Sciatica

Posted on: September 29th, 2016 by Pro Active No Comments

What is sciatica?

Sciatica is leg pain that follows the sciatic nerve distribution. Frequently it is caused by irritation of the origins of the sciatic nerve in the spine. Sometimes people experience pins and needles/tingling or numbness. There are however more reasons than just nerve irritation that can cause back and leg symptoms which can make the term confusing. Sciatica is NOT back pain. Back pain commonly arises from poor movement of joints and soft tissues.

How to tell if you have sciatica:

  • It is difficult to determine from symptoms alone whether there is true nerve irritation. A combination of your history and details of the symptoms, evaluation of diagnostic tests and a physical exam are required.
  • At M+D Pro Health/ProActive Health we can do a detailed assessment to determine the source of your symptoms.

How to manage sciatica: this very much depends on what the source of pain is.

  • Conservative management including advanced orthopaedic physiotherapy aimed at any mechanical contribution from poorly moving joints and soft tissue is a good place to start.
  • Advanced orthopaedic physiotherapy can be targeted to stuck/tight areas that influence the back. This often does not initially include treating the back locally, but working to make sure your upper back, hips and other joints are moving well and not impacting your low back or sciatic nerve.
  • Core Training: Retraining core muscle function is an important component, as improper use of your core muscles can actually put more pressure on areas that are already painful. At ProActive Health we use Ultrasound Imaging to ensure you are using your core muscles properly to support your spine.
  • Acupuncture including electro-acupuncture and dry needling at times can be helpful as part of a multimodal approach.
  • Medication can be helpful to decrease inflammation and nerve irritation if present. Pain medication and muscle relaxants can be helpful in the acute phase.
  • Interventional pain management specialists will sometimes inject anti-inflammatory / pain relieving substances directly into the back along with medication management when standard if conservative treatments are not improving symptoms.
  • Surgery is indicated in a small percentage of patients with a true disc herniation; 9 out of 10 people will get better without surgery even if they have a disc herniation. Surgery can also be helpful when nerves are irritated by arthritic changes of the spinal facet joints.

Who needs surgery?

Typically surgery is used for cases where the dominant pain is in your LEG, and when symptoms are not improving after a course of conservative management.

BACK SURGERY IS NOT INDICATED IN MOST CASES OF BACK PAIN!

What does surgery do?

Surgery removes the irritating piece of disc or bone spur.

What does the surgery entail?

Surgery for sciatica typically requires decompression of the irritated nerve. This is frequently done as a day surgery with a small incision, short duration and virtually no blood loss. The surgeon cuts an inch long incision, cuts a small window of bone to expose the nerve and move the nerve off of the disc. The disc protrusion is then shaved off and then the incision is closed. It takes around 2 hours, and you walk out of the hospital later that day unless you have other medical issues (ie. Sleep apnea).

Should I exercise?

It is important to stay active and generally speaking if it feels okay then do it, if it doesn’t feel good/aggravates your symptoms don’t do it, and within this be as active as you can. If you are concerned or frustrated when you try and exercise, we can give professional advice on how to safely increase your activity, which exercises are helpful or may be aggravating for you.

Patient examples:

Ms. H, a 52 year old homemaker presented to the clinic complaining of right-sided leg pain consistent with a sciatic nerve distribution. There was evidence of nerve involvement on examination and MRI. Treatment consisted of hands on manual therapy aimed at restoring joint motion above and below the low back, some acupuncture to help with pain, and within four weeks she began a core strengthening exercise program and symptoms resolved.

Mr. F, a 45 year old carpenter came in for an assessment and described leg pain of 8 weeks duration. His MRI showed no significant findings, and he was found on assessment to have joint restriction in his foot, knee and hip. His symptoms fully resolved with four sessions of manual therapy aimed at restoring movement to these areas, and he was discharged with a home exercise program to maintain the mobility and strength in his leg.

Ms. C a 28 year old administrator presented with an 8 month history of left sided leg pain. She did not respond to manual therapy, and an MRI was arranged which showed a disc herniation causing nerve compression that matched her symptoms. A consult with the surgeon was arranged and surgery performed. There was a marked improvement in leg pain and she returned for core muscle training post operatively.

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