back pain

Understanding pain: Sciatica

Physio assessing low back of patient

What is sciatica?

Sciatica is quite a generic term. It is frequently used to describe pain down the back of the leg. In reality there could be number of causes for such pain. Including muscle injury or referred pain. However if the nerve is contributing to the pain – this is known as sciatica. Why the nerve is painful varies, hence the ‘generic’ tag!

Nerve pain

Nerves can produce pain if structures or tissues nearby are inflamed.  For example if you sprain your back. The resulting inflammation can sensitise the nerve leading to pain (known as peripheral sensitisation). Such pain is rare as most sprains will not effect a nerve in this way. In addition, the good news is, the sensitivity of the nerve will often resolve on its own.

More commonly what we see in persistent pain is not just peripheral but central sensitisation.  Central sensitisation is a form of hypersensitivity of the nervous system. In other words, the nervous system can become sensitive to stimuli that are not normally painful. Touch, movement and other non-noxious input can all contribute or even trigger a pain response. Stress, fear and fatigue can induce further hypersensitivity. It may be the emotional and behavioural responses that amplify the central sensitivity the greatest.  A system that is wound up in this way may also develop spontaneous pain.  So this is how pain occurs without damage or injury. How an individual may feel leg pain without trauma.

Other types of nerve pain

There are other types of nerve pain which are rare. Where an injury can happen to the nerve itself (neuropathic) . However even when this does occur the pain usually resolves with time.

How to treat sciatica

Sciatica put simplistically represents variations in sensitivity of the nerve. Ultimately the goal is to reduce the sensitivity in whatever forms it occurs. Much can be done to calm and settle this hypersensitivity. By targeting behaviour and beliefs around pain, as well as through gradual exposure to previously painful activities.

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