Sciatica is the term commonly used by many patients to describe any leg pain which radiates from the low back. Back pain with radiation into the leg can come from several different structures including muscles, nerves, and joints, therefore determining the origin of the referred pain is critical for optimal treatment and resolution of symptoms.
In medical terms, referred pain into the limbs from a trapped nerve in the spine is defined as radicular pain. If a nerve root in the neck is being irritated it can cause radiating pain into the upper limb (arms and hands) and if it is in the low back it can cause radiating pain into the lower limb (leg and foot). The pain distribution is often specific and dependent on which nerve root is being irritated.
Sciatica itself is not a diagnosis, but describes the specific distribution of radiating pain which occurs as a result of the irritation or compression of the sciatic nerve.
While this may be the result of a disc bulge or herniation, there are many other conditions that present as sciatic pain. These include spinal subluxations, degenerative joints and muscle tension.
Along with radicular pain*, an irritated spinal nerve can also cause additional symptoms to be reported by the patient. Nerve compromise may also cause symptoms such as pins and needles, numbness or tingling, as well as very specific loss of muscle strength.
The diagnosis of what is causing the sciatic pain is made clinically by our chiropractors by conducting both orthopaedic and neurological testing to assess for nerve irritation or damage. These will assess muscle strength, sensation and deep tendon reflexes. Spinal assessment will show if there are any areas of subluxation or abnormal spinal function which can be improved with chiropractic care.
Trigger points within a muscle may also result in referred pain, where the distribution of pain resembles sciatica, but is not actually caused by nerve compression or irritation. This muscular pain is often easily relieved with chiropractic care.
* Radicular pain is a type of pain that radiates into the lower extremity directly along the course of a spinal nerve root.
‘Bulging disc’, ‘prolapsed disc’ and ‘herniated disc’ are terms commonly used to describe various injuries to the inter-vertebral discs, which sit between each of the vertebrae in the spine.
Commonly described as ‘shock absorbers’ or ‘cushions’, the role of the inter-vertebral discs is to absorb the load during spinal movement. The cartilage discs are made of two components; the nucleus pulposus on the inside, composed of a watery, gelatinous material, surrounded by the tough, fibrous tissue called the annulus fibrosis on the outside.
Damage to the discs may occur slowly over a period of time - due to repetitive micro-trauma or degenerative changes, or as a result of a sudden exertion that over-strains the disc material. As part of the natural aging process, the inner nucleus dehydrates, which can result in the annulus bulging outwards beyond the margins of the vertebral body.
Symptoms of a lumbar disc injury vary and may range from back pain, with or without buttock and leg pain, pins and needles, muscle weakness in the legs, changes in bowel and bladder habits, to no obvious symptoms at all.
If your chiropractor suspects a disc injury, he or she will perform a full orthopaedic and neurological exam, and may refer you for further imaging such as CT or MRI scans to confirm the diagnosis and decide on your suitability for chiropractic care.
Although disc related back pain can be very debilitating, most lumbar disc injuries heal without the need for surgery.
Critical factors in the management of disc problems include pain reduction, restoration of spinal joint function, control of muscle spasm, and prescription of a muscle strengthening rehab program.
Our chiropractors are experienced in all of the above factors in the management of disc conditions, and are ideally placed to help you through your recovery and return to normal function.
Sacroiliac Joint Dysfunction
Chiropractors have long known the importance of the sacroiliac joint in the assessment and diagnosis of low-back pain. Low-back pain commonly results from dysfunction of the sacroiliac (SI) joints. These are the joints that are found on each side of the pelvis connecting the sacrum to the ilium.
For many years within the medical profession, there existed a viewpoint that the sacroiliac joints did not move and therefore could not cause pain. This has since been found to be false and more recently the importance of the SI joint has been widely recognised.
Sacroiliac joint pain typically is felt when shifting from sitting to standing, is located on one side and is often caused by a twisting injury. Dysfunction at the sacroiliac joint is also known to refer pain around to the groin on the same side.
Your chiropractor will endeavour to address the cause of your symptoms by restoring optimal movement and function to the joint, subsequently relieving muscle tension and pain.
What does the research on Sciatica and Disc Injuries say?
Patients suffering lumbar disc herniation managed via Chiropractic spinal manipulative therapy demonstrated clinically significant improvements. Leemann, S et al. (2014).Outcomes of acute and chronic patients with magnetic resonance imaging – confirmed symptomatic lumbar disc herniations receiving high velocity-low amplitude spinal manipulative therapy: A prospective observational cohort study with one year follow up.Journal of Manipulative & Physiological Therapeutics, 37 (3); 155 – 163
Chiropractic appears to be an effective sciatica treatment method. Assendelft, W et al. (1992).The efficacy of Chiropractic manipulation for back pain: Blinded review of relevant randomized clinical trials. Journal of Manipulative & Physiological Therapeutics, 15(8); 487 – 494
Given that the majority of patients suffering disc pathology will improve following non-operative therapies such as Chiropractic, a trial of conservative management is warranted before examining operative techniques. Daffner, S (2010).Cost and use of conservative management of lumbar disc herniation before surgical discectomy. The Spine Journal, 10(6); 463-468
A large percentage of acute and chronic lumbar disc bulge treatment patients using Chiropractic care demonstrated clinical significant improvements, with no adverse events. Leeman, S (2014). Outcomes of acute and chronic patients with magnetic resonance imaging – confirmed symptomatic lumbar disc herniations receiving high-velocity, low amplitude spinal manipulative therapy: A prospective observational cohort study with one year follow up. Journal of Manipulative Physiological Therapeutics, 37(3); 155 – 163