Sciatica

Sciatica is a commonly mis-diagnosed problem. Most patients with any kind of leg pain or sharp low back pain will say that they have sciatica, but true sciatica is less common than you may expect. There are many forms of leg pain that are not sciatica at all.

The Sciatic Nerve.

The sciatic nerve is the longest nerve in the body. The nerve comes from the bottom three nerves at the base of the spine, L4 to S1. These nerves exit the spinal canal, and then all join together to become one nerve, the sciatic nerve. After joining together, the nerve then passes near the pelvic joint, then near or sometimes through the deep buttock muscles, and then on down the back of the leg to the heel and foot where it branches into smaller nerves.

Irritation to the sciatic nerve can come from any where along its path. It may come from inside the spine and affect one of the nerve roots before they join together; it may be outside the spine in one of the nerve roots before they join together. It may be as the sciatic nerve passes the pelvic joint, or as it traverses the buttock muscle area. Much more rarely, it may be due to some trauma lower in the leg.

What is sciatic pain like?

Sciatic nerve pain is typically a sharp, lancing, shooting pain that radiates down the back of the leg into the heel or foot. Most often the patient will not want to stand on that leg. Usually the patient will have a bizarre body language where they are trying to lean away from the painful leg, as if to avoid it. Often the pain is worse with coughing or sneezing, and the patient is unable to fully straighten the painful leg while sitting down.

If the pain that you have is sharp, but is localised around the pelvic joint, then it is probably not sciatica. If the pain is in your leg, but is more of a dull ache, or a vague achy sensation, then it is probably not sciatica.

How do I know if I have sciatica?

Your chiropractor deals with this kind of problem all the time. Your chiropractor will take a thorough history, will ask you how you got the pain, perform a range of nerve function tests, and will examine your spinal and pelvic biomechanical function. The results of the examination will determine whether x-rays are needed, or even if a CAT scan of the spine to measure any disc damage is necessary. A bulging disc in the lumbar spine irritating a nerve root is one of the most common causes of sciatica. Your chiropractor will discuss all the treatment options with you in detail.

What treatment is available?

Treatment will vary depending on which structure is causing the sciatic nerve irritation. It may range from traction to reduce a lumbar disc bulge, to specific joint adjustments if the pain is from the joints, to deep tissue massage if the sciatica is from the buttock muscles. Although very painful, most cases of sciatica are manageable with conservative care, very few cases progress to surgical level.

Your chiropractor will discuss future prevention strategies with you after the problem has been stabilised. This may include weight loss, muscle toning exercise, ergonomic issues in the work place, and more. Correcting a problem, only to continue doing all the things that gave it to you in the first place is not very wise.

Remember when finding your chiropractor to always be sure that they are a member of the Chiropractor's Association of Australia.

Article courtesy of Lee De Coster, Chiropractor in Leederville WA. For more info visit www.leedervillechiropractic.com.au