Sciatica

Sciatica is a line of pain down the back of your leg anywhere from the middle of your mid buttock to the bottom of your foot. It can just be in your buttock, or from your buttock to your knee, or half way to your knee, or just in your calf, or any combination or variation of these. But it has to the back, not the side or front of your leg).

Not Sciatica

Sciatica is not pain in the side or front of your leg. Your sciatic nerve runs down the middle of the back of your leg so that is the only place you can have sciatica. Nerve pain in your quads, the front of your thigh, comes from T12 to L2, a bit higher up the back.  

Pain down the side of the thigh, usually is usually associated with the sacro-iliac joints. These are the joints between the spine (sacrum) and the two pelvic bones (ilia).

Common

In my experience the sacro-iliac joints are a common cause of lower back, pelvic and leg pain. Very common.

Sacro-iliac problems are usually easy to treat and often easy for my patients to self manage. They just have to know what to do and that's what I love to teach them.

The sciatic nerves is made up of 5 pairs of nerves that come from either side of your lower spine. From L3to S2.

 Sciatica is caused by

·        Strain of the joints or soft tissue in the low back, pelvis or buttocks

·        Degeneration of the lower spine – severe arthritis

·        Badly bulging or prolapsed disc

If the facet joints at the back of the spine are damaged or strained, the muscles that cross them are also effected.

Bad arthritis in the low back causes loss of disc height, degeneration of facet joints at the back of the spine, and bony growths called osteophytes or spurs. All of these factors can cause a narrowing of the hole that the nerve passes out of the spinal column through.

Contact

If this narrowing gets bad enough it will put pressure on the nerve and cause pain. A badly bulging or prolapsed (slipped) disc presses on one of the nerves that leave your spine, to become your sciatic nerve. A mild or moderate bulge will not do this.

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It can be anything from annoying to agonizing. The worse it is, the more likely you are to have done damage to the disc. While signs and symptoms can suggest disc damage, the only way to definitely diagnose a disc prolapse is to have a CT or MRI scan. Plain X rays won't do it, as they only give us a clear image of the bones.

Treatment

Treatment depends on severity. Mild to moderate pain will only need  conservative treatment  See an osteopath or other manual therapist. If it's just a strain, it will usually settle in days or a couple of weeks with 3-6 treatments.  If there is damage you will require periodic treatment after the acute attack has settled,

If you have bad or severe pain that persists despite conservative treatment, and there are positive findings on X ray, CT or MRI, surgery may be required.

What you can do.

Rest. Never overlook the importance of rest.  Fatigued muscle cannot support or move you properly. This will contribute to your pain.

Antinflammatories and other analgesia, including herbs, can be very useful in controlling pain.

Heat. A hot shower or bath can be soothing. So can a hot water bottle or wheat bag. Heat relaxes tight muscles and promotes blood flow through the area.

Be active in looking after the problem with stretching and exercising. A flexible back brace can be helpful when it's acute.