What is sciatica?
The term sciatica is used
to describe the inflammation and/or compression of the sciatic nerve - the longest nerve in the body which
runs from the back of the pelvis through the buttocks and down both legs to the
feet.
Nowadays clinicians tend to refer
to sciatica as radicular pain - a shooting
or grinding pain which radiates from the lower back down the length of the
sciatic nerve. Sometimes the pain can be
accompanied by numbness and/or weakness in the legs and feet which is known as radiculopathy.
Sciatica can be an extremely painful and
debilitating condition with sufferers finding it difficult to walk, sleep and
go about their normal daily activities.
The good news is that most acute
(short-term) episodes of sciatica can generally be resolved within a few weeks with
over the counter anti-inflammatory
drugs - alongside the continuation of normal daily activities. However, if sciatica becomes a long-term
problem (for more than six weeks) sufferers need to seek medical advice from a
specialist, making sure they receive the correct diagnosis and treatment.
Sciatica is commonly associated
with a bulging or herniated disc. A bulging
disc is when the whole or part of the
disc bulges outside of its normal space between the vertebrae. A herniated
disc is when the inner nucleus of the disc actually ruptures out of its
casing. Both conditions - which are sometimes
commonly referred to as a ‘slipped’ disc
- can cause compression or irritation of the sciatic nerve. Other causes of sciatica include spinal stenosis (narrowing of the nerve passages in the spine), a
spinal injury or infection, or a growth or tumour within the spine.
Sometimes other
conditions can mimic the symptoms of sciatica but they are not related to
direct compression or inflammation of the sciatic nerve. Somatic pain in the lumbar spine can produce referred pain in the nerve endings within the discs, facet joints or sacroiliac
joints. As somatic pain is not
caused by compression of nerve roots, there is usually no accompanying numbness
or weakness. It tends to centre over the
buttock area and upper thigh but can extend to the foot.
Sciatic symptoms are also associated with Piriformis
Syndrome. When the piriformis muscle (located
deep in the hip/buttock) becomes tight or inflamed, it can cause irritation of
the sciatic nerve. Sufferers may feel numbness in the buttocks and pain when
climbing up or down stairs and while sitting.
Piriformis Syndrome can
be treated with strengthening and muscle balancing exercises, deep massage
and/or dry needling into the muscles.
Sciatica
caused by a herniated or bulging disc
The spine has 24 individual bones (vertebrae) stacked on top of
each other. Discs are the protective pads of connective tissue dividing them -
the ‘shock absorbers’ which protect the spine when we run or jump.
Without realising it, we cause small weaknesses in our spine
every day with prolonged sitting or standing in certain positions - at
workstations or hunched over the ironing board for example. If too much pressure is put on a disc, a
weakness may develop and it’s possible for the whole or part of the disc to
bulge out of its normal position or even rupture and the gel inside to bulge
outwards - rather like a jam doughnut being squeezed!
The damaged disc can
put pressure on or cause irritation to the spinal nerves or a single nerve root
- most commonly the sciatic nerve. Evidence suggests that the inner gel-like substance of the disc can cause an inflammatory response in sciatic nerve
roots or compression of the nerve. Sometimes it can be a combination of the two
which is causing the sciatic pain.
In
rare instances, the nerves at the bottom of the spinal cord can become compressed. Known as Cauda Equina (see below), this can result in urinary and/or bowel incontinence and is a
medical emergency which may require immediate surgery.
What treatments can help with sciatica?
For most people, their sciatic episode will be acute (short-term) and they will
recover naturally whilst going about their normal daily activities.
However, chronic (long-term) sciatica usually requires a combination
of anti-inflammatory medicine, self-help techniques and physical
therapy - which can include the targeted disc treatment IDD Therapy.
If patients have exhausted non-invasive treatments and are still
in pain, they may need to consider invasive procedures such as steroid
injections or surgery.
Painkillers
Over-the-counter non-steroidal
anti-inflammatory drugs such as Ibuprofen
are usually prescribed for sciatic pain.
For patients with asthma,
high blood
pressure, liver disease, heart disease or stomach and digestive
disorders, GPs may suggest Paracetamol as an alternative.
If symptoms are severe, your GP may prescribe a mild
opiate-based painkiller such as Codeine
or a muscle relaxant such as Diazepam.
Exercise and lifestyle changes
Sciatica exercises - consisting of stretching
and core-strengthening in order to support the spine - can reduce pain and provide conditioning to
prevent future recurrences.
Some patients may need to make lifestyle changes to avoid activities or
situations which might put undue stress on the lower back and offset a bout of
sciatica.
Awkward working positions such as those where the 'trunk' is twisted or hand is above the shoulder; heavy lifting; playing golf; excessive driving
and walking (for more than 1 hour at a time) are all linked with sciatica.
Bridging the gap between hands-on
physical therapy and invasive procedures, the IDD Therapy programme offers a non-invasive targeted disc treatment for
patients with sciatica or symptoms
indicating a disc herniation or bulge.
Safe and gentle pulling forces are used to distract (draw apart)
and mobilise specific spinal segments where discs are damaged or herniated,
removing pressure and irritation from targeted discs and trapped nerves.
Patients receive a structured programme of regular IDD Therapy
sessions, allowing the body to adapt to treatment whilst progressively
relieving pain and improving mobility. For long-term sufferers, a series of
treatments is needed to achieve long-lasting therapeutic changes.
Distracting and mobilising the
disc(s) in this way is particularly relevant given the sometimes indistinct
origins of sciatica: opening up the disc space promotes the flow of nutrients
and oxygen, assisting the dilution
of any inflammatory toxins which may
be causing irritation to the sciatic nerve whilst also relieving pressure from it.
IDD Therapy Case Study 1 – Margaret (65), retired nurse from Hereford.
“I’d suffered with
lower back pain on and off for a couple of years but after a knee replacement
operation in 2011, it got much worse and I also began to get a grinding sciatic
pain in my leg when I’d been sitting for too long or walking for any length of
time.
I ended up needing a stick and I found it very difficult to do my normal daily activities and even
simple things like dressing myself and standing at the sink to wash the dishes
were a problem.
My clinician, Mark Roughley (Leominster Osteopaths) recommended a programme of IDD Therapy to treat the two disc bulges in my spine. He continually assessed
my progress during the programme and suggested gentle exercises to do at
home to compliment the treatment.
At the end of the programme, I was virtually pain-free and able to enjoy
my usual daily activities including walking with my friends - something I’d
really missed. I’d definitely recommend
IDD Therapy - it’s given me back my life!"
IDD Therapy Case Study 2 – Scott (38), scaffolder from
Chingford
“Last year my episodes of sciatica became severe and sometimes
my leg would actually go numb when I stood for too long.
I was in so much pain I
could hardly walk and was only sleeping for a couple of hours a night. I needed to take painkillers every day but
even with regular medication, the pain was too much for me to bear - and I’m a
big strong bloke!
My doctor sent me for some osteopathy and acupuncture sessions
but they didn’t help and an operation was the last thing I needed - being
self-employed, I couldn’t afford the time off work for a start!"
After a review of Scott’s recent MRI scan, Dan Smith (Sports and Spinal Physio) confirmed a large disc bulge and he decided that Scott was an ideal
candidate for the IDD Therapy programme.
"I finished my treatment programme in Spring of last year and I’m feeling
fantastic; my pain has drastically reduced and I’m able to walk, drive and
sleep properly. I still have to take
care of my back and avoid heavy
lifting but this
is nothing compared to the debilitation I suffered before my treatment.
It’s
really not an exaggeration to say that IDD Therapy has changed my life
completely. Without it I’d still be in
agony on a four month waiting list for a back operation…”
A clinician’s view
“With the IDD programme we can help to change a patient’s
outlook, setting them the realistic goal of becoming pain-free and being able
to get back to their normal daily activities. Specific exercises
are tailored to the progressive stages of treatment, developing the patient’s
confidence in movement as both safe and constructive to their recovery.”
Research shows that IDD Therapy patients with a herniated disc -
most of whom suffered sciatic radiation
- showed a good to excellent improvement in 86% of cases.1 A follow-up study revealed continued pain
reduction in IDD Therapy patients one year after treatment.2
When non-invasive treatments aren’t working
In some cases a patient’s sciatica can be so
debilitating that they are not able to begin a physical therapy programme. There will also be patients who have tried
non-invasive methods without success. In
these situations their GP may feel that steroid injections or even surgery
should be considered.
Epidural steroid injections
Epidural steroid injections dispense medication
directly to the inflamed area around the sciatic nerve. Although the effects tend to be
temporary (providing pain relief for as little as one week up to a year) an
epidural steroid injection can provide relief for a short term sciatic episode or for
enough time to allow a patient to progress with a non-invasive treatment plan
such as IDD Therapy.
When
would surgery be considered?
With the exception of emergency surgery in cases of Cauda Equina
(see below), infection or cancer, surgical procedures are typically considered
when the patient has exhausted non-surgical options and remains in pain and is
unable to go about their normal daily activities.
Since spinal surgery carries the risk of infection, failure and
a low risk that the spinal nerves will be damaged during surgery, surgeons
ensure that the patient is aware of all non-surgical options as well as the
relative risks and benefits of surgery.
When sciatica becomes an
emergency
In exceptional cases, sciatic pain presents itself alongside other
more serious symptoms such as urinary
or bowel incontinence and/or loss of sensation in the inner thighs,
buttocks, back of legs.
These symptoms could be a sign of Cauda Equina Syndrome, a relatively rare but serious condition involving loss of function of the
nerve roots in the lumbar vertebral canal at the foot of the spinal cord.
Caused by trauma, tumor, infection or
herniated disc/spinal stenosis, it is a medical emergency which may require
urgent surgical intervention.
References
1 Shealy CN and
Borgmeyer V. Decompression, Reduction and Stabilization of the Lumbar
Spine: A Cost- Effective Treatment for
Lumbosacral Pain. AJPM 1997. 7(2):63-65
2 C.
Norman Shealy, MD, PhD, Nirman Koladia, MD, and Merrill M. Wesemann, Long term
effect analysis of IDD Therapy in low back pain. American Journal of Pain Management Vol. 15 No. 3 July 2005
To see more IDD Therapy patient testimonials and to find out the location of your nearest IDD Therapy Disc Clinic go to www.iddtherapy.co.uk