Sciatica is a term used to describe a pain down the back of the leg and is associated with back pain. The causes of the radiating leg pain include pressure on the nerve root, inflammation and an immunological response (1). Adverse pressure on the nerves of your body can be caused by muscle imbalance, sacroiliac sprain, piriformis syndrome, lumbar spine facet syndrome, gluteal muscle strain, and disc herniation. Rarer causes include spinal stenosis, malignancy and spondylolisthesis.

In medicine sciatica is a general term to be used when adverse neural tension has been found or is suspected. however, as you can read above there are many muscle syndromes that can place adverse tension on your nerves. The routine use of x-ray or MR Imaging is not recommended for sciatica. A neurological examination is recommended to ensure any sensation changes are stable (2).

Treatment for Sciatica looks to resolve the muscular syndrome and restore muscle balance which can often times be enough to relieve nerve tension. Once pain has been imprinted on the brain it is not as simple as ‘un-trapping’ something and the tension goes away. Building back balance into your body is exactly that a building project done in stages to steadily alleviate and stimulate repair over a 2–3-month period.

When disc herniation or prolapse is involved the time frame to getting better is longer and for those after 6 months of conservative treatment with exercise and psychological goal setting from a CBT perspective are still not resolved, then the 2-year journey to surgery can commence. However, surgery provides no guarantees as failed back syndrome alludes.

Overall steady progress is expected with breaks in the storm of radiating pain coming anywhere from 4-12 weeks. Breaks in the storm of pain are a sign things are resolving and so too is it a sign of resolution when your leg pain begins to return to back pain only.

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References:

1. Ostelo RWJG (2020) Physiotherapy Management of Sciatica. journal of Physiotherapy
2. Jensen RK et al (2019) Diagnosis and Management of Sciatica. BMJ 327 6273