It’s important to dispell common myths and be aware of what sciatica actually is before any treatment decisions are made. Sciatica is often associated with lower back pain hence is commonly misunderstood and in some cases poorly managed.
In this article, we shed some light on Sciatica and also provide a couple of useful tips on how to identify a good practitioner to get the right help!
What is Sciatica?
Sciatica is a term used to describe a set of symptoms rather than a single disease or single condition. It is identified as severe pain or discomfort running from the low back and buttock region to the back of the leg making its way down to the foot and in more severe cases.
Sciatica is caused by abhorrent pressure or irritation to the sciatic nerve- hence its name. The sciatic nerve originates from multiple low back spinal nerves that exist from the low back region (lumbar spine). If your fingers represented the low back spinal nerves then your forearm would represent the sciatic nerve….getting the picture?
The sciatic nerve weaves through muscles in your buttock and thigh splitting into 2 nerves at approximate knee level reaching the foot. It is the largest nerve in our body (as it’s a long way from the low back to the foot) and it is in charge of muscle power and sensation for our lower extremities- it’s not the only nerve but it is the main one.
So what can cause Sciatica I hear you ask? Well just about anything that can compress or irritate the sciatic nerve starting at the low back where it originates to the end of the foot. Imagine a hose that is compressed or kinked, this can happen at multiple places – no rule saying you can only have one kink, right? Should the compression be long-standing it can have devastating effects, ever heard of foot drop? you don’t want to! The general rule of thumb is, the further the Sciatic pain travels from its origin (the low back), the more serious the compression/ irritation is – This is a Red Flag Alert!!. The symptoms can be debilitating and in truth, it needs to be because its the only way your body can protect you from further damage to the Sciatic nerve and that’s to get you off your feet- Immediately!. That’s why you struggle standing, sitting or any kind of movement, it’s the bitter taste of tough love I’m afraid.
So What Are The Common Causes Sciatica?
Fortunately for us, most common causes of sciatica are treatable but the longer you leave it, the harder it is to manage it with a conservative approach such as Chiropractic, Osteopathy or Physiotherapy. Below is a list to give you a taste of the complexity of sciatica and to empower you not to settle with “Sciatica” as a diagnosis as it tells us nothing we don’t already know. You don’t need a medical degree to work out you have low back pain radiating down your leg (Sciatica) but you do need one to tell you why!
- Piriformis Syndrome
- Sacroiliac joint dysfunction
- Abnormal Spinal Movement
- Lumbar Disc herniation or prolapse (slipped disc)
- Degenerative Disc Disease
- Lumbar Spinal Stenosis
- Spinal tumours
- Spinal Infections
- Ankylosing Spondylitis
5 Myths About Sciatica
•Sciatica is a disease: Sciatica is a set of symptoms rather than a single diagnosis in itself, meaning it does not explain the cause of the pain. It is simply the medical term used amongst professionals to describe pain referral along the sciatic nerve. TIP – if you are currently seeing a health professional who thinks “sciatica” is a diagnosis get a second opinion.
•Sciatica is caused by a slipped disc: This in part is true, but it’s not the full story as there are many causes of Sciatica as mentioned above.
•All treatments for sciatica are the same: This is where things can go terribly wrong. Firstly, its a matter of common sense to realise the primary cause must be identified correctly before any treatment options can be recommended. If an inexperienced practitioner misses the correct diagnosis it is unlikely to resolve or worse, allow an undiagnosed condition to progress further. The complex network of low back nerves combined with multiple causes of sciatica does make it challenging but not impossible to get right. Fortunately for us, the more sinister causes of sciatica are rare so don’t think the worse case scenario, just see someone that understands and regularly works with sciatica.
•Surgery should be your first treatment option: Any self-respecting surgeon would recommend you exhaust all conservative treatment methods before any surgery would be offered. This naturally would exclude causes such as trauma, infections or tumours where surgery may be the first port of call. Fortunately, in the majority of cases, the only time surgery is considered is when noninvasive conservative treatments have proven to be ineffective or severe loss of muscle functions has already occurred and the body is heading for a crisis.
Because most causes of sciatica are of a disc/mechanical origin, correct treatment alongside stretching and strengthening exercise can be an effective solution. Let us not forget, surgery is very invasive and carries risks not always guaranteeing results, so, it should definitely be down your list of treatment options. TIP: As a general rule of thumb, if your back pain is worse than your leg pain you are more likely NOT to need surgery and more likely to respond to conservative treatment such as Chiropractic, Osteopathy or Physiotherapy.
•Sciatica is hereditary: Sciatica can happen to anyone at any time, regardless of their family’s health history. Again, it does depends on the cause of the Sciatica before any conclusions can be drawn.
How Can Conservative Treatment Help?
As previously mentioned if Sciatica is due to physical causes such compression or irritation due to aberrant joint movement (spinal or sacroiliac joints), mild to moderate disc prolapses or muscle involvement (piriformis syndrome) Chiropractic, Osteopathy or Manipulative Physiotherapy can be extremely effective using traditional and conservative treatment protocols that are evidence-based. Treatment will primarily consist of reducing nerve compression, improving joint motion quality and range, improving blood circulation and easing muscle tissue tension/spasm in the spine, buttock, and leg. Your health professional will also assist by giving advice on how to avoid poor posturing while performing normal activities of daily living and teach correct lifting techniques. Rehabilitative exercises come much later once the disc compression and facet joint dysfunction is dealt with otherwise the risk of aggravation is high.
As you have come to understand it really depends on the primary cause and severity of sciatica before you can claim anything definitive. The important thing is to look for someone that really gets what sciatica is. By now you are correct in assuming you need a thorough physical examination where structures are challenged and specific orthopaedic/neurological tests are engaged to assess the level of performance.
In addition, it is highly likely an MRI may be requested to confirm a diagnosis and/or exclude the more sinister causes of sciatica. Should the sciatica be due to a disc prolapse or disc bulge (the most common causes) the MRI will show how big the prolapses/bulges are and whether we are dealing with just one level or multiple levels. Our experience is, there is a surprisingly high number of multiple disc levels affected, usually, we see a major one with one or two minor ones that are closely following in the footsteps of the big one so no time to waste! Be assured though, high levels of pain does not necessarily mean surgery. It’s not uncommon to have patients being carried into our practice because the pain is so great they can’t stand or walk. We are able to advise you of surgery is likely once you are examined thoroughly and your response to treatment is carefully monitored.
TIP: If all you’ve got out of consulting with a health professional is ” you have sciatica” without any further explanation and the only clinical test is “can you touch your toes”, our advise is, seek a second opinion and seek it fast! Get the right help and do not accept “you just have to live with it” as our experience is, in most cases you don’t.
TIP: Our preference is to refer our patients for an MRI rather than a CT scan. A CT scan is equivalent to 400 X-rays in regards to radiation levels whereas an MRI has none (Magnetic Resonance Imaging). Because an MRI “excites” our body’s hydrogen molecules in a magnetic field and as we are mostly made out of water (H2O) the pictures have greater clarity hence are less likely to miss anything. In addition, for any soft tissue lesions, MRI is the preferred method of analysis. It is our view MRI technology is the currently the best that’s on offer as a diagnostic tool. Plain film X-rays will not detect disc damage as it can not show any soft tissue at all and discs are soft tissue (not hard tissue like bone).
We hope we have shed some light on Sciatica and have given you some insight as to how to assess your assessor. Please share this article if you have found it useful and you are most welcome to call the clinic if you need further clarification or advise on Sciatica.
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