Sciatica is a pain that radiates from the low back down a lower extremity. It is caused by irritation of the sciatic nerve. The sciatic nerve radiates sensation from the lower extremities and lumbar area of the low back. It is common for people to recover from sciatica without a surgical operation. The sciatic nerve is the longest and largest nerve in the body — it is as thick as one of your fingers where it arises in the lower spine. It then travels from your lower back through your hip and buttock and down your leg where it divides into two branches at the knee. Each leg has its own sciatic nerve. This painful low back condition affects men and women alike. It presents as significant pain that radiates from the lower back and moves down into the buttock, along the back or side of the thigh, and down into the calf. The pain can even extend to the feet and toes. The pain follows the path of either of two sciatic nerves that branch off from the lumbar nerves (lower spine: L4-S1). Each nerve travels down a leg.

Patients with sciatica usually feel pain only on one side. The primary cause of sciatic pain is unnatural compression of the lumbar nerves (nerves that branch out from the lower spine).There are number of causes for sciatica including Spinal Disc Herniation, spinal Stenosis, spinal Subluxations /Misalignment, tumours, piriformis Syndrome and Pregnancy.

Sciatica is a symptom associated with leg pain, which might feel like a bad leg cramp, or it can be excruciating, shooting pain that makes standing or sitting nearly impossible. The pain might be worse when you sit, sneeze, or cough. Sciatica can occur suddenly or it can develop gradually. You might also feel weakness, numbness, or a burning or tingling (“pins and needles”) sensation down your leg, possibly even in your toes. Less common symptoms might include the inability to bend your knee or move your foot and toes.

Diagnosis:

Sciatica is most commonly diagnosed by:

· History taking

· Complaints of radiating pain in the leg, which follows a specfic dermatome pattern.

· Pain generally radiates below the knee, into the foot and dermatome maps used to locate the distribution of the pain.

· Patients complain about low back pain, which is usually less severe than the leg pain and also report sensory symptoms.

· Overall, if a patient reports radiating pain in one leg and has a positive result on one or more neurological tests, indicating nerve root tension or neurological deficit, the diagnosis of sciatica seems justified.

The use of imaging to confirm the diagnosis of sciatica is not very useful but they are used to find the underlying cause of the sciatica.

Treatment:

For severe cases of sciatica an epidural steroid injection or nerve blocks is often used. This treatment consists of an injection of a steroid in the affected area to reduce the inflammation and pain. The effects are temporary and can last from one week to a year. Epidural injections are not successful for many patients.

For extreme cases of Sciatica elective surgery may also be an option. This surgery attempts to eliminate the underlying. When the underlying cause is lumbar spinal stenosis, a lumbar laminectomy surgery is recommended. With this surgery, the small portion of the bone and/or disc material that is pinching the nerve root is removed.

In cases of where a disc is herniated, a microdescectomy is recommended.

      Role of physiotherapy in Sciatica management

       A very important part of the physiotherapy can be informing the patient about sciatica and providing them appropriate education. During physiotherapy it is very important that your physiotherapist gives you necessary information, advice, posture and ergonomic corrections to improve your symptoms faster and about staying active and give them information about treatment options and modalities. It is very important that the patient is physically an active participant in therapy and can take responsibility in the treatment process. Massage therapy along with physiotherapy treatment has proven to be useful with the treatment of back pain. It promotes blood circulation, muscle relaxation and the release of endorphins.

      Mckenzie spinal techniques can be helpful in providing relief from the back pain.You should make sure you see a physiotherapist who are more hands on and perform Mckenzie techniques. 

Manual therapy (hands-on mobilization of the joints in your back). Physiotherapists skilled in manual therapy use precise hands-on techniques to relieve stiffness and improve movement of the joints and muscles of your spine. 24 hours muscle soreness is expected after manual therapy. 

Movement exercises that restore motion and decrease radiating or referred pain. Most physiotherapists prescribe these exercises, using a protocol called the McKenzie method. If your pain is chronic, do not fear; physiotherapy can still help! Along with the first two options, chronic low back pain is best managed with