Sciatica is a very common complaint amongst people of all ages, occupations and fitness levels, however many people don’t understand what it really is, what has caused it and what they can do about it. Some people experience it in a relatively mild form, while for others it can be quite debilitating, interfering with normal daily activities and movement.
What is it?
As chiropractors, many people come to see us with the ‘diagnosis’ of sciatica, a term which is often misunderstood. To suffer with sciatica means to suffer with pain or symptoms down the back of the leg, typically to the knee or ankle. Sciatica is the result of pressure, injury or damage to the sciatic nerve, and may coincide with numbness, weakness or tingling in the leg. The sciatic nerve stems from the lower part of your spine and sacrum on either side, and travels down each leg. The sciatic nerve supplies the power to muscles in the back of your thigh, knee and calf, as well as sensation down the back of your leg and sole of your foot. Pain in your low back or down the front of your thigh should not be labelled as sciatica.
Do I have sciatica?
Sciatica is a symptom of a problem, rather than a problem itself. There is, therefore, no such diagnosis of sciatica (it would be the same as being given a diagnosis of ‘knee pain’) and it is important to seek professional advice to identify the cause for the symptoms. The experience of sciatica can vary greatly from person to person, depending on the cause, and as such, so will the management.
Sciatica can be present in one or both legs, and may be accompanied by weakness, tingling or areas of numbness in the back of the thigh, knee, calf or foot. The pain may feel like bolts of lightning down your leg, a burning sensation or even an intense ache. In some cases, people experience an increase in symptoms if they have been in one position for a prolonged period of time, bend or turn in a certain way, cough or sneeze. It is also possible for there to be a loss of bowel or bladder control in severe cases.
What causes it?
As sciatica is a symptom- rather than a condition- is can have a variety of causes, some more serious than others. It is important to have a thorough history and examination undertaken so the patient can find relief as quickly as possible, and to avoid unnecessary concern, costly investigations and inappropriate treatment. Here is a brief outline of some of the more common causes of sciatica.
Disc Disease: Excessive stress on the intervertebral disc, causing a bulge, prolapse or herniation of disc material into the central canal or lateral canal, placing pressure on the spinal cord or spinal nerve.
Lateral Canal Stenosis: Narrowing of the space where the nerve root exits the spine, either from a disc bulge or degeneration, causing pressure on the spinal nerve as it passes through.
Piriformis Syndrome: Tension, spasm or trigger points in the piriformis muscle (narrow muscle underneath your gluteals) which interferes with the sciatic nerve as it passes through the area, either directly or indirectly.
Posterior Facet Syndrome: Inflammation of the joint capsules at the back of the spine, irritating the nerve roots as they pass through the lateral canal.
Myofascial Pain Syndromes: Tension, spasm or trigger points in muscles that have pain referral patterns down the leg, including gluteus medius and minimus.
Sacroiliitis: Inflammation of the sacroiliac joint, seen in some types of arthritis, causing tension around the sacral nerve roots.
Iliolumbar Syndrome: Inflammation or sprain of the iliolumbar ligament, between the 5th lumbar vertebra and the top of your pelvic bones, referring pain down the back of the leg.
Trochanteric and Ischiogluteal Bursitis: Inflammation of the normal bursa on the top of the hip or underneath the sitting bone. Typically painful upon touch or pressure and often refers pain down the back of the thigh.
What can I do to help my recovery?
In most cases, conservative care is recommended. Consult your chiropractor, who will advise you on the best way to manage your particular complaint, and help you return to normal function as soon as possible. Applying ice to the painful area is recommended for the first 48-72 hours to help reduce any swelling, and it is paramount to keep moving as much as possible (bed-rest is not recommended).