Sciatica is a commonly used term to refer to that sharp shooting pain down the back of your leg. It is, however, a symptom of an underlying cause, not a diagnosis itself. In this post we will explore some of the different possible causes of this uncomfortable symptom..
Many causes for sciatica are nothing to be concerned about and can be treated and generally ease with time, despite being uncomfortable and often painful. However, in some cases the cause for sciatica can be more sinister and require attention immediately.
If you’re experiencing sciatica in both legs, have a weakness or numbness in both legs that is progressing, have numbness in the saddle area (genitals), bowel and bladder changes, seek medical attention immediately.
The most common cause of sciatica is a lumbar radiculopathy, this is when the nerves exiting the spinal canal in your low back become compressed or irritated, but there are also causes for this cause, some of which are discussed below…
Discs between the spinal vertebra can become herniated. In many cases this won’t interfere with the nerve roots exiting the spinal canal, and they may result in just lower back pain or be asymptomatic. However, If a herniated disc pushes onto a nearby nerve root, you will likely experience some nerve pain that will follow the path of this nerve. If this is in the low back, the pain commonly refers down the back of the leg via the sciatic nerve (S1).
Disc herniations are most common in the bottom few spinal levels, so can also affect other nerve roots which will cause leg pain in different locations. This allows us to diagnose which levels might be affected, alongside neurological testing of reflexes, sensation & muscle strength.
The central canal of the spine can become narrowed and put pressure on the spinal cord, often seen in older age groups where the spine is more prone to degenerative changes. Often lumbar spinal stenosis is asymptomatic, but it can result in irritation of the sciatic nerve and cause leg pain too!
In these cases leg pain is often worse with back extension, prolonged standing and walking. Often progressing in its' intensity until you rest or bend forward. It is also called neurogenic claudication.
Symptoms are typically in both legs accompanied by lower back pain, with numbness and tingling present in the majority of patients.
The piriformis muscle runs from the bottom of your spine (sacrum) to your hip crossing the path of the sciatic nerve. In some people the sciatic nerve runs through this muscle, and in these cases, the sciatic nerve may be more prone to irritation.
If the piriformis muscle becomes overused, irritated or inflamed, it can compress the nearby nerve resulting in sciatic nerve irritation and the leg pain you may be experiencing. Typically patients experience:
- Chronic pain in the buttock and hip area
- Pain when getting out of bed
- Inability to sit for a prolonged time
- Pain in the buttocks that is worsened by hip movements
The good news is chiropractic care may be able to help. Sciatic pain and its causes are conditions that chiropractors are trained to treat and see regularly in clinic.
During a chiropractic consultation we will take a detailed case history, conduct a thorough physical and neurological exam to localise the cause of your pain. We will then work together to create a personalised treatment and rehabilitation plan. If needed we can also organise a referral for imaging or another appropriate care provider if chiropractic isn’t suitable for you at this time.
The classic chiropractic spinal manipulation is not always an appropriate treatment for our patients, especially those with acute disc prolapses. Below are some different techniques that our chiropractors might use to help you with your sciatica symptoms.
Flexion-distraction is a form of traction that gently mobilises and stretches your spine, gaping your vertebrae and opening up the spaces where the nerves are getting compressed.
As well as stenosis and disc herniations, flexion-distraction can be used to treat many other causes of lower back pain. It can reduce pain and stiffness associated with osteoarthritis and can be helpful if you have sacroiliac syndrome, ankylosing spondylitis, sprains, and strains. It's also very effective in treating muscle spasms or low back pain unrelated to a specific condition. The technique is gentle enough to use after spinal surgery and can be a safe therapy option for those who have osteoporosis.
In a study published in The Journal of Physical Therapy Science, researchers examined the effects of flexion-distraction manipulation on patients with lumbar spinal stenosis. Study participants who received flexion-distraction manipulation as part of their treatment experienced a greater reduction of their painful symptoms than those patients whose treatment did not include the technique.
NCBI: Journal of Physical Therapy Science: Effects of Flexion-Distraction Manipulation Therapy on Pain and Disability in Patients with Lumbar Spinal Stenosis, 30/6/15
Acupuncture stimulates the nerves in skin and muscle, producing a variety of effects. It increases the body's release of natural painkillers, endorphins and serotonin, in the pain pathways of both the spinal cord and the brain. This modifies the way that pain is felt.
Modern research shows that acupuncture can affect most of the body's systems including; the nervous system and muscle tone.
This can be a useful tool to help patients struggling with neurological pain, and to relax muscle spasms.
Information obtained from the British Medical Acupuncture Society, cited 02/06/14
To find out more about your sciatic pain and whether chiropractic treatment could help, book an appointment today.