Sciatica - a common problem with varied causes

Sciatica is often used to describe back pain that is associated with varying degrees of leg pain. Saying I’ve got sciatica because you’ve got pain in your back and leg is like saying you’ve got a headache…there can be many causes and not all are actually true sciatica.

True sciatica is caused by ‘pinching’ or inflammation of the sciatic nerve which is the longest and largest nerve in the body. It is composed of nerves that originate from both the lower back and the sacrum. Other muscle and joint injuries can also mimic sciatic type pain. The two more common ones are hamstring injuries and sacroiliac joint sprains.

Classically the pain radiates from the lower back, down the butt and into the leg below the knee. The pain tends to be a sharp, burning pain which is often aggravated by certain movements particularly flexing forwards and extending the leg. Sitting in a car can be especially painful. With more severe compression of the nerve muscle weakness in the leg can occur in conjunction with numbness and or pins and needles.

Underlying sciatica can be spinal injuries such as disc herniations/ bulges, degenerative discs, bone spurs and spondylolisthesis (where one vertebra slips forward on the other). Spasm or injury to the piriformis muscle which runs over the top of the sciatic nerve is also a frequent offender.

Diagnosing the local problem is the first step, then working backwards in a holistic way gives us a better understanding of the many predisposing factors at play and therefore what needs to be accounted for in a well-rounded treatment program.

For example, piriformis muscle spasm may be pinching the sciatic nerve. This in turn could be a compensation issues such hip and pelvic mis-alignment, stabilising muscular weakness or foot dysfunction to name but a few.

In the case of a damaged lumbar disc, this could be the results of years of poor posture, spinal stiffness and core weakness. In either case, all the contributing factors need to be addressed for the best result both short and longer term.

In many cases not only do the predisposing issues need to be addressed but also the way your body may have compensated for the injury itself over time. Usually these structural body changes take place long before the pain hits. Pain is your body’s was of telling you that is has run out of ways to compensate for the underlying problems.

To consider also is that nerves are of the slowest tissues in the body to heal so patience and persistence is key to recovering from a sciatic nerve injury. There can be quite a time lag between doing the right things to take the pressure of the nerve and your symptoms going away. For longstanding injuries this can be months so don’t give up.

At Well Aligned Cammeray, Chiropractic care takes a holistic approach. invariably treatment is a balance between hands on work to help bring the body back into balance and prescriptive exercise rehabilitation to strengthen and support. We look forward to seeing how we can help you!

Dr Andrew Richards (Chiropractor)