True sciatica is when the sciatic nerve is compressed causing pain in the leg. However, the term is usually misused to describe back pain with nerve compression. That may not sound important but they present differently and the treatment is different. A search of the NHS will tell you that the sciatic nerve is most commonly trapped by a slipped disc. This is another description we want to avoid.
Firstly, a ‘slipped disc’ sounds scary and paints a false picture. The disc doesn’t slip out of place, it’s not flopping around inside your back. It’s better to think of it like a tire which is normally incredibly tough. However, this tire is filled with gel rather than air. If the tire starts to balloon and expand we call that a disc bulge and most people will have at least one. If the outside of the tire tears and some of that gel is pushed out we call that a herniation. Both a bulge and a herniation can cause nerve compression which can be painful. Importantly, there’s little or no correlation between what you seen on MRI and your symptoms. That’s always a hard fact to ignore and it’s one that both doctors and patients struggle with.
Secondly, the sciatic nerve is comprised of many different nerve roots and it cannot be compressed by a disc herniation. The real term for this is lumbar radiculopathy which describes a disc herniation or bulge compressing a single nerve root. This is far more common that true sciatica.
There are two main ways to damage a disc; compression and shear force. An important thing to know is that a disc herniation doesn’t suddenly happen. Lifting your child didn’t cause it. A vigorous sneeze didn’t cause it. Unless you have a serious car crash, or something of similar force, it probably slowly developed over months or years.
The symptoms of true sciatica are pain deep in the buttock, travelling down the back of the leg, down into the calf and sole of the foot. If severe enough there may be numbness, tingling and muscle weakness. The pain is normally aggravated by sitting, movement causing nerve compression and can be relieved in certain postures. It can be caused by muscle spasm, when muscles become tough and fibrous, sitting on your wallet and some nastier things. However, let’s focus on lumbar radiculopathy as this is probably what you’re looking for help with.
With a lumbar radiculopathy the pain is similar but also presents as low back pain. Classically, it’s worse in the morning and gradually eases after some gentle movement. Coughs, sneezes and bumps in the road can all be very painful. With increasing nerve compression the leg pain with travel further and be more severe. A key part to the healing process is when the pain starts to localise to the low back. It’s good news if your leg pain goes, even if you back pain is worse for a time.
Time plays an important role. The disc has a poor blood supply so it’s very slow to heal. Setting your expectations low can make it mentally easier to deal with. This isn’t a muscle strain, you’re not going to be doing cartwheels in a couple of weeks. If the pain does rapidly resolve then it probably wasn’t a disc herniation.
The goal of treatment is to relieve stress on the low back so that the disc and nerve can start to heal. In today’s society we all sit too much and move too little. As a result our hips are too stiff, our glutes are weak and our backs too tight. A key part of treatment is to correct that imbalance by ensuring that hip mobility is good, the glutei are strong and the back muscles are only active when needed. When the back muscles are overactive they compress the spine which causes pain and overtime can injure the disc. When the hips are too stiff the posture of the low back will change causing shear force which also gradually causes damage.
At our chiropractic clinic in Woking we use a combination of mobilisation, massage and rehabilitation exercises. However, one of our special techniques is focal vibration therapy. Vibration therapy has years of research to show that it significantly improves strength, coordination and balance. Patients with chronic low back pain are poor in all 3 areas which causes excessive stress and pain. Vibration therapy also offers pain relief and has no reported side effects so it’s incredibly safe to use. This is a bonus as it’s quite common to have a reaction to treatment using other therapies. I’ve seen many patients with years of chronic low back pain who have seen real improvements once they start using vibration therapy. The best bit is that you can use it at home to support your recovery.
Change position frequently, don’t sit for more than 30 minutes and go for short walks daily. If the pain is too much use pain killers. In most cases the pain will resolve over time but you might want help from a chiropractor or physio. Be sure to contact a healthcare professional if you start to experience numbness in both legs, loss of bowel or bladder control, or weakness in your legs.
You are always welcome to contact us if you have any questions.