We regularly have patients that call saying they have Sciatica. The only catch is what does Sciatica actually mean?
This is where it becomes a grey area, as the medical definition for Sciatica is as follows…
“Sciatica refers to pain or discomfort associated with the sciatic nerve. This nerve runs from the lower part of the spinal cord, down the back of the leg, to the foot. Injury to or pressure on the sciatic nerve can cause the characteristic pain of sciatica: a sharp or burning pain that radiates from the lower back or hip, possibly following the path of the sciatic nerve to the foot.” – https://medical-dictionary.thefreedictionary.com/sciatica
So, in a nutshell, your pain is being caused by the compression of the sciatic nerve however you don’t know what is compressing it! This is the catch as there are a number of different conditions that can cause this.
Let’s look at the most common cause first…
A bulging or herniated lumbar disc which is commonly termed a “slipped disc”. A term that in itself is misleading as the discs don’t physically slip, instead they are fluid-filled structures that can weaken with overuse or if they are put under too much pressure, such as lifting something too heavy. If the fluid forces its way through the disc lining then it becomes a herniation, which is what is commonly termed a slipped disc. Think of an out-of-ground swimming pool with rubber sides filled with jelly, then put a lid on top. Overuse could be something like repeatedly bending to lift your kids. This is like someone kicking the same spot in the side of the pool which, initially doesn’t cause a problem but, over time, the side starts to weaken then it begins to bulge. Whereas trauma is like having 100 people standing on top of the lid and then all jumping in one spot forcing the jelly into the opposing side with such force it causes the side to bulge or tear.
Disc bulges or “slipped discs” can be diagnosed by our Chiropractor, Osteopath or Physiotherapists. We do this based on specific questions that look at how the pain presents, when it started and how it started. Then we use several special tests to further clarify our diagnosis of a disc bulge or herniation. If after doing all of this we still aren’t certain, or the severity of your symptoms is such that you can’t tolerate any testing, an MRI is the imaging of choice as this enables us to see the extent of the disc bulge or herniation.
The next BIG question is WHY did it happen?
Some are obvious, such as attempting to lift something too heavy out in front of you like a heavy plant pot, deadlifting in the gym or a large awkward piece of furniture. In that instance, we don’t have to spend much time looking for the WHY. Instead, we focus on settling your pain levels and working with you to promote disc healing before strengthening your lower back to try and prevent any future reoccurrence.
BUT…
Sometimes there isn’t an obvious cause. For example, you are working from home (COVID!) then out of the blue you bend down to put your shoes on and feel a twinge in your lower back. You don’t think much of it but over the next couple of days, you start to develop pain in your buttock on one side. Then over the course of the week, it starts to travel further down your leg, making sleeping particularly uncomfortable. These are the cases when we need to work out WHY! Of course, there are far too many possibilities to list but, in this instance, it could be tight hips brought on by the lack of activity working from home creates. Or perhaps you now don’t go to the gym and an old weakness is showing itself. Or perhaps your home desk set-up is all wrong… sitting at a dining room table with a laptop for 8+ hours a day. All of these could be the cause or a combination. That’s where we can really help, as not only will we work at settling your sciatic pain through a combination of different hands-on treatments, possibly medical acupuncture, home exercises and advice, but once we have achieved this, we will work on the WHY!
All that said one key point to make is it isn’t only “slipped discs” that can cause Sciatica.
Hence in our eyes, Sciatica in itself is not a diagnosis. Other conditions that can cause entrapment of the sciatic nerve and give you sciatica are spinal stenosis, piriformis syndrome, osteoarthritis of the hip, sacroiliac dysfunction, sacroiliitis and so the list continues.
For this reason, we would always recommend seeking advice from one of our therapists on your condition, as they will be able to diagnose the cause of your sciatica and advise as to whether they can help. If they can’t help, they will always guide you as to your next step, whether that be an MRI or a different medical professional.
If you would like our help but you’re not sure who you need to see, you can always contact us via the contact form, over the phone or email us on info@thehealthub.co.uk
Sam Pargeter
Sports Chiropractor and Clinic Director