How to Recognise and Deal with Sciatica: Interview with Dr. Massimo Esposto

How to Recognise and Deal with Sciatica: Interview with Dr. Massimo Esposto | UPMC Italy

Back pain is a very common disorder, but we often refer to it in a generic way, without taking into account the different causes that can trigger it. To better understand sciatica-related back pain, we interviewed Dr. Massimo Esposto, Physiotherapist at UPMC Salvator Mundi International Hospital. Dr. Esposto helped us clarify what sciatica is and what its distinctive symptoms are.

Dr. Esposto, first of all what is sciatica and how can we recognise it?

Sciatica is a term that refers to pain caused by inflammation or compression of the sciatic nerve, the largest nerve in the body. This important nerve originates in the lumbosacral plexus, located in the lower part of the spine, and extends through the gluteus, the back of the leg, to the foot. Various conditions, such as herniated discs, degenerative diseases of the back, deep gluteal region syndrome, and oncological diseases, can put pressure on the sciatic nerve, triggering sciatica.

The pain associated with sciatica has the particular characteristic of starting in the lower back and radiating downwards with a greater intensity, down the back of the leg, to the foot or toes. This pain irradiation is a hallmark that helps differentiate sciatica from other lower back pain.

Common symptoms associated with sciatica include:

  • Intense pain down the leg and less so in the back
  • Sensation of 'electric shock' along the path of the sciatic nerve
  • Numbness, often described as a 'pins and needles' sensation
  • Burning or tingling sensation in the affected area
  • Muscle weakness in the areas served by the sciatic nerve.

Interestingly, actions such as coughing, sneezing and laughing can increase the intensity of pain caused by sciatica.

What are the causes of sciatic pain?

It is crucial to understand that sciatic pain can arise from a variety of sources, ranging from medical conditions to environmental influences and lifestyle choices. Identifying the underlying cause of the pain is crucial in determining the most appropriate physiotherapy treatment for each individual. When patients come to the specialist with symptoms of sciatica, first a thorough physiotherapy evaluation is performed.

Factors that can trigger sciatica include:

  • Ruptured disc: a ruptured or herniated intervertebral disc is one of the most common causes of sciatic pain. The disc can protrude over the root of the sciatic nerve, causing pain.
  • Deep gluteal region syndrome: occurs when deep muscles in the gluteal region (including the piriformis) contribute to increased pressure on the sciatic nerve.
  • Spinal stenosis, a condition in which the spinal canal narrows, putting pressure on the sciatic nerve. This can occur as the spine ages and degenerates.
  • Pregnancy: anatomical and hormonal changes during pregnancy can put pressure on the sciatic nerve, causing pain.
  • Osteoarthritis, a common form of arthritis, can affect the spine and lead to irritation of the sciatic nerve. Trauma such as pelvic fractures and spinal injuries can directly damage the sciatic nerve.
  • Tumours in the lumbar or pelvic area can compress the sciatic nerve, causing pain.
  • Obesity: excess weight puts additional pressure on the spine and can increase the risk of sciatic pain.
  • Ageing can lead to spinal degeneration and increase the likelihood of sciatic nerve problems.

When it comes to sciatic pain, how can physiotherapy help? What treatments are considered useful?

First of all, it is essential to establish the possible contributing factor(s) to the patient's problem. Based on the diagnosis, a specific and effective treatment plan will be drawn up. In the acute phase of pain, it is crucial to proceed with extreme caution in treatment, starting with neurodynamic techniques that favour gliding and adequate oxygenation of the nerve tissue, in collaboration with the medical staff who, depending on the irritability of the symptoms, may decide to flank pharmacological therapy. Next, we introduce exercises aimed at improving mobility and strengthening the back and lower limbs. The treatment continues gradually, focusing on the patient's functional goals and thus on returning to activities that are important to him/her.

If physiotherapy does not solve the problem, what options are available?

In the vast majority of cases, sciatic pain can be managed with rest, lifestyle modifications, physiotherapy, and the use of over-the-counter pain medication.

However, if the pain persists, worsens, or hinders daily life, it is essential to consult the doctor again. In some cases, steroid injections may be recommended to reduce inflammation. In more severe cases or those resistant to conservative treatment, surgery could be considered.

What signs indicate the need for urgent medical intervention in the presence of sciatic pain?

Certain symptoms should be taken very seriously. If you experience sciatica on both sides of your body, or if you experience pain or numbness in both legs that worsens over time, it is important to consult a doctor immediately. Problems with urination, such as difficulty starting or holding urine, should be treated urgently. In addition, if there are problems with bowel control, if sciatica is associated with high fever or persists unexplained with weight loss, it may be a more serious spinal condition. In these situations, it is imperative to consult a specialist without delay, as immediate treatment may be required.

In conclusion, back pain can be caused by many different conditions, and sciatica is only one of them. Recognising the specific symptoms of sciatica is crucial for an accurate diagnosis and appropriate treatment. If you suspect that you suffer from sciatica or experience similar symptoms, it is always advisable to consult a healthcare professional.

Specialists from UPMC Salvator Mundi International Hospital will be at your disposal on Saturday 4 November for a free assessment of your back health. Book your appointment.