The Complete Guide to Sciatica - Types, causes and treatments
In this blog we will look at:
- What is the sciatic nerve?
- What actually is sciatica?
- What are the types of sciatica?
- Who is at risk?
- What causes sciatica?
- What are the symptoms?
- How is sciatica diagnosed?
- What are the non surgical treatment options?
- What are the surgical options?
- Which health care professions do what?
- How long will it take to get better?
If you suffer from sciatica it’s vital that you understand what is the cause of your sciatica, the assessment and treatment options available to you and who you should see to regain your health.
WHAT IS THE SCIATIC NERVE?
The sciatic nerve is the name of the longest nerve in your body. It is actually made up of two nerve roots that exit from the lower lumbar spine and three nerve roots that exit from the sacrum.
It travels from your low back out through your buttocks and down your thigh to your knee, calf, foot and toes. Your brain connects with the muscles in the lower leg and feet via the sciatic nerve, controlling muscle activity and sensation in your leg. It is vital for the control of your movement, sensation and balance.
WHAT IS SCIATICA?
Sciatica is actually the term that we use to describe any pain or symptoms, such as tingling or numbness that travel down the path of the sciatic nerve. Just like the word “headache” it is not an actual diagnosis of your problems, just an accurate description of the location of your pain.
Sciatic pain can be anything from a mild ache in the to levels of pain of such severe intensity simple tasks such as walking, bending, sitting or even just standing up can be difficult and in some cases impossible.
What are the types of sciatica?
There are two types of sciatica:
The discs between the vertebra can bulge, herniate or sequestrate (burst) causing direct pressure on the nerves leaving the spine. Pressure directly onto the spinal cord from within the spine can also compromise the function of the sciatic nerve. Tight muscles through the buttocks and top of the legs can also irritate and put pressure on the sciatic nerve.
In most of these cases the leg pain is worse than the back pain and described as a sharp, burning, shooting pain. It is often associated with a feeling of numbness, pins and needles, hot and cold sensation and muscle weakness.
With neurogenic sciatica there are usually abnormal neurological exam findings such as a loss the normal reflexes, muscle weakness and sensory changes.
In some cases the pain is worse in the back than it is in the leg and doesn’t usually have a shooting quality to it. Abnormal neurological findings, such as reflex changes, objective weakness and sensory changes, are unlikely to be present.
Who is at Risk for Sciatica?
It is estimated that over 40% of the population will experience sciatica at some time. The most common age for developing sciatica is between 40 to 50 years of age however it can affect any age group.
The major risk factors associated with sciatica are patients who have
- Pre-existing spinal degeneration
- Loss of normal spinal movement
- A Sedentary Lifestyle
- Employment involving in heavy work especially lifting
What Causes Sciatica?
1. Disc Bulge or Herniation
The intervertebral disc is constructed of outer rings of cartilage inside of which there is a soft centre called the nucleus pulposus.
When the disc bulges (prolapses) the nucleus polyposis has shifted with the disc however it remains contained within the outer cartilage rings. A bulging disc is very common in patients over 40 years of age.
When the disc herniates (sequestration) this soft material escapes out of the disc through tears that occur in the outer fibers of the cartilage called annular tears. The nerve roots are extremely sensitive and the subsequent sciatic pain is caused by irritation of the spinal nerve roots, inflammation caused by proteins contained in disc material or a combination of both. They are caused by pre-existing weakness in the annulus or a sudden increase in pressure through the disc, poor posture over time damaging the discs, a sudden unexpected load or a motor vehicle accident.
2. Degenerative Joint Disease
3. Spinal Stenosis
There are many different causes of spinal stenosis including spinal degeneration, damage to the spinal joints between the vertebra and cysts or tumors growing within the spinal canal.
4. Abnormal Spinal Movement
5. Sacroiliac Joint Dysfunction
6. Piriformis Syndrome
The most common causes of a spondylolisthesis are trauma to the spine, arthritis and degeneration, pathology (such as cancer or infection), and previous surgical procedures to the spine.
9. Muscle Strain
10. Tumors, Fractures, Infection
11. Ankylosing Spondylitis
WHAT ARE THE SYMPTOMS OF SCIATICA
The symptoms of Sciatica are usually a combination of
- Sharp, shooting or searing pain in the leg
- Numbness or pins and needles in leg and foot
- Weakness when moving the leg or foot ,
- Electric shock sensation in back or legs
- Burning or prickling sensations
- Inability to bring the foot upwards (walk on heels)
- Weakness in lifting the big toe or ankle up
- Pain and/or numbness on top of the foot, particularly between the big toe and second toe.
- Pain and/or numbness to the lateral, or outside, of the foot;
- Difficulty raising the heels off the ground
These symptoms will vary depending on many different factors, including the cause and location of the symptoms. While these symptoms can be severe and debilitating, it is rare that the sciatic nerve is permanently damaged.
The location of sciatic pain is:
- back of the thigh
- back and outside of the calf,
- foot and toes.
The symptoms are usually only experienced in one leg but can occur in both.
With sciatica most patients will find that:
- Pain that is worse when sitting or standing
- Pain improves when lying down or walking
- It difficult to stand up or walk normally
- Pain is aggravated by sneezing or coughing
Cauda Equina Syndrome
Rarely people suffering sciatica can also experience a loss of bowel or bladder control or a progressive weakness or loss of sensation in their legs. These are symptoms of a possible cauda equina syndrome. This condition is very serious and anyone experiencing these symptoms should contact their doctor urgently. If the nerve is compressed and the pain and symptoms are severe, surgery may be warranted.
How Do You Find the cause of sciatica?
A thorough history and examination must be completed to determine the cause of your sciatica.
Often specific information at this stage starts to point to the location of the cause. Certain symptoms are unique depending on the underlying cause of the sciatica. For example, bending the body backward or walking more than a short distance will often aggravate sciatic symptoms when spinal stenosis is the cause. Bending the body forward may trigger symptoms if the cause is a lumbar herniated disc.
The most common tests include:
- Computer Tomography (CT scan)
- Magnetic Resonance Imaging (MRI)
- Blood tests
These tests help find the cause and also rule out any other pathologies as the cause of your symptoms so the most appropriate treatment can be given.
HOW DO YOU TREAT SCIATICA
Many people who experience sciatica get better within a few weeks or months using a functional approach to treatment without surgery.
Nonsurgical Treatment for Sciatica
If you suffer from sciatica its most likely started from a functional, mechanical problem in your spine. The initial aim of your treatment is to remove the irritation of the nerve, reduce inflammation in the area and improve the movement in your spine.
It is important to stop you aggravating the problem further by avoiding activities such as bending, lifting and prolonged sitting. In severe cases you will need painkillers and anti-inflammatory medication to help control the symptoms while the cause is removed. Initially stretching exercises are also an important part of your treatment.
The most important thing is that once your condition has stabilised your health care practitioner designs an individual treatment program and exercise regime to remove the underlying cause of your sciatica.
There is a broad range of treatment options available and sciatica generally responds best to a combination of the treatments below.
Spinal Manipulation and Mobilisation
Poor biomechanical function in the lower back is usually involved of the cause of sciatic pain. Spinal manipulation and mobilisation aims to restore normal balanced movement to the spine which will remove the irritation of the sciatic nerve and stop the sciatica. It is normally combined with specific flexibility and strengthening exercises to surrounding musculature to achieve the best long term improvement possible. Chiropractors, osteopaths, doctors and physiotherapists who have completed further training in this area.
TENs and Ultrasound
Epidural Steroid Injections
Acupuncture and Dry Needling
Surgical Treatment for Sciatica
For the small number of people that when the pain is severe or does not get better with conservative treatment, a more structured treatment approach, and possibly surgery, may be the best option for finding pain relief and preventing or minimizing future pain and/or dysfunction.
Surgery should be a last resort and is sometimes necessary, especially if bowel and bladder control is affected. If your chiropractor has any doubts about the cause of your problems or whether they can help you they will refer you to your doctor or a spinal surgeon for another opinion.
Surgery for sciatica is considered when the patient has the following:
- Severe leg pain that has persisted for greater than six weeks
- Pain that is not relieved after all non surgical treatment such as chiropractic, drug treatment and injections
- Severe Limitations on the patient’s ability to participate in normal everyday activities
The most common types of surgery
Who treats sciatica?
Chiropractors aim to restore the normal spinal function to your spine, strengthen the surrounding muscles and balance the neurological control of the region. This is achieved by using specific spinal techniques and a specific rehabilitation exercise program
Clinically chiropractors generally find that most of their patients suffering from sciatica get relief after a period of chiropractic care, exercises, rest and avoiding any aggravating activities.
How long will it take to get better?
The healing process takes time and varies from person to person, often depending on the severity of the condition and the history of the complaint. However, how active and compliant you are in your own treatment will influence your recovery time.
The recovery time can take days weeks or even months depending on the cause of your pain and will vary from perosn to person.
what to do if you have sciatica?
If you are experiencing sciatic pain it is important to achieve an accurate diagnosis prior to commencing any treatment. This is achieved through a thorough examination process that allows your chiropractor or other health professional to discover the cause of your sciatica and design the best treatment for you.
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