By Michael O’Doherty (Chiropractic Moves – Paddington, Brisbane)
Sciatica is an injury usually characterised by low back pain that radiates (or refers) into one leg. It is the most common kind of referring lower back pain and is sometimes called lumbar radiculopathy or sciatic neuropathy.
The Sciatic Nerve
The sciatic nerve is the longest in the body. Therefore, it has a number of functions and one those is ‘supplying’ (relaying signals) sensation to the skin of the side and back of the leg and foot. It also supplies signals from the brain back down to the hamstring muscles and some muscles of the calf.
The referral pain in sciatica usually travels down the back and outer side of the leg to the foot, and classically a sudden, “lightning bolt” of pain. Sciatica may occur many times throughout the day, especially with certain movements. It may be accompanied by deep or achy pain, pins and needles, or a tingling or crawling sensation of the skin. Sometimes it feels like burning or a feeling of numbness, and can also cause weakness of the hamstring and calf muscles down the same leg.
Low Back Pain & Sciatica
Sciatica is very frequently accompanied by low back pain. As the sciatic nerve originates in the lumbar spine is formed from strands from a number of spinal nerves, from L4 to S2 levels of the spine. It can be caused by spinal issues such as stenosis or bulging discs. Sciatica can also be irritated further along its course such as irritation through the piriformis muscle.
There are several different structures and diseases that can cause sciatica. Health professionals who see cases of sciatica initially will want to rule out things like infection, cancer, diabetes, arthritis and more. This is generally followed by a more thorough physical assessment to determine the causes of the pain.
Do I need an X-ray or a Scan?
X-rays are rarely useful for diagnosing or managing sciatica and almost never used. Similarly, CT scans are rarely useful for sciatica. MRI scans are good at demonstrating disc injuries and protrusions that can cause sciatica, but even they are rarely required.
A majority of cases can be diagnosed by a qualified health professional person without a scan. However, a MRI can be a useful tool to plan a surgery or to rule out any different conditions, such as cancer.
Treatment for Sciatica
Most people with Sciatica will benefit from avoiding long periods of rest and keeping up normal daily activities as much as possible.
Some over the counter medications are useful, especially for short term pain management, and should be discussed with a GP.
Exercise seems to be the most useful therapy for sciatica. This should be in the form of structured supervised exercises. So, walking the dogs or getting your pedometer steps up probably isn’t enough! Exercise programs should include some strengthening exercises, some stability and balance work. The aim of exercise is to increase range of motion, reduce pain, and speed up the return to normal activity.
Adjustments or mobilisations like those commonly delivered by chiropractors and physios are useful treatments for sciatica. These appear to reduce pain, increase range of motion and may help people get back to normal activities earlier. Manual therapies can be used in addition to exercise and rehab. And, like most therapies, they could have side effects that you need to discuss with your chosen health professional.
Massage and acupuncture may be useful in reducing pain in the short term. However, these have poor evidence for the long term management of sciatica.
Low back surgery can work quickly for some people who fail 12 or more weeks of rehab, or if their condition gets worse. Referral to surgery is generally reserved for cases where nothing else is working. It is expensive, time consuming, and patients will often still require rehab post-surgery. Try seeing a rehab professional before going down the surgical route!
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