Sciatica- Vale Chiropractic
Sciatica is a condition whereby intense pain is felt down the back of the leg, and often as far down as the foot. Pain can sometimes, but not always, be felt in the back also. The pain may be associated numbness and pins and needles in the buttocks, leg and/or foot, there may also be weakness in the muscles of the foot and lower leg. Sciatica will affect between 13-40% of us in our lifetime (1).
The sciatic nerve forms after exiting the lumbar spine in your lower back, it runs down the back of your pelvis, into the buttock and down the back of the leg into the foot. Compression or irritation of the nerve along its course can cause sciatic pain. Symptoms of sciatica typically extend to below the knee from the buttocks, across the back of the thigh, to the outer calf, and often to the foot and toes (2). Heavy lifting, bending and twisting can increase your risk of developing it.
What can cause compression of the sciatic nerve?
Prolapsed disc
Often known as a "slipped disc", it usually effects the lower 2 levels of the lumbar spine affecting the L5 and/or S1 nerve roots, 90% of sciatica cases are believed to be caused by a prolapsed disc (2). This happens when damage is done to the firm outer layer of the disc, causing the softer, jelly like, inner layer to bulge out towards the damaged side. When the disc bulge touches the nearby nerve, it can cause mild to severe pain, often associated with areas of pins and needles and/or numbness in the area supplied by the disc. Weakness can also be felt in the muscles supplied by the impinged nerve.
Tight muscle- piriformis
The piriformis muscle attaches at the lower spine and diagonally into the top of the femur (thigh bone that forms the hip). The sciatic nerve runs vertically underneath it (in some people the nerve actually runs through the muscle), and so when this muscle tightens up and goes into spasm, the nerve can get pinched, causing pain in the buttocks region and down the back of the leg.
Spinal stenosis
Spinal stenosis is a narrowing of the space where the nerve exits the spinal cord. It is usually caused by boney changes of the vertebrae that occur from degeneration over the years. Pain, tingling, and numbness can be felt in the effected foot or leg, there may be cramping in the legs after being stood for a long time. Bending forwards often helps to relieve the pain.
Spondylolisthesis
This is where a vertebrae moves forward in relation to the vertebrae below it, which can then press against the nerve. It can be caused by a stress fracture, degeneration over time, trauma or congenital (birth defect). It is more common in people that participate in sports where hyperextesnion of the spine occurs such as football, gymnastics and weightlifting. It is often associated with tight hamstrings and a tenderness in the lower back.
Other causes
Rarer causes of sciatica include infection and cancer.
How can Sciatica be treated?
It is important to find out what exactly is causing your sciatica in order to find out which treatment options would be best for you. There are various treatment options available depending on the cause of your sciatica and the severity of symptoms.
Manual therapy- including spinal manipulation, mobilisation and soft tissue techniques (NICE)
Inflammation reduction (ice therapy or anti-inflammatories)
Exercise programmes including light stretching and walking (NICE)- it's important to remain active
Painkillers
Epidural Injections
Surgery
Prevention
Exercising core muscles regularly
If you have these symptoms, along with new symptoms of; loss of control over bowel or bladder, tingling or numbness in the genital region, or sciatica in both legs- this could be a sign of a more serious condition known as cauda equina syndrome and you should go straight to A+E.
References
1. Stafford M.A, Peng P, Hill D.A, (2007). Sciatica: a review of history, epidemiology, pathogenesis, and the role of epidural steroid injection in management. British Journal of Anaesthesia 99 (4) pp 461–473
2. Koes, B.W., van Tulder, M.W. and Peul, W.C. (2007). Diagnosis and treatment of sciatica. British Medical Journal. 334(7607), 1313-1317.
3. Low back pain and sciatica in over 16s: assessment and management. NICE guideline [NG59] 1.2. 2016