What is Sciatica and can Osteopathy help?
Lumbar radiculopathy, or as it is commonly known Sciatica, is the name given to pain caused by irritation or compression of the sciatic nerve or any of the five nerve roots which combine to form the sciatic nerve. Sciatica is therefore not a diagnosis; it is a symptom.
Sciatica typically only affects one side of the body. The pain, often described as burning, searing, shooting or sharp, is usually worse when sitting, bending, coughing or bearing down on the toilet. The intensity and nature of the pain often make it difficult to walk or to even bear weight on the affected side.
In addition to pain, compression of the sciatic nerve can also cause altered sensation such as pins and needles and numbness, or weakness of the muscles supplied by the sciatic nerve or one of its subsidiaries. An example of this would be ‘foot drop’ where weakness in the muscles that run along the outside of the shin bone results in the foot dropping whilst walking. The toes often drag on the floor on the affected side as the leg is moved forward. This occurs due to damage to the common peroneal nerve (a subsidiary of the sciatic nerve) or damage to the L4 nerve root, one of the five nerve roots which combine to form the sciatic nerve.
How can Osteopathy help?
The truth is, sciatica often resolves on its own with pain relief and anti-inflammatory medication but may take from a few weeks to many months. Osteopathy can help by speeding up the recovery process and it’s not just me saying this. NICE, the National Institute for Health and Care Excellence recommends osteopathy alongside exercise for sciatica.
Pain control should start by using over the counter medication. If this is not adequate, your GP may prescribe stronger anti-inflammatories such as naproxen or other medication which helps to dampen down nerve related pain such as amitriptyline, gabapentin, or pregabalin.
The aim of manual therapy is to reduce muscle tension, enhance spinal joint mobility and decrease compression/irritation of the sciatic nerve or individual nerve roots. Gentle traction techniques in particular are really helpful in reducing compression of the nerve.
It is not all about manual therapy and exercise though. The management of disc injuries is multifactorial and relies greatly on appropriate advice and self-management strategies. Having a positive attitude towards your back pain, and having the belief and trust that exercise and activity will help and not hinder your recovery is vitally important. Manual therapy combined with exercise and self-management is proven to be the most effective method of treating most cases of back pain and sciatica.
There is a myth that osteopaths can put a ‘slipped disc back in’ using magical manipulation wizardry. Unfortunately this is not true. In fact, the truth is, discs do not slip. That's right, discs do not slip, never have and never will. We will explore this in more detail later.
Occasionally I may refer someone to their GP for further investigation, but this is unusual. X-rays and MRI Scans are very rarely required and offer little in terms of identifying where the pain is coming from.
When you should absolutely go to see your GP, or better still go straight to A&E, is where there has been a sudden change to your bowel or bladder habits such as retention or incontinence, or where you have noticed numbness or altered sensation around your genitals or anus.
Want to find out more about the sciatic nerve and sciatica?
Please read on…….
The sciatic nerves (one either side) are the largest and longest nerves in the human body. They start as a collection of nerve roots which originate from the spinal cord and exit the lower spine through tiny openings called foramina.
These five nerve roots combine to form one large sciatic nerve which at its thickest is approximately the thickness of a man’s thumb. The sciatic nerve runs deep in the buttocks before travelling down the back of the thighs. Just above the back of the knee it divides to form the tibial nerve and the common peroneal nerve. The tibial and common peroneal nerves supply the muscles, and receive sensation from, the whole of the lower leg and foot.
Common causes of sciatica
The vast majority of sciatica symptoms result from lower back disorders that put pressure on, or cause irritation to; one of the five nerve roots which form the sciatic nerve.
The most common cause of sciatica is an intervertebral disc problem in the lumbar spine (lower back). A herniated disc or bulging disc may press on a nerve root directly or may irritate the nerve root due to the build-up of inflammation in the area. When a lumbar nerve root is irritated, pain is often felt in a specific area of the leg called a dermatome. For example, compression of the L4 nerve root will often cause symptoms along the inside of the calf, foot and big toe, whilst compression of the L5 nerve root is likely to cause symptoms along the outside of the calf and the top of the foot.
Disc herniation, which often follows a disc bulge, occurs when the soft inner material (Nucleus Pulposus) of the disc leaks out, or herniates, through the outer rings of cartilage (annular fibrosus). This is what is often referred to as a ‘slipped disc’. Check out this excellent video.
Another cause of sciatica is Spinal Stenosis. Stenosis means narrowing. The narrowing can occur in the spinal canal, through which the spinal cord runs, or can occur in one of the tiny foramina, through which the individual nerve roots pass.
Stenosis can be as a result of degenerative bone disorders such as arthritis, or simply due to age. The spinal discs contain a lot of fluid and throughout the day, this fluid is forced out by the effect of gravity. As the fluid escapes, each one of the twenty three discs becomes thinner. By the end of the day we are about half an inch shorter than we were in the morning. Overnight as we sleep, the fluid is replenished in the discs and we wake a full half an inch taller. As we age however, the ability of the discs to reabsorb fluid diminishes and over time, as each disc thins, the adjacent vertebrae move closer together. This decreases the size of the small foramina through which the spinal roots pass and the possibility of a nerve root being trapped increases.
Other fairly common causes of sciatica include Piriformis Syndrome and pregnancy. The sciatic nerve runs very close beneath, or sometime even through, the piriformis muscle. Any inflammation or spasm of this muscle can therefore irritate the sciatic nerve. In pregnancy, the weight of the foetus at the front increases the curve in the lower back. The increased curve closes up the foramina through which the nerve roots pass and sciatica is the inevitable consequence.
The patient’s description of the pain, numbness, tingling etc, and its location along with the activities or positions which exacerbate or relieve the symptoms are a key factor in the diagnosis of sciatica.
The knee and ankle reflexes may also be affected. Compression of the L4 nerve root may diminish the knee reflex whilst compression of the S1 nerve root may alter the ankle reflex.
The two main tests for sciatica are the The Lasègue's Sign, often called the Straight Leg Raise Test, and the Slump Test.
Exercise and activity
It is important to continue with your normal activities and exercise within the limits permitted by your symptoms. Activity is very unlikely to cause further harm. Staying active ensures a faster return to work, reduces the risk of long-term physical impairment, and reduces the risk of recurrent back pain.
No one exercise has been shown to be significantly better than any other for improving low back pain, so pick an exercise that you enjoy and are comfortable with.
Points to remember
Despite what you may have read or may have been told, there are no magic bullet fixes for sciatica. Back pain and sciatica can be complex and challenging to treat effectively.
Your back is designed to bend and twist and to carry heavy loads for up to a hundred years. Your back is strong and difficult to damage. If you do have back pain it doesn’t mean that your spine is ‘weak’ or ‘vulnerable’.
Whilst sciatica can be painful and potentially debilitating, it is very rare for there to be permanent sciatic nerve damage and complete resolution is to be expected.
You can return to work before you are pain-free. If necessary, ask for modified duties. Complete pain relief, more often than not, only occurs after resumption of normal activities.