Sciatica refers to an irritation of the sciatic nerve, the sciatic nerve comes from the lumbar and sacrum then down the legs. An irritation to the sciatic nerve can commonly give you backpain, however sciatic irritation can give rise to a multitude of symptoms, such as pain along the back of the leg, pins and needles or even weakness. Sciatica itself is not a diagnosis but an irritation to the sciatic nerve.
Sciatica Irritation and Back Pain
To understand the complaint of sciatica you need to understand the path of the nerve and the surrounding structure. It starts in the lumbar spine/sacrum then into the buttocks, under the piriformis muscle then down the posterior (back) other leg until it splits into two just above the knee, and travels either side to the soles of the feet. Commonly, when most people have pain in the leg a diagnosis of sciatica is made. However, the nerve gives a sensation of pain into the buttock, lower leg and soles of the feet, in the back of the thigh it can be felt in a straight line down the middle which can be followed with a finger down its path to the knee (just above). If there is a whole area of pain around the posterior thigh (back) it’s possible the posterior femoral nerve is irritated. Osteopaths are able to assess and differentiate nerve pain patterns and associated muscle and joint function.
Slipped Disc (technically no such thing but a common term none the less that means lots of things to different people), more commonly a semi-prolapse or prolapsed disc, herniated or ruptured disc.
The Sciatic nerve is the major nerve into the leg and therefore the highway of a mass of information, this makes a large and varied picture, you may feel tingling which can be only just noticeable , to loss of sensation, severe pain or even a burning sensation. It can stop you in your tracks with pain.
Sciatica most often occurs on one side, usually experiencing a pain in one part of the leg or hip and numbness in other parts. The pain or numbness may also be felt on the back of the calf or on the sole of the foot. The affected side of sciatic may have a feeling of weakness into the leg.
Sciatica can vary considerable depending on cause, i.e. piriformis – here the nerve is irritated by muscular compression and tension so any movements requiring this hip muscle to contract can increase pain, a stenosis on the other hand will increase the pain if anything increase the pressure within the spinal cord such as coughing, sneezing, movement will also increase the pain.
With Sciatica a diagnosis is best, you then know what you’re dealing with.
Tests that can help determine on the suspected causes may include:
•MRIs or other imaging tests
Because sciatica is a symptom of another medical condition, the underlying cause should be identified and treated. As osteopaths we look to identify which structures are involved and if necessary refer you for further investigation to your doctor a scan.
Osteopathic treatment for sciatica may consist of soft tissue to the tight muscles, manipulation and mobilizing the concerned joints allowing better movement, often treatment is useful for the surrounding muscle and joints as these may be working harder or may also be stiff and tense.
The following steps may help to calm your symptoms and reduce inflammation.
•Apply heat to tight muscles as this may relax them.
•Ice onto the painful area, for the first 48 – 72 hours this can help manage inflammation.
•Talk to you doctor or pharmacist and possible take over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol). Make sure you don’t rely on them as you need to get to the root cause.
•If you do not know what structures ie muscle, joint etc causing the pain medication and self help can be a little hit and miss, ie a facet strain requires different exercise to a muscle problem.
•Mobility is usually the best way forward, though initially take it easy and grade your return starting gently, heavy lifting or twisting is not a good idea and best avoided 4 -6 weeks again this depends on your levels of fitness, strength and flexibility and ultimately why it’s there.
Sciatica is nerve pain and as such can be difficult to treat, as osteopaths we may refer you back to your doctor and if necessary give you a referral to a neurologist.
Expectations For Sciatica
Sciatica can get better on its own, that will only happen if you change the influencing factors and the main reason it’s there. Sciatica can have some serious complications depending on the cause.
If you are experiencing any of the following, it’s more than home care and you should call your doctor right away:
•Unexplained fever with back pain.
•Back pain after a severe blow or fall.
•Redness or swelling on the back or spine.
•Pain traveling down your legs below the knee.
•Weakness or numbness in your buttocks, thigh, leg, or pelvis.
•Burning with urination or blood in your urine.
•Pain that is worse when you lie down, or awakens you at night.
•Severe pain and you cannot get comfortable.
•Loss of control of urine or stool (incontinence).
•You have been losing weight unintentionally.
•You use steroids or intravenous drugs.
Prevention varies depending on the cause of the nerve damage. However some of the issue to cover are;
•Your posture, if you spend 8 hours slouched at a desk then yes there is a good chance you will get back pain of some sorts
•Strength/flexibility, always work within your bodies capacity, or increase your bodies ability
•Your mental/emotional state, influences the way we feel, this affects what we do, how we do it or not as the case may be
•Your food and diet, you are what you eat, vitamins and minerals have certain functions for the body to work
•Hydration, fluid is vital for pretty much all body functions, keep it up and the purer the better.