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  • Dr Claire Chittleborough

Injury blog: Sciatica

Have you ever bent forward to pick something up and had a sudden shoot of pain down the back of the leg to the foot? This is a familiar scenario to a lot of us. If you have experienced such a thing, you’ll know just how much discomfort it can cause. A common cause of pain like this is sciatica.

What is sciatica?

Sciatica is a condition that causes pain that originates from the low back and travels down the back of the leg to the foot. The pain follows the pathway of the sciatic nerve, a large nerve that starts in the lower spine, runs down the back of the thigh to the knee, where it splits to form two other main nerves that serve the lower leg and foot. The leg pain associated with sciatica is usually more severe than the low back pain.

Causes

Sciatica has many different causes. The most common cause, equating to approximately 90% of all cases of sciatica, is a lower lumbar spine herniated disc that presses on one of the nerve roots that form part of the sciatic nerve. A disc herniation usually occurs as a result of

numerous small traumas to the disc material, caused by lots of bending and lifting with a poor technique and a weakened trunk or ‘core’. There is usually an event that is the ‘straw that breaks the camel’s back’ moment (classically picking up a heavy object and twisting) that creates the excruciating shooting pain down the leg. A period of grumbling lower back pain will commonly precede this event.

Other causes of sciatica include:

Narrowing of the holes in the spinal column, which similarly to a disc herniation, leads to compression of nerve root tissue (this could be from age-related bony changes)

Spinal injury / trauma

Tight muscles in the buttock that compress the sciatic nerve

Tumours (a rare cause)

People who are more at risk of sciatica include those who are obese, sit for prolonged periods of the day, and people who have a job where they must bend and lift heavy objects.

Signs and symptoms

The classic symptom of sciatica is pain that radiates or shoots down the back of the leg and travels to the foot. Other signs and symptoms may include:

Lower back pain (usually less severe than the leg pain)

Numbness and/or pins and needles down the leg

Weakness of the leg

Increased pain with sitting, coughing, sneezing and passing stool

Sciatica most commonly affects one side of the body only. Sciatic pain that affects both sides of the body can occur, but is much less common. Sciatica can sometimes be accompanied by changes in bowel, bladder and sexual function. These cases are not common, but should be treated with a visit to the emergency department at a hospital.

Treatment

The majority of cases of sciatica respond well to a conservative, hands-on approach. People commonly seek help from a chiropractor for treatment of this condition. Before treatment begins, it’s important to book an appointment for an assessment. During an assessment we will ask you lots of questions, carefully watch you move, and feel what is happening with your body. This will help us to reach an accurate diagnosis and formulate a treatment plan to get you moving well again. If we need to, we will refer you for imaging of the spine, but this is usually only for cases that do not respond to an initial course of treatment or where we suspect a more serious cause of the condition.

Treatment does depend on the cause. For disc herniation leading to sciatica, we aim to manage the disc herniation. For instances where tight muscles in the buttock are compressing the sciatic nerve, our approach will be to calm and stretch the angry muscles. As the root cause of most sciatica cases involves instability in the trunk region, we will prescribe you exercises to begin improving your core strength. Stretches that help to increase the flexibility of the hip are also beneficial with some cases of sciatica. After a bout of sciatica, your nervous system will have taken a literal hit. This can lead to tension from the spine down the leg. We can prescribe nerve stretches as well as perform hands-on treatment to help relieve this tension.

Our treatment doesn’t stop there either. We will look at how you move, bend and lift, advising you of any changes that can reduce the risk of a recurrence in the future.

The initial stages of sciatica can be extremely painful, so you may need a visit to the doctor to get a prescription for pain medication. Although we don’t specifically prescribe meds for any condition, sometimes there is a need for it. After all, many of us have to work or keep a household and this can be very hard to do when you are in excruciating pain!

Our advice to you is to get in to see us as soon as possible. Early intervention will mean the quickest possible recovery time. If you are experiencing sciatica, please call us today on 0413 774 399 to set the ball rolling on your recovery!

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© 2018 Dr. Claire Chittleborough

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