SCIATICA


Sciatica is a medical term used to describe the pain, numbness, tingling sensation or weakness felt in the lower extremities that emanate from the lumbar area (lower back) as a result of the irritation of the sciatic nerve. This discomfort felt from sciatica is often referred to as sciatic nerve pain. The sciatic nerve – the largest nerve in the human body, originates from nerve roots in the lumber area of the spinal cord, passes down through the gluteal muscles of the buttocks to supply the lower limbs with nerve endings. This is why sciatic nerve pains are typically felt behind the thigh and radiates down below the knees.

Causes of sciatica

There are six major causes of sciatica that are mostly lower back problems;

  • Lumbar herniated disc
  • Degenerative disc diseases
  • Isthmic spondylolisthesis
  • Lumbar spinal stenosis
  • Piriformis syndrome
  • Sacroiliac joint dysfunction

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Symptoms of sciatica

1. Pain that is felt constantly on one side of the buttocks or legs. Sciatica is hardly felt on both sides
2. Sharp pains that occurs behind the lower extremities rather than dull pain
3. Pain in the lower back that is not as severe as leg pain when experienced
4. Pain that emanates from the lower back, or buttocks and runs through the course of the sciatic nerve down to the back of the thigh and continues to the leg and foot
5. Tingling sensations, numbness and weakness down the legs
6. Severe pains in the legs that may prevent one from standing or walking
7. Pains in the foot or toe depending on where the sciatic nerve is affected
8. Pain is minimal when a patient is lying down or taking a walk but becomes severe when patient is standing or sitting.

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Diagnosis of sciatica

The following steps are taken to diagnose sciatic nerve pain;

Case history taking: Taking a history about the symptoms, the pain; type of pain, its severity, when it was first noticed, how frequent the pain comes, what relieves or worsens it, etc.

Physical examination: the doctor physically examines the patient’s body especially the back paying attention to the spine for alignment, deformities, swellings, discolouration of the skin area etc.

Laboratory investigations: Spine X-rays, CT scan, MRI, electromyogram are all used to ascertain the exact cause of sciatica.

Basic treatment of sciatica

There are two broad categories of sciatic nerve pain treatment. They include;

1. Non-surgical treatment and
2. Surgical treatment

Non-surgical treatment

This is done to relieve whatever symptoms that are from irritated or compressed nerve roots. A lot of these techniques are available, but a combination of two or more of these strategies usually comes out more efficient.

  • Osteopathy, see more detailed description below

• Heat or cold therapy: in the acute phase, cold compress is applied within 20-30 minutes of incidence. This suits the nerves and muscles in the region and prevents inflammation. Hot application is done much later to encourage venous drainage, which further reduces inflammation and pain eventually.
• Pain medications: non-steroidal anti-inflammatory drugs like ibuprofen and diclofenac and oral steroids might be prescribed by your GP.
• Epidural steroid injections: direct steroid injections are administered into the sciatic nerve area that is experiencing the pain. These are usually used after a specialist consultation


Surgical Management

This involves surgical procedures to correct the underlying cause. The two main surgeries primarily considered are:

• Microdiscectomy and
• Lumbar laminectomy

Prevention of sciatica

To some extent, sciatic nerve pain can be prevented by refraining from some activities that could expose one to having lower back traumatic injuries. Also exercises like yoga, pilates or Foundation Training that we have at The Perrymount can go a long way to preventing degenerative or arthritic lower back conditions that could have resulted into sciatica.

How osteopathy can help sciatica

Many people with sciatica seek help from osteopathy. They have usually seen their GP and have strong painkillers, muscle relaxants and may well have had X-rays or an MRI. The MRI is necessary to see if there is a disc bulge causing the sciatica. It is worth noting that many, many people will have a disc bulge that is causing no problems at all. If you haven’t seen your GP you can still visit an osteopath, we are trained to know whether to refer you to your GP for further tests. At The Perrymount we actually have access to very quick appointments for private MRI’s, often the next day.

Our osteopath’s at The Perrymount won’t just look at you as a “disc bulge”! We will look at you as a whole person to treat you for symptom relief but also to see why the underlying sciatica happened in the first place. This could be do to tight muscles, imbalanced muscles, poor posture or a host of other issues.

Interestingly, the mid back and neck if hunched over, like many of us suffer today, puts huge strain on the low back in the direction that can cause and aggravate sciatica caused by a prolapsed disc. This means treatment should be focused around these areas, not just the low back painful area.

We will also make sure you have a personalised program of exercise and lifestyle changes to help you maintain a health back. We have found fantastic results using the Foundation Training Jacqui Black offers.

Nutritional advice can even be offered to help decrease inflammation and look at other issues that are related to weakened abdominals and low back muscles and ligaments. More is written on this in our back pain e-book you can download below.


References

Sciatica Symptoms, Causes, Treatments, Exercise - WebMD. (n.d.). Retrieved from http://www.webmd.com/back-pain/guide/sciatica-symptoms
Sciatica | Sciatic Nerve Pain | Causes, Diagnosis, and ... (n.d.). Retrieved from http://www.webmd.com/back-pain/tc/sciatica-topic-overview
Sciatica: Get Facts on Treatment and Symptoms. (n.d.). Retrieved from http://www.medicinenet.com/sciatica/article.htm
Sciatica Nerve: Get Tips for Pain Relief - eMedicineHealth. (n.d.). Retrieved from http://www.emedicinehealth.com/sciatica/article_em.htm


If you would like to book an appoinment with one of our osteopaths please give us a call on 01444 410944 or leave us a few details below and we will be in touch with you shortly


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