gain in nerve function. In simple terms radicular pain refers to when a nerve is irritated as it passes through the tunnel of the spine in either the neck or back. Its common patients believe the nerve is pinched, however the nerve is just irritated.
Signs and Symptoms of Radicular pain:
+ Leg pain worse than back pain
+ Positive straight leg raise
+ Pain below knee
+ Localised pain
+ Shooting pain
+ Dermatomal distribution
+ Reflexes normal
+ Muscle strength normal
Signs and Symptoms of General Referred pain:
+ Back pain worse than leg pain
+ Poorly localised
+ Dull ache
+ Negative straight leg raise
What are the Causes of Sciatica/Radiculopathy?
+ Disc herniation or protrusion
+ Injury to ligaments
+ Injury to muscles
+ Arthritic spurs (bone spurs)
+ Inflammation from a different injury
+ Repetitive movements
+ Spondylolisthesis
+ Obesity
+ Repetitive manual work
+ Work bending down
+ Driving a lot
+ Mental stress
What is the Treatment of Sciatica/Radiculopathy?
The Physiotherapist will assess if the nerve is truly pinched on and being obstructed. If this is the case the Physiotherapist will likely send you for a scan and refer you onto an Orthopaedic Back Surgeon or Neurologist. This is required to full out any need for surgical intervention.
If the Physiotherapist determines the nerve is irritated but functioning well then, the Physiotherapist will try a variety of techniques that will help alleviate your pain. These include:
+ Soft tissue massage and dry needling to decrease muscle spasm around the compressed nerve.
+ Mobilisation of the spine to decrease joint stiffness and take pressure off the nerve by allowing more space for it to pass through.
+ Strengthening exercises for weak muscles to prevent the injury from returning.
+ Education & advice about which positions to avoid, and which positions will help.
+ If Physiotherapy is not assisting in relieving the patient’s pain, then a corticosteroid injection is recommended.