Sciatica Condition
‘Sciatica’ is a layman’s term used to describe a common back problem, and as such, it is not a clinical definition of any specific condition. Sciatica refers to the pain of the sciatic nerve, a lumbar nerve, which is the strongest and largest nerve in the body. This large nerve can sustain a hanging weight of 700kg (the weight of 7 adult men) before breaking.
The roots of the sciatic nerve control motor, sensory and mixed functions via the bones, muscles and skin and it divides into two sections which pass down from the spine, through the pelvis, buttocks, and down the back of each leg.
Since no sciatic nerve root corresponds physiologically, different types of pain can be produced; e.g. a dull ache is felt in the bone, numbness (acroparisthesia) in skin, severe pain, and sharp pain in muscle – and of course these symptoms can overlap.
Causes
Common causes of sciatica typically include disorders at the lower back (lumbar spine) level, such as:
- A bone spur, which can lead to nerve compression.
- Lumbar radiculopathy, which leads to pain in the lower part of the body.
- Herniated disks, which can compress the sciatic nerve.
- Nerve compression and nerve irritation. When the sciatic nerve is irritated or compressed it can lead to sciatic pain.
- Spinal cord compression.
- Spinal stenosis, characterised by narrowing of the spinal canal, which can pinch the sciatic nerve.
- Sitting down for long periods of time. This can put pressure on the sciatic nerve and lead to pain.
- Spondylolisthesis, which can lead to the compression of the sciatic nerve.
- Sciatic nerve injury or nerve damage.
- Piriformis syndrome, which derives its name from the piriformis muscle located in buttock region.
To go into more detail about the aforementioned causes, the Sciatic nerve is in close proximity to adjacent discs (1.2-1.5 mm), which is why so-called discogenic pain can arise.
This pain, however, is caused by the tethering or rubbing of the nerve sleeve, and not by the discs themselves, while compression of the nerve doesn’t necessarily cause any pain.
As a result of mechanical friction affecting any of the nerve roots, the condition can become inflammatory, which is extremely painful.
If not treated properly this will lead to scarification in the area around the inflamed sleeve which in time would result in devascularisation (reduced blood supply to the veins).
The body reduces the supply of blood to certain veins if parts of the body are scarred and no longer require it as much as when the tissue was healthy. This process, which occurs as a result of the condition and also as a consequence of surgery, often produces referred pain along those nerves which are affected.
Symptoms
Symptoms of sciatica typically include:
- Lower back pain
- Pain that radiates to other parts of the body
- Leg pain, when the tibial nerve or peroneal nerves, both of which are located in each leg, become affected.
- Numbness across the areas where the sciatic nerve travels
- Tingling
- Feeling weakness in your lower back and lower body
These symptoms can manifest only or one side of the body, or in more rare cases, it can occur in both sides of your lower body (back, hips, legs).
Sometimes these symptoms can overlap with those of other conditions, such as cauda equina syndrome, which is the pinching of the cauda equina situated at the lowermost part of the lumbar spine, as well as those symptoms affecting the tibial nerve or peroneal nerve, especially when one of the main symptoms is leg pain.
Sciatic Nerve Pain Treatments
Treatment options for sciatica include some form of spinal decompression (but not physical manipulation), physiotherapy, anti inflammatory pain relievers, and surgery as a last resort.
The treatment of sciatica is easily carried out by decompressing the sciatic nerve at the affected joint level, in order to remove the source of friction against the nerve. Relief from pain is felt after only a few sessions when neuro-muscular and skeletal functions are restored. The straight-leg raising test (Lasague Test) can give a good indication of the level of compression required and which section of the spine is causing the problem.
As with any chronic nerve root impingement it can several months for the sciatic nerve as well as the spinal nerve roots to rejuvenate properly and for the numbness to completely subside. Nerves rejuvenate at the rate of 24 hours per millimetre of nerve.
Spinal surgery (discectomy) is often performed with a view to removing some or all of a disc to relieve pressure on the sciatic nerve. However, the consequences of weakening the stability of the spinal column by removing or fusing discs together causes much more harm than the original condition did.
Needless to say, this procedure is entirely unnecessary when the same result can be achieved in a few weeks of physical therapy. The key to success (as with all physical therapy) is in finding a practitioner who is qualified and experienced in treating this condition.
It can safely be said that for the vast majority of spinal conditions surgery is neither necessary nor effective, as it almost always leads to long term complications and suffering for the patient, out of all proportion to the original condition. The use of metal rods, screws and plates and the cutting away of parts of the spine, even the heating of discs to cause them to shrink (IDET procedure) represent a rather crude approach to the treatment of spinal problems and is not a method of ‘treatment’ that we can ever recommend.
The procedures of Orthopaedic Medicine outlined above do not involve operating on a patient, and all treatment is safe and manageable as well as being highly effective.
However, manipulative treatment for sciatica is not a good idea because it causes trauma in the area around the nerve sleeve, which then has to heal a second time, further exacerbating the condition.
If elasticity of the soft tissues is diminished, localised or referred pain will be more readily produced. Chronic sufferers should therefore not have their spine manipulated, but rather mobilisation should be used to remove friction on the affected nerve roots.
