A Pain in the Bum!

Emma has a problem. She has a pain in her rear end. Specifically, she has a nasty sharp pain in her right buttock, and it extends all the way down her leg, to her ankle. Worse, still, the pain is sharp and shooting, and gets worse when she sits. Coughing, sitting on the toilet and driving the car are almost unbearable. Work is getting harder to manage, her sleep is rubbish, and intimacy with her husband is definitely not on the cards. What horrifying malady has befallen her? She visits our clinic to see a Chiropractor, who informs her that the symptom she has is called “sciatica”. So, what is “sciatica”?

Sciatica is the common term used for pain down the leg stemming from irritation to the sciatic nerve, in the back. It is often part of a condition that health professionals call “lumbar radiculopathy”. The sciatic nerve is the largest nerve in the body. It starts as five “nerve roots” in lower back spinal cord. Outside the spine these nerve roots join and form the sciatic nerve, running deep through the muscles of the hip and bottom, then down the back of the leg, before it divides again into smaller nerves behind the knee, and in the foot.

Sciatica is a nerve pain due to irritation of or pressure on the sciatic nerve itself. It should be said, however, that pain down the leg can also come from a number of other causes. More on that, later.

Emma is sick of her sciatica, and she wants to know if someone can just “chop it off”. Her Chiropractor politely informs her that she will be requiring her sciatic nerve for walking and general use of her leg. The sciatic nerves (one for each leg) carry all sorts of signals from the brain to the lower limbs, and from the lower limbs back to the brain. Some of these signals control muscles (motor nerves). Some sense movement of joints (proprioceptive nerves). Some sense pain or temperature changes (nociceptors). Sudomotor nerves, which most people have never heard of, control the sweat glands. Some of the nerves (pilomotor nerves) even control the movement of the little hairs that would have been on Emma’s legs, if they hadn’t been waxed off, a few weeks ago.

When we get sciatica, nerve pain down the leg, it is likely because something is irritating the sensory parts of the nerve. That irritation to the nerve might feel like pain, pins and needles, numbness or even like insect crawling on the leg. If the sensory part of the nerve is affected, then the motor nerve might also be affected. If the motor (muscle controlling) nerve is affected, it would show up as weakness of certain muscles. For example, the part of your sciatic nerve originating at the L5 level of your spinal cord is responsible for bending your big toe up to the ceiling. Emma’s Chiropractor tested the strength of her big toes. To Emma’s surprise, she could barely generate any strength with her right big toe.

Emma is alarmed. What on earth is causing this nerve pain? Does she have a tumour or some kind of cancer growing in her spine? Her Chiropractor reassures her that it is not a tumour. He tells her that most commonly sciatica is a result of compression or irritation to the lowest levels of the spine at L4/L5 or L5/S1, usually caused by a malfunctioning “disc”. More on discs, in a future article.

What’s the worst that can happen?

In severe cases the individual may develop a “drop foot”, where the muscles of the lower leg no longer work properly due to damage to the nerve. In this case a professional evaluation is urgent. Although she didn’t realise it, Emma’s Chiropractor has been watching how she moved from the moment he saw her in the waiting room. Thankfully for Emma, while she does have some weakness in her big toe, she doesn’t have the dreaded “drop foot”. While she is relieved, she does think it’s a bit odd that the Chiropractor is now asking her about how her bowel and bladder are going. He explains that occasionally the nerves to the bladder or bowel may be affected and it may lead to incontinence. If this happens in relation to the spine, it is considered a medical emergency and needs to be addressed immediately to not sustain lasting damage. Emma is happy to report that everything is functioning normally.

The Chiropractor carefully examines Emma’s lower limbs for subtle changes to the nerve function like changes in sensation to the skin, weakness of certain muscles or reduced tendon reflexes.

What can be done to sort out sciatica?

For some people with sciatica, making small changes to their habits can be enough. For many males, taking their wallet out of their back pocket not to traumatise the sciatic nerve every time you sit down might resolve the problem. For those with pain from irritated discs, periods of standing up during your work day, rather than sitting all day, is usually very beneficial. A sit-stand desk can offer great help if you have a disc bulge compressing your sciatic nerve. Correct lifting technique is essential, to protect the low back, if your job involves that kind of activity. Losing weight and exercising will be beneficial to reduce the stress on the spine and increase spinal stability. However, many cases, like Emma’s, also greatly benefit from Chiropractic treatment.

Can chiropractors help sciatica?

Emma is in the right place to get answers to her sciatic nerve problem. In most cases of benign sciatica there is a good prognosis for conservative treatment like chiropractic. The first priority is proper diagnosis, so the right sort of treatment, advice and exercises can be administered. Chiropractors are primary health care practitioners who specialise in the diagnosis and treatment of musculoskeletal disorders, with a special interest in the spine. Treatments may consist of adjustments, exercises and/or muscle therapy depending on the requirements the case. No two cases are the same. Each person has a unique mix of causes and symptoms. While diagnosis is a science, treatment is both an art and a science, and sometimes a few different approaches are tested before the right treatment is determined.

A last word on other causes of sciatica

Aggravated discs pressing on sciatic nerves are not the only cause of sciatica. There are other causes, several of which we have listed, below. Sometimes more than one of these is contributing to the pain. You Chiropractor will be able to differentiate between the various causes, and suggest a course of action.

  • Sacroiliac pain: Your pelvis can produce pain similar to that of a sciatic pain. The difference is that the leg pain is “referring” from the joint and not from nerve irritation. Typically these do not radiate beyond the knee.
  • Facet joint pain from the lumbar spine. These are the little “knuckle” joints in the spine. Typically, facet joint pain does not travel past the knee.
  • Stenosis: Narrowing of the spinal canal or the space where the nerve exits the spine can occur with arthritis and other conditions. It becomes more common in old age.
  • Spondylolisthesis: This is a reasonably common condition, in which one vertebrae slips forward over another one due to a stress fracture or fractures acquired in childhood. Most people with this condition do not know that they have it. It sometimes causes sciatica. The Chiropractor will easily be able to diagnose this condition with an x-ray, if they suspect it.
  • “Muscle knots”: Traditionally tight, sensitive band of muscle has been called trigger points. Certain muscles will produce pain down the leg similar to that of the sciatic nerve. Some common sites are gluteus maximus, gluteus minimus and the piriformis muscle.
  • “Piriformis Syndrome”: Commonly the sciatic nerve can be trapped under the piriformis muscle, deep in the hip and produce leg symptoms. This one is easy to spot, and very easy to treat.
  • Systemic disorders: diabetes, thyroid disorders, alcoholism, malnutrition, cancer, infections.

If you have symptoms of sciatica, and need answers, call us and book in to see one of our Chiropractors.