An Introduction to Sciatica

image001I hear the word sciatica a lot, sometimes used accurately, sometimes not. Sciatica is a description (pain in the sciatic nerve), not a diagnosis. This article will focus on the most common source of sciatica, which is the intervertebral disc pressing on a nerve. This used to be called a “slipped disc”, and is nowadays called a herniation. (You may hear the words bulge and prolapse used too).

image002The centre part of the disc (nucleus) can force its way to the outside of the disc, sometimes even breaking though the outer protective layer, placing pressure on a nerve.

Typical appearance of acute sciatica: walks with a limp, leans slightly forward, leans to one side.

PrintPeople experience pain/tingling/pins & needles in the back of the thigh, and often either in the calf or the outside of the leg, and sometimes into the foot too. There may be weakness in the affected leg. There is frequently surprisingly little or no back pain.

The sciatic nerve itself is formed deep in the buttocks from 5 nerve roots (L4-S3) which exit the spine.

What causes sciatica?

Lumbar disc injuries invariably occur when people are bending forward and twisting at the same time, often while holding something heavy. Sometimes, though, it’s not possible to attribute a disc injury to a single occurrence, and it may just be an accumulation of small traumas.

Who gets sciatica?

Those most likely to suffer a disc herniation are the 30-50 age group, men twice as likely as women. The youngest person I’ve seen with a disc herniation was 22, and the oldest was 84! Other examples are:image005

  • 47 year old man, manual job, lifted heavy metal frame, then leant forward and twisted to put it down
  • 52 year old lady was carrying a heavy tv into her house with a friend (i.e. leaning forward) and had to turn awkwardly
  • 38 year old man was hit from behind in his car

Do people with sciatica get better?

MRI scans have shown that the herniated part of the disc shrinks back over time, with partial/complete resolution in two-thirds of people after 6 months, and the vast majority of people are completely better after 2 years. If, however, a person is still in severe pain after 6 weeks, and there has been no improvement, consult a neurosurgeon.

Osteopaths see large numbers of patients with sciatica; osteopathy seems to help by accelerating the healing time and reducing pain. It is essential that any manual therapy doesn’t aggravate an injured disc. I prefer to use a gentle, rhythmic approach called harmonics, along with a combination of stretching, working with the muscles, and freeing up other areas of the spine which are restricted. Reassurance and advice to the patient are also key to avoiding further injury, and also encouraging healing.

A few sciatica tips

  • At night, lie on your side with pillow between your knees
  • Lie on the floor rather than the sofa; try 2-4 pillows under your knees
  • AT ALL COSTS avoid bending forward and twisting to the side
  • If you have to cough, make sure you don’t twist at the same time
  • Don’t lie down all the time; some gentle movement is good

If you would like to discuss how osteopathy may be able to help you, or to make an appointment, please ring 0121 354 7306, or email peter@suttonosteopathypractice.co.uk.

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