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SCIATICA - About sciatica and what we can do to help
Sciatica
by Damian Moore M.Ost
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Sciatica is irritation of a nerve, which typically causes pain in the buttock and radiating down the back of the thigh. Patients often talk of pain being in a line and it is variously described as shooting or stabbing.
Strictly speaking there is no such thing as the sciatic nerve but I’ll use it as shorthand for pain generated by either the nerve roots or the peripheral nerve in this area, the tibial nerve, which is part of the sciatic bundle. |
What causes Sciatica?
The nerve supply to the area can become compromised in either the low back, where the nerve roots exit the spinal column, or in the buttock, where the nerve passes close to, or even through the piriformis muscle.
In the low back the nerve roots pass through gaps between the vertebrae, called foramina. This is the first place where nerve root irritation can occur. There are a number of reasons why these foramina can close up and restrict the free movement of the nerve root. First the space between the vertebrae may have decreased, this may be due to the normal ageing process; as the disc ages it holds less water and therefore thins, this is one reason why we lose height as we age and why our backs don’t absorb shocks as well. Another reason why a particular pair of vertebrae may get closer together is following damage to a disc. If some of the contents of the disc are extruded during a bad disc prolapse then they are not replaced, less contents equals thinner discs, the extruded material can also irritate the nerve chemically. Sometimes the disc just bulges as it ages, sagging like the sides of a doughnut, this not only effectively thins the disc but can press on the nerve, particularly when bending forward. Sometimes there is also a postural element to the situation, the foramina are at back of the spine so are closed by arching the back so the belly sticks out or bending towards the affected side or turning toward the opposite side, muscle imbalances poor abdominal tone or joint problems elsewhere can cause these postural changes either causing or contributing to the problem. Local inflammation of a facet joint my also cause direct irritation of the nerve, or muscular spasms which can in turn irritate the nerve. Finally the sciatica may be caused by tight muscles directly squeezing the nerve, most typically Piriformis.
In the low back the nerve roots pass through gaps between the vertebrae, called foramina. This is the first place where nerve root irritation can occur. There are a number of reasons why these foramina can close up and restrict the free movement of the nerve root. First the space between the vertebrae may have decreased, this may be due to the normal ageing process; as the disc ages it holds less water and therefore thins, this is one reason why we lose height as we age and why our backs don’t absorb shocks as well. Another reason why a particular pair of vertebrae may get closer together is following damage to a disc. If some of the contents of the disc are extruded during a bad disc prolapse then they are not replaced, less contents equals thinner discs, the extruded material can also irritate the nerve chemically. Sometimes the disc just bulges as it ages, sagging like the sides of a doughnut, this not only effectively thins the disc but can press on the nerve, particularly when bending forward. Sometimes there is also a postural element to the situation, the foramina are at back of the spine so are closed by arching the back so the belly sticks out or bending towards the affected side or turning toward the opposite side, muscle imbalances poor abdominal tone or joint problems elsewhere can cause these postural changes either causing or contributing to the problem. Local inflammation of a facet joint my also cause direct irritation of the nerve, or muscular spasms which can in turn irritate the nerve. Finally the sciatica may be caused by tight muscles directly squeezing the nerve, most typically Piriformis.
How can we help?
There are many possible causes of your sciatica and it is my job to work out the most likely structure or structures involved. We can then develop a treatment plan to minimise the musculoskeletal barriers to recovery. By sharing the load more evenly through the joints in your back, removing undue muscular tightness and addressing imbalances, and by working with you to strengthen and support areas of weakness and using pumping techniques to help flush away excessive inflammatory materials we are able to help many people with sciatica reduce or fully remove their symptoms.
When should you see a doctor?
If you have noticed any clumsiness, difficulty walking or any wasting of your muscles; or if you have symptoms occurring in both sides simultaneously and/or have altered sensation in your saddle area and/or are having difficulties either being able to initiate going to the toilet or with continence please see your doctor or visit accident and emergency.
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