Do you think you have sciatica? - insights by Dr Chris

Some of the most common phrases I hear in practice are

• I got the sciatica 
• My sciatic is playing up 
• I’ve got sciatica down both legs
• My friends got sciatica
• My mum has sciatica

Everyone has sciatica or knows someone with sciatica! 

Let's cut to the chase! Have you 'got sciatica?' What really is sciatica, why do we get it, can we fix it and do you 'need' surgery?

There are lot of myths with sciatica - Let's bust some myths…

So what is it?

Sciatica by definition is a pain that is referred into the hip, thigh leg or foot where its origins are from the lower back. Sciatica is actually a symptom with a variety of underlying causes unique to each individual. About 2% of the adult population may experience sciatica in their lifetime.

Causes

The most common cause of sciatica can be a disc protrusion or disc bulge pressing on the exiting nerve root that refers pain into the leg, along the course of the nerve or into the area of the leg that the particular nerve supplies sensation to.  

Other causes of sciatica include anything that can compress the exiting nerve root. This could be an overgrowth of bone which may cause lateral canal stenosis (narrowing of the hole where the spinal nerve exits or overgrowth of some of the ligaments in the lower back again narrowing the space for the nerve root.  Finally and very rarely other causes of nerve compression can be cysts or tumors that grow in the space where the nerve sits although these are extremely rare.  

Missed or Misdiagnosed?

Anyone that knows me knows I am a stickler for an accurate diagnosis! It's very common for sciatica to be poorly diagnosed and therefore poorly managed. Common misdiagnoses that I encounter include

• Piriformis Syndrome
• High Hamstring Tendinopathy
• Bursitis
• Sacroiliac Joint Dysfunction
• Plus many more

Why is this so? The reason for difficulty in achieving an accurate diagnosis rests with poor reliability of the tests used and time taken to examine the patient. In the clinic a straight leg raise is the most common test used - but this alone not a comprehensive examination.

Other investigations such as xray (useless) CT (wrong test) and MRI (high chance of false positive) have their shortcomings and do not replace the use of a thorough history and high quality physical examination which employs a combination of orthopaedic and neurological tests to improve the accuracy.

Symptoms of Sciatica

• Leg pain greater than back pain
• Pain in one leg
• Numbness and pins in needles in the same area
• Pain in the hamstring, calf or foot but also buttock, hip or groin and rarely genitals

The large variation in symptoms location of pain is related to a few key factors:

• Which level of disc (or other structure) is involved
• What type of disc injury has occurred:
  • Annulat Tear
  • Disc Protrusion
  • Disc Extrusion
  • Disc Sequestration

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These variable disc injuries can have quite different symptoms. We will be discussing this topic in more detail in a future post on disc injuries.
Risky Business

These place you at risk of developing lower back pain and sciatica type symptoms.

• Occupations that involve large amounts of bending forward and twisting
  
• Repetitive Lifting
  
• Jobs where whole body vibration occurs - machine operators and truck drivers
  

Effective Treatment Options

• Well prescribed rehabilitation exercises
  
• Time - 70% have improvement at 4 weeks. Unfortunately 30% still have pain at 1 year
  
• Manual therapy
  
• Expert advice on activity modifications
  
• Ergonomic advice / Education
  
• Some medications
  
• Epidural Injections
  
• Spinal Surgery (not better than conservative treatment at one and two year follow ups)
  

Ineffective Treatment Options

• Paracetamol (Panadol)
  
• NSAID (Nurofen etc)
  
• Traction
  

Prevention

• Maintain healthy body weight
  
• Lower psychological stress
  
• Don’t Smoke
  

An accurate diagnosis to any ailment or injury is the key starting point. As a Chiropractor my first role is achieving an accurate diagnosis but then once we have identified the injured tissue we must ask the important question - in this case - why is the disc (or other cause) failing to function well.

• What biomechanical or ergonomic factors have caused this disc to fail?
  
• How can we guide you to better movement and better function to prevent and restore this tissue to health and to prevent recurrence?
  
• What strategy and lifestyle changes can we help you make yourself to live pain free and do the things you want to do?
  

That is what we aim to achieve with your health at Health Associates.

Dr Chris Bowles
Co-founder of Health Associates
Principle Chiropractor
Learn more about Dr Chris Bowles

Dr Chris is available for consultations on Monday, Wednesday, Thursday and Saturday.

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