Sciatica

Sciatica is pain felt in the buttock and leg, sometimes all the way to the foot. It is caused by pressure or entrapment of one of the spinal nerve roots which form the sciatic nerve. It may be associated with low back pain, altered sensation in the leg and/or foot (pins and needles or numbness) and weakness in the muscles of the legs or foot.

Sciatica can vary in severity, but can be an extremely debilitating and frightening condition.

Common causes of sciatica:

Intervertebral Disc Injury.
Discs sit between the vertebrae in our spine and function rather like shock absorbers helping to promote movement within our spine.
The disc is made up of an outer fibrous shell and an inner gel-like nucleus. With ageing, or due to injury, the outer fibrous shell can become damaged and the gel from within the disc can make the disc wall bulge (disc bulge), or if the shell is broken, it can burst out, like toothpaste from a tube (disc prolapse).

Discs can bulge without causing any pain as part of the ageing process, and we may even experience a prolapse with little pain. However, if the disc or the displaced disc matter put pressure on nerves exiting the spine, this will cause pain and may affect sensation and strength. The spinal nerves exit the spinal canal through a small hole, and if this is narrowed by the disc, the nerve becomes trapped.

Spondylosis ( Osteoarthritis)

As we age our disc start to dry out and this can lead to the discs losing height. This can lead to a narrowing of the space through which spinal nerves exit the spine, making trapped nerves more likely. The body may also start to produce small bony spurs between the vertebrae called osteophytes. If an osteophyte causes pressure onto a spinal nerve this will also cause sciatica.

Other conditions

There can be other causes of low back pain with pain referring into the leg which are not sciatica. (Pseudo-ridiculopathy).

Myofascial pain syndrome. Pain felt into the buttock and the leg may come from myofascial trigger points in muscles in the low back or buttock rather than from the sciatic nerve. Myofascial trigger points are contractures in taut muscles capable of referring pain.

Piriformis Syndrome

The piriformis is muscle in the buttock through which the sciatic nerve passes. If this muscle becomes too tense it may cause sciatic like symptoms.

Sacroiliac joint dysfunction.

The Sacroiliac joint is one of the joints in our pelvis. If it’s movement becomes restricted, or if the ligaments which stabilise become too loose we can experience pain in the back of the pelvis usually on one side and pain that may refer into the buttock, groin and leg.

How we treat Sciatica

Sciatica is one of the commonest conditions successfully treated in my clinic. As with all conditions understanding the cause of the pain is the first key step.
During an initial consultation I will try to determine the cause of the problem and decide if I can arrive at a working diagnosis. If so we can agree on an appropriate treatment plan.

Depending on the cause of the problem we may treat with techniques including foraminal gapping, massage and stretching, joint mobilisation, trigger point acupuncture, low light laser, spinal manipulation and exercise therapy.

Radicular pain (pain from a trapped spinal nerve) may take longer to resolve than most forms of musculoskeletal pain (although sometimes resolves surprising quickly!) and needs careful management. However, in my experience, most cases will resolve without the need for more radical medical intervention ( i.e. spinal injections or surgery).
If treatment is not possible or you need imaging first, with your permission, we will make the appropriate referrals and discuss other options with you.