Sciatica Pillars

Contents

Chapter 1: Introduction to Sciatica

Chapter 2: Common Causes of Sciatica

Chapter 3: Characteristics of Sciatica

Chapter 4. Diagnosing Sciatica

Chapter 5: Causes and Risk Factors

Chapter 6: Treatment Options for Sciatica

Chapter 7: Advanced Treatment Techniques for Sciatica

Chapter 8: Home Care and Self-Management

Chapter 1: Introduction to Sciatica

1. DEFINING SCIATICA: UNDERSTANDING THE BASICS

Sciatica has long been underestimated for its ability to destroy lives. Its common knowledge that virtually all sciatica starts in the lower back, becoming a cascade of tight muscles and inflamed nerves running down the back of the leg often into the ankle and foot. It usually affects only one side of your body; the medical term for sciatica is lumbar radiculopathy.

In truth sciatica isn’t actually a condition at all, but rather a set of symptoms associated with any irritation to the sciatic nerve, with over 90% believed to be due to herniated or slipped discs by the NHS. However, like everything, this is a gross oversimplification of a very complex disorder.

As a chiropractic clinic that specialises in disc injuries, sciatica has become our bread and butter. This report aims to detail the vast learning curve any therapist or patient should understand if dealing with sciatic pains.

2. The Prevalence of Sciatica in the UK

Much is written about back pain (including our own extensive blog) but comparatively little data is available regarding what proportion of the population suffer sciatica. Making understanding the problem, especially when you accept that most back pain with or without leg pain is transient and doesn’t get reported to the GP.

Even so we estimate at any one time, a barely believable 40% of the population report back pain, with an estimated 2-5% reporting sciatica (still easily over 1million people in the UK alone).

However, when we look at GP appointments, 60% of lower back patients have been said to report back pain, which tells us two crucial pieces of information:

1. Not all leg pain is Sciatica.
2. By the time pain has been around long enough or is severe enough to get medical advice, the likelihood of an additional sciatic complaint, is far more likely.

The average timeline for sciatica is a brutal 6-12 weeks.

3. The Economic Impact of Sciatica in the UK

Put simply, the economic impact of sciatica is unknown but is likely to be in the £Billions. It has been said that 30% of sciatica become chronic and 20% of cases are unable to return to work.

4. Overview of the Anatomy: What’s getting on your nerves?

The sciatic nerve is the largest nerve in the body, it forms from spinal nerve roots at base of the spine joining together like a river to form a thick band that runs through the buttock, back of thigh into the calf and shin and foot.

Most of the pain is created by an impingement as the nerve exits the spine but can also be from irritation in the buttock or lower leg.

5. Differentiating Sciatica from Other leg Pains.

When we are talking about sciatica, its likely because we want to treat sciatica and get it better, therefore the source of the pain is crucial to understand. I would say that ‘true’ sciatica involves impingement of the nerve root; however, other local tissues such as the Sacroiliac joints and facet joints can refer pain in the leg in similar ways.

Additionally, none of the conditions happen in isolation, a patient with a disc injury irritating the sciatic nerve, is also likely to overload the facet joints and place undue strain on the sacroiliac joint via subsequent muscle dysfunction – we call this a cascade reaction.

Identifying the ‘first domino to fall’ is key to putting the correct treatment plan in place; I would go as far as to say the reason we have high rates of failed back surgeries is likely because medics have failed to address these co-factors in their equations.

6. Chronic vs Acute Sciatica

Certain assumptions are required to discuss longevity of the condition. Firstly, the presumption that 90% of sciatica is initiated by a disc injury; if we run with this theory and add to it that 30% turns chronic and is still present after a year, then are we saying that the patient still has the same level of tissue damage after a year or five years for that matter… Unlikely.

Many patients experience improvements measured in weeks or months, so why do some heal, and some become chronic? And does the character of the condition change with the length of condition and the body’s attempts to heal?

In truth few patients are ever going to donate their healthy bodies to science to fundamentally answer these questions but clinically we see clear distinctions between acute disc injuries and subsequent inflamed discs, both in their character and therefore our approach to their care.

7. Sciatica and Chiropractic Care

Disc injuries are the top shelf of back pain as far as how complicated a case could be. At their worst the level of inflammation and pain make traditional chiropractic techniques contraindicated, so I would hope that most manual therapists these days would avoid trying for glory on a patient who is displaying clear signs and symptoms of a disc injury and subsequent sciatica.

Unfortunately, disc injuries aren’t always clear cut; many patients present with minor grade I or II disc ‘sprains’ which might not take too well to an aggressive hand but could respond to a gentle touch.

Additionally, as already mentioned much leg pain is actually referred joint pain, which is a chiropractor’s bread and butter and therefore highly responsive to traditional chiropractic care.

So, with this spectrum of conditions at play, the key is, if your experiencing leg pain that you believe to be from the back then it important to see a chiropractor or manual therapist who specialises in such cases and has the experience to treat with care.

Chapter 2: Common Causes of Sciatica

Sciatica is caused by any condition that compresses or irritates the sciatic nerve or the spinal nerves that form it (L4, L5, S1). Before treating sciatica, it is important to identify the root cause and the tissues that are affected, so that we may tailor the treatment plan to match the tissue that is damaged.

“Nothing in life is to be feared; it’s only to be understood. Now is the time to understand so that we may fear less.”  ~ Marie Curie

The causes of sciatica can be divided into three groups:

• Spinal Causes, which are related to the vertebral column.
• Non-Spinal Causes, which are related to the surrounding tissues.
• Pathological Causes (fortunately quite rare)

Spinal Causes

1. Slipped Disc (aka Prolapsed or Herniated disc) 

Sciatic nerve pain has been estimated clinically to cause by a herniated disc with compression on a nerve root in 90% by the NHS. Whilst the damage is located in the lower back, it most commonly causes shooting pains going down their lower extremity. The location of a person’s symptoms usually depends on the nerve root that is affected (L4, L5, S1-3), the pain is often so intense in the leg that the patient reports feeling little or no lower back pain.

2. Inflammatory disc disease:

Possibly the most interesting aspect of disc pathology is that it is not all pain patterns are necessarily a result of direct pressure on the nerve root as we have believed for over a century. It is the current thinking that both the inflammatory and immune systems are activated in previously damaged discs and both can create a chemical response that inflames and irritates the nerve root thus causing pain.

This is a ground-breaking statement mostly because current medical or surgical interventions tend to be orientated around physical findings on imaging such as MRI’s. If the pain pathways can occur without significant visible damage this explains why so many patients are in limbo with medical doctors who can’t find the source of their pain, potentially leading to misdiagnosis, failed back surgery or the patient getting told the pain is all in their head.

3. Spinal stenosis:

Degenerative changes within the spine narrow the spaces where the nerve roots form the sciatic nerve and emerge from the spine, which can result in their compression. This is a form of advancing arthritis which includes loss of disc height, facet joints thickening, degenerative growth spurs, and thickened calcific ligaments.

4. Spondylolisthesis: 

This is a condition in which one of the vertebrae in the spine has shifted drastically out of position and caused compression. This can be an acute issue generally related to micro-fractures in the spine mostly in adolescent years or post trauma, often this can go unnoticed for decades until slow degenerative changes which occur over the years and the previous damage exacerbates the degenerative process and its ability to reduce the space required for nerve roots to exit the spine.

5. Back injuries.

Road accidents, falls, and sport injuries may cause injuries that affect the sciatic nerve or its roots. The impact may directly injure and inflame the nerve or, occasionally, fragments of broken bone may compress or irritate the nerve.

6. Pregnancy:

The growing uterus and foetus can alter the mechanics and put pressure on the sciatic nerve roots, causing inflammation, irritation, and pain.

Non-Spinal causes

1. Sacroiliac Joint Dysfunction (SIJ)

The sacroiliac joint is believed to refer pain into the back of the thigh when dysfunctional. However, the sacroiliac joint’s proximity to the sciatic nerve is of additional importance. The sciatic nerve runs directly past the sacroiliac joint; making dysfunction or inflammation in this joint likely to pressurise or inflame the nerve, mimicking the exact symptoms of disc-based sciatica.

Therefore, it’s common for sacroiliac dysfunction to present with symptoms similar to sciatica, which often leads to diagnostic misunderstanding. Hence, any pain and discomfort experienced in the lower back, buttocks, and legs can be clinically confusing.

Furthermore, many of the structures that obstruct the function of the SIJ are also impacted by the sciatic nerve, therefore it’s entirely plausible, if not probable, that an SIJ dysfunction is secondary to disc damage and presenting with an overlapping dual pain pattern.

To be clear, there are many patients that have both Damaged Discs and Sacroiliac Dysfunction; leading to the eternal chicken-and-egg-quandary, as to which came first or is most significant! This topic is of such magnitude that it earned its own discussion below.

2. Piriformis Syndrome:

The great deceiver. Piriformis syndrome remains a controversial diagnosis at best, in 20 clinical years specialising in these conditions I have never found a patient whose angry piriformis muscle does have surrounding it a multitude of other dysfunctions that likely predate the piriformis spasm being felt

Disc damage, SIJ dysfunction, muscle imbalances are all stereotypical of a person who suffers with a tight piriformis muscle and are all far more plausible an explanation than the tiny percentage of patients said to have an anatomically flawed piriformis muscle. It’s a lazy diagnosis and working towards the root cause is far more effective at creating a lasting result than soft tissue techniques in the area alone.

Pathological causes

Fortunately, pathologies that represent serious implications to a person’s health are a tiny fraction of a single percentage point or in other words very, very rare.

1. Tumours 

Not all tumours are cancerous, non-cancerous growths can also be present in the vertebral column such as spinal tumours, schwannoma of the sciatic nerve, lipomas, and neurofibromas, which all can cause nerve compression.

However, cancer cells from other parts of the body such as prostate, pancreas, etc. may migrate to the spine and cause metastatic spinal cord compression. These metastatic cancer cells may compress the lumbar spinal cord and result in sciatica pain, tingling, numbness, and progressive weakness in the legs.

Sometimes, it’s hard to differentiate the symptoms from traditional causes of sciatica to those caused by a mass on your spine. However, there are some key differentiating symptoms usually caused by spinal tumours, such as:

• Unexplained weight loss.
• Feeling generally unwell.
• Progressively worsening symptoms in the leg
• Pain that’s more severe at night.
• Loss of control of your bladder or bowels.

If you’re experiencing these then we suggest seeking a medic as a matter of urgency

2. Infections: 

These include osteodiscitis, osteomyelitis, epidural abscess, fungal infections, tuberculosis, Lyme disease, herpes zoster, etc.

Intervertebral disc space infections lead to severe back pain, fever, chills, weight loss, muscle spasms, and painful or difficult urination. Spinal canal infections often produce severe back pain, tenderness, and again fever.

Once more there is generally a feeling of unwellness that is associated with infections.

Chapter 3: Characteristics of Sciatica

Understanding the Pains and Effects of Sciatica

1. Location of pain
2. Characteristics of the Pain felt.
3. Likely Intensity
4. How long will it last?
5. Prognosis & Chances of Recurrence
6. Complications that require medical assistance

1. Location of Pain

Sciatica pain can be a real puzzle, often leaving individuals wondering exactly where the discomfort comes from. It is widely accepted pain originates in the lower back, but many patients don’t recognise any back pain within their experience with the leg pain produced by far outgunning the rest of the body when the brain receives its feedback.

The sciatic nerve has a specific area of the leg to which it provides instruction, which limits the areas which we can feel sciatica – this is known as a dermatome, likewise there is a specific set of muscles affected known as a myotome.

The sciatic nerves distribution includes the gluteal area & back of the thigh before splitting into smaller nerves at the knee travelling deep into the calf and wrapping around the shin before entering the ankle and foot respectively.

One of the more baffling aspects is that for some people the pain is a flowing experience where a patient could draw on the nerve with some accuracy whilst for others the pain jumps from one are to another leaving aspects of the leg seemingly unaffected.

Other areas of the leg can experience nerve pain but they would not be known as sciatica; for example, the femoral nerve controls the front of the thigh and would be known as femoralgia.

2. Characteristics of Sciatic pain

Sciatica is like a chameleon when it comes to the characteristics of the pain it inflicts. For some, it’s a sharp, stabbing sensation that makes one wince, while for others, it’s a persistent, dull ache that refuses to take a day off. There’s also the notorious burning sensation, which feels like an unending flame along the nerve path.

It is likely that the cause of the nerve damage plays a large part in the character of pain felt, it is believed that a compression-based irritation gives off the perfect pencil line formation of pain running down the back of the leg, whilst more inflammatory origins will produce a more diffuse pain pattern.

Once more giving a nod to the importance of understanding the cause of sciatica and not just the location of pain.

3. Pain Intensity

One of the most fascinating aspects is how these pain characteristics can change over time or even throughout the day. It’s not uncommon for the pain to start off as a mild ache in the morning and evolve into a sharper, more intense sensation by the evening or upon activity.

For some, it’s a minor irritation, a background noise that’s easily ignored. For others, it’s an overwhelming sensation that dominates their daily life. Its not unusual for sciatica to overwhelm a patient’s entire day, highly impacting their ability to even stand up.

Factors such as the underlying cause of the sciatica, individual pain tolerance, and even lifestyle choices play a significant role in determining the intensity of the pain. Activities like prolonged sitting or certain types of physical exertion can exacerbate the pain, making it more intense. Understanding these triggers and how they influence the intensity of the pain is crucial for guiding our path to recovery.

4. How Long Will It Last?

One of the most common questions about sciatica is, “How long will this last?” The answer, unfortunately, is not straightforward. The duration of sciatica pain can range from a few days to forever, little is known on the exact reasoning why this is, but lifestyle is likely to be a major factor.

Undoubtedly there is an additional correlation with the degree of damage that is sustained, a mild disc tear could resolve in a matter of weeks, vs a large disc herniation which is more likely to be discussed in terms of months than weeks.

In some cases, sciatica is a short-lived affair, a temporary discomfort that resolves with minimal intervention. On average it is believed most sciatica will be resolved before the 6–12-week mark, however it is important to note that 30% of sciatica becomes a chronic, long-term challenge.

5. Prognosis & Chances of Recurrence

The prognosis for sciatica varies widely, but the good news is that many people make a full recovery. However, it’s important to be aware that sciatica can recur. The chances of recurrence depend on factors such as the initial cause of the sciatica, lifestyle choices, and adherence to treatment and preventive strategies.

To improve your prognosis and reduce the chances of recurrence, a proactive approach is essential. This includes regular exercise, maintaining good posture, and, if necessary, making ergonomic adjustments to the work and living environments.

6. Complications that Require Medical Assistance

While most cases of sciatica are manageable, some situations warrant immediate medical attention. Complications such as progressive numbness, or weakness in the legs, and/or loss of bladder or bowel control are considered red flags.

In these cases, it’s crucial to seek medical assistance as soon as possible. These symptoms could indicate serious underlying conditions such as nerve damage or compression that require prompt and sometimes aggressive treatment.

Pain alone is not considered an emergency by the medical community.

Chapter 4. Diagnosing Sciatica

Diagnosing Sciatica: A Comprehensive Guide

1. Role of Medical History in Diagnosis
2. Diagnostic Tools and Techniques
3. Imaging Techniques: MRI and X-Rays
4. Differential Diagnosis: Separating Sciatica from Similar Conditions
5. Medical Emergency?

1. Role of a thorough Medical History in Diagnosis 

Taking a trip down memory lane might not seem like the best use of our time at the initial chiropractic appointment, but when it comes to diagnosing sciatica, your medical history is a goldmine of information.

We chiropractors will start by asking you about your current symptoms. When did you first notice the pain? Were you doing anything specific you doing at the time? Have you experienced similar symptoms before? This information gives a chiropractor clue about the nature of your sciatica.

But it’s not just about your recent history. Your chiropractor will also delve into your past medical records. Have you had any previous injuries or surgeries, especially in your back or legs? Do you have a history of conditions that could affect your nerves, like diabetes? All these pieces of the puzzle are crucial in forming an accurate diagnosis.

Lifestyle factors also play a significant role. Your job, hobbies, and even your daily routine can influence your risk of developing sciatica. For example, if your job involves heavy lifting or prolonged sitting, this could be a contributing factor. Similarly, if you’re an avid runner or cyclist, the repetitive motion could be impacting your sciatic nerve.

Understanding your medical history isn’t just about identifying the cause of your sciatica but also its nature; this all helps your chiropractor tailor a treatment plan that’s right for you. For instance, if you’ve had a previous back surgery, or a suffering an aggressive injury then certain chiropractic techniques need to be modified or ruled out altogether. This comprehensive approach is key to ensuring you get the most effective treatment.

2. Diagnostic Techniques 

When you visit a chiropractor with sciatica symptoms, one of the first thing they’ll do is conduct a detailed physical examination. Anyone willing to adjust you before thoroughly understanding and explaining the nature of your condition is a cowboy at best and an outright danger on a bad day.

This isn’t just about establishing where it hurts; it’s a comprehensive review of your body’s functionality. Your chiropractor might ask you to perform certain movements or exercises. This helps them observe your posture, muscle strength, reflexes, and even how your pain changes with different positions.

These tests often include neural or nerve testing such as the Straight Leg Raise test, where you’ll be asked to lie down and raise your leg. This helps to identify if the sciatic nerve is involved. Muscle tests, which identify specific flaws in the various muscle groups controlled by the sciatic nerve, are also commonly used to assess nerve function.

A key part of this diagnostic journey is differentiating between potential causes of your pain. Sciatica symptoms can be caused by various issues, from a herniated disc to piriformis syndrome; with often multiple areas failing at the same time creating a cascade effect.

By conducting a thorough examination, your chiropractor can either pinpoint the source of your discomfort or identify the surrounding issues influencing the pain in order to build the differential diagnosis to its full form.

In some cases, if the cause of your sciatica isn’t clear from the physical exam and your medical history, further tests may be needed. But don’t worry; your chiropractor will guide you through this process with the utmost care and attention.

3. Imaging Techniques: MRI and X-Rays 

Sometimes, the story of your sciatica needs a little more clarity, and that’s where imaging techniques like MRI and X-rays come into play. In our jobs we often feel like mini-Sherlock Holmes, the detectives of the medical world – the more clues we have to work with the more likely that we can deduce the culprit.

Much has been said by both the chiropractic and the medical profession regarding imaging. Medics now suggest 12 weeks wait before imaging sciatica, and many chiropractors choose to work with out imaging to make their life easier.

The DISC Chiropractors, as specialists in Disc Injuries and trapped nerves such as sciatica have no such qualms. We are strong advocates for having on site Xray facilities, often essential to rule out contraindications for our advanced treatment protocols. But even beyond this we spy for the hidden clues within the images which many medics would disregard as normal wear.

X-rays, on the other hand, are more focused on your bones. They can show if there’s any misalignment in your spine or if arthritis is a contributing factor to your sciatica. While X-rays aren’t as detailed as MRIs for soft tissue, they’re invaluable in giving a complete picture of your spinal health.

MRI scans useful in diagnosing sciatica. They provide a detailed view of your body’s soft tissues, including muscles, ligaments, and, most importantly, your spinal discs and nerves. An MRI can reveal if a herniated disc is pressing on your sciatic nerve or if there are other issues like spinal stenosis (narrowing of the spine) causing your pain.

However even MRI has long been removed from its pinnacle of infallibility, images struggle to differentiate certain aspects of tissue health, such as whether we are looking at new or old damage to the disc. We have learnt the painful lesson over the years, that MRI information is only half the puzzle and if findings don’t match the physical exam, then maybe the camera does lie!

It’s important to note that not everyone with sciatica will need an MRI or X-ray. These are typically used when your symptoms are severe, persistent, or if there’s a suspicion of a more serious underlying condition. Your chiropractor will carefully consider your symptoms and medical history before recommending these tests.

4. Differential Diagnosis: Separating Sciatica from Similar Conditions 

Sciatica is a bit of a master of disguise – it can mimic other conditions, making differential diagnosis a critical step in your care. This process involves distinguishing sciatica from other conditions with similar symptoms.

We have already reviewed the plethora of associated conditions that can mimic or multiply a person’s sciatic pains.

So what is important to note is that your chiropractor will use a combination of your medical history, physical examination, and sometimes imaging to differentiate sciatica from these and other conditions. This might include specific movements or stretches that trigger your symptoms. For example, certain activities might exacerbate pain from a herniated disc but not from piriformis syndrome.

Understanding the exact cause of your sciatic symptoms is crucial because it directly influences your treatment plan. For instance, if your sciatica is due to a herniated disc, your chiropractor might focus on spinal decompression therapy to relieve disc pressure. But pain from the piriformis muscle may initially focus more on stretching and relaxing the piriformis muscle.

5. When is Sciatica a Medical Emergency? 

While sciatica is often a manageable condition, there are times when it can turn into a medical emergency. Knowing these warning signs is crucial for your health and safety.

One of the most serious complications of sciatica is cauda equina syndrome. This rare but severe condition occurs when there’s extreme pressure on the nerves at the lower end of your spinal cord. Symptoms include severe lower back pain, loss of bladder or bowel control, and significant weakness or numbness in your legs. If you experience these symptoms, it’s essential to seek immediate medical attention.

Another red flag is sudden, or progressively severe pain in your lower back or leg, accompanied by significant numbness or muscle weakness. This could indicate a significant nerve compression that requires urgent care.

Our general health status should be noted along side the pain, if you are feeling significantly unwell, have fever or have had a rapid loss of weight then caution dictates that you should seek out medical help to rule out infections or cancers.

In these situations, time is of the essence. Delaying treatment can lead to permanent nerve damage, so it’s vital to act quickly. If you’re ever in doubt, it’s always better to err on the side of caution and seek professional medical advice.

Remember, these emergency scenarios are rare, but being aware of them is an important part of managing your sciatic pain. Most cases of sciatica can be effectively treated with chiropractic care and lifestyle adjustments. But by knowing when sciatica is a medical emergency, you can ensure that you get the right care at the right time.

Chapter 5: Causes and Risk Factors

1. Occupational Risks

Certain jobs undoubtedly increase the risk of developing sciatica due to repetitive movements, heavy lifting or driving long distances. Workers who regularly carry out tasks that put a strain on their lower back are more likely to suffer from nerve compression and herniated discs.

For instance, construction workers, warehouse staff and those in healthcare roles where patient lifting is frequent can find themselves at greater risk. Whereas driving, particularly large vehicles, has the dual aspect of both prolonged sitting and the slackening effect of vibration on ligaments to contend with.

Adjusting workplace ergonomics can play a significant role in. Proper training on how to handle heavy objects and ensuring that seating supports the lumbar region may help decrease episodes of low back pain leading to sciatica.

Employees should also be encouraged to take regular breaks from sitting or standing in one position for too long to maintain flexibility and reduce pressure on the lumbar spine. Correct lifting techniques and other ways of reducing these occupational risks should be considered.

2. Ageing and Sciatica: The Connection

The natural progression of ageing plays a significant role in the development of sciatica. As individuals grow older, their spines undergo degenerative changes known as stenosis, that can lead to sciatic pain.

The discs between vertebrae lose hydration over the year, becoming less flexible and more prone to bulges, the loss of function shift weight rearward towards spinal joints which subsequently develop osteoarthritis too, resulting in narrowing of the spinal canal or foraminal stenosis which can also compress the nerves.

Muscle weakness and reduced bone density are other age-related factors that impact spine health. These conditions make it harder for older adults to maintain a correct posture and increase vulnerability to musculoskeletal injuries, including those affecting the lower back.

3. Obesity: A Contributing Factor?

Just as age can play a role in the development of sciatica, obesity also stands out as a significant influence on spinal health. Carrying extra weight increases pressure on the spine and can lead to degenerative disc disease, one of the main causes of sciatica.

Interestingly there is evidence that obesity isn’t directly liked to disc herniation negatively, with less damage seen in the larger of identical twins.

However, developing excess body fat after maturity, especially around the midsection, shifts your centre of gravity and strains your lower back. This added stress can contribute to conditions such as herniated discs or spinal stenosis which press against the sciatic nerve resulting in pain.

It’s important to note that even modest weight loss can relieve some of this pressure and improve symptoms.

4. Sitting and Physical Inactivity

I doubt anyone in the health sphere hasn’t heard the phase “Sitting is the new smoking”. Sitting for extended periods contributes significantly to a sedentary lifestyle, increasing the risk of developing sciatica as well as many other health concerns.

This lack of movement results in muscle stiffness and weakens the core muscles that support the spine. When these muscles are weakened, extra pressure is placed on the spinal discs, potentially leading to complications such as herniated or bulging discs.  Furthermore, the spine relies on movement to pump nutrients into the discs as they have no direct blood supply. Regular breaks from sitting help prevent this issue by promoting blood flow and allowing muscles to stretch and strengthen with office workers being advised performing a few standings stretches every 20-30 minutes as ideal for disc health.

Incorporating even small amounts of exercise into daily routines can counteract some harmful effects of prolonged sitting. 10000 steps a day is a much-trumpeted goal for those of us seeking health, however new research has shown that a modest 4000 steps a day can significantly extend your life.

5. Genetic Predisposition and Sciatica

While sitting too much and living a sedentary lifestyle can significantly increase the risk of sciatica, genetics may also stack the deck against you. Some people are born with a higher likelihood of developing conditions that lead to sciatica.

These inherited traits can affect spinal anatomy, such as variations in disc structure or vertebral shape, which might make an individual more susceptible to herniated spinal discs or lumbar spinal stenosis.

Additionally, researchers have found certain genes that are associated with increased chances of suffering from chronic lower back pain and sciatica. If close family members struggle with severe back problems or nerve damage, it’s possible you could face similar issues.

However much of the genetic blame game should come with the caveat that it is possible to override certain genetic traits, this is known as epigenetic control… for example, a persons risks of developing certain cancers are significantly reduced if they exercise regularly; often reducing by as much half the likelihood of the genetic trait ‘displaying’.

6. Diabetes

Diabetes also plays a significant role in the onset of sciatica; This condition affects millions worldwide and can lead to diabetic neuropathy, which whilst technical affects the same nerve has a different mechanism of injury

It is fairer to separate the peripheral or foot neuropathy with sciatic damage occurring in the lower back, but people living with diabetes need to manage their blood glucose levels diligently as part of their overall health routine to mitigate the potential for nerve damage long term. However both conditions have increased likelihood in patients with diabetes.

7. Smoking

Just as diabetes can impact nerve health, smoking emerges as another significant risk factor for sciatica. It’s not just about the lungs—smoking wreaks havoc on the entire body, including the spinal region.

Cigarettes contain harmful substances that promote inflammation and degeneration of intervertebral discs, conditions closely linked with sciatic discomfort. Regular smokers may find themselves at a disadvantage, dealing with more severe symptoms and potentially longer recovery times due to impaired blood flow and tissue repair mechanisms.

Some studies list smoking as the number one risk factor for sciatica, with patients being 3x more likely to be smokers.

8. Pregnancy

Pregnancy can be a beautiful experience, but it is also a time when women are more vulnerable to sciatica. The weight of the growing baby and changes in posture can put pressure on the sciatic nerve.

Hormonal shifts during pregnancy cause muscles and ligaments to relax, which might increase the risk of disc herniation or piriformis syndrome, both conditions linked with sciatic nerve pain. To manage symptoms effectively, pregnant women are advised to engage in regular light exercise such as prenatal yoga or swimming and manual therapy like that available, at the Disc Chiropractors.

Chapter 6: Treatment Options for Sciatica

Philosophy Behind Chiropractic vs Conventional Medicine regarding Sciatica

The divergence in treatment philosophies between chiropractic care and conventional medicine is quite pronounced, particularly in their approach to sciatica.

1. Conventional Medicine

This approach often focuses on symptom management, primarily through medication and, in some cases, surgery. The emphasis is on alleviating pain and discomfort, often employing a more reactive strategy to the symptoms.

As previously discussed, it is mandated by the UK’s, National Institute of Clinical Excellence, that all patients should be offered a form of physical therapy prior to relying on strong medication or be considered for a surgical consult.

Unfortunately, these services are severely underfunded within the NHS, and lack the support to provide much more than a fact sheet and some stretches. One-size-fits-all with little or no heed paid to the type and temperament of sciatica faced and therefore approach necessary.

Ultimately this is often a source of great frustration for many patients that we eventually see in the clinic.

2. Chiropractic Care

In contrast, chiropractic philosophy leans towards a more holistic and proactive approach. It views the body as an integrated system and seeks to treat the underlying causes of sciatica, not just the symptoms.

This can involve spinal adjustments to correct misalignments and mobility issues and restore proper function to the nervous system, believing that this can reduce nerve irritability responsible for inflammation, muscle spasm, pain, and other symptoms of sciatica.

3. Conventional medicine: An overview of NICE guidelines

Common timelines:

Week 1: Over the counter medication

Week 2: GP may consider a short course of stronger medication.

Week 6-12: NHS Physiotherapy Referral

Week 12+: Referral for MRI & Surgical Consultation

The catalogue of things GPs are asked not to recommend is far too long to list!

4. Chiropractic Care: An Overview

Chiropractic care for sciatica involves a non-invasive, drug-free approach. The treatment plan may include spinal adjustments or manual manipulations, as a form of physical therapy. These methods aim to provide relief by improving spinal alignment, enhancing mobility, and reducing nerve inflammation.

5. Importance of Finding a Specialist

Selecting a chiropractor who specialises in sciatic treatment is crucial.  I speak as a person who having suffered from sciatica found my own chiropractic knowledge and understanding severely lacking. Our training revolves around caring for those patients who are able to respond to a physical format of care; acute disc injuries are generally seen as too-hot-to-handle by a traditional chiropractic approach.

6. Addressing Safety Concerns

Unfortunately, not all disc damage presents in a classic manor, with the nightmare scenario being a low grade disc herniation is misdiagnosed as a simplistic muscle spasm and is treated in a tradition rotational manor; with the potential to increase the level of inflammation or size of the bulge.

In these cases its important to understand that the disc damage was in all likelihood inevitable, with something as innocuous as a trip or sneeze potentially just as likely to create a similar experience

However, by finding a chiropractor or osteopath who I specialist and therefore has a deeper understanding and experience in managing sciatica, leading to more tailored and effective treatment plans. They can also safely navigate through the complexities of the condition, ensuring that the care provided is both effective and suitable for the individual’s specific needs.

It’s important for patients to openly communicate their medical history and current symptoms for a safer treatment experience. Safety in chiropractic care, especially for conditions like sciatica, it is paramount. Its important to talk opening about your fears and ask your chiropractor to discuss the pros and cons involved with the techniques involved.

From personal experience classic rotational adjustments for my disc injury, initially flared up my pain and required a considerably more conservative approach but were then fundamental in my later recovery.

7. Advanced Forms of Care

So, if traditional chiropractic techniques, aren’t ideal for disc injuries then how do you build a clinic that specialises in just those conditions – the answer lies in technology and the advanced forms of care available. Such as the following therapies available at our Surbiton based Disc Clinic:

• Spinal Decompression Therapy – regenerates discs and un-traps nerves.
• Laser Therapy – reduce inflammation.
• Instrument Assisted Adjusting – joint mobilisation.
• Neuro-Muscular Stimulation – resets peripheral nerves.
• HI-Frequency Electromagnets – enhances core stability.

Our unique Disc Injury & Sciatica Protocol targets an 80% improvement rate in just 9 short weeks. And has a 93% satisfaction rating!!!

8. Surgical Options

While chiropractic care focuses on non-surgical treatments, in some severe cases of sciatica, surgery might be considered. This is typically reserved for cases where conservative treatments have failed, and the patient is suffering from significant neurological deficits or severe unrelenting pain ongoing for 3-6 months.

Our stats show that 6% of our disc injury patients, require a surgical referral, but often in these cases the patients will have gained some significant pain relief in the build up to surgery, which has in turn allowed them to strengthen up the lower back prior to surgery, and a better understanding of the follow up care that will be require and can be provided by our specialist clinic.

In summary, treating sciatica involves a multifaceted approach, with chiropractic care offering a unique and holistic perspective compared to conventional medicine. By understanding these different philosophies and treatment options, individuals suffering from sciatica can make informed decisions about their health and choose a path that aligns with their personal health goals and needs.

Chapter 7: Advanced Treatment Techniques for Sciatica

Having thrown scorn at the medical communities handing of the sciatica endemic and at the same time, it is only fair that we review the technology and techniques that we have developed at ‘The DISC Chiropractors’ that I believe set us above and beyond to be the UK’s first specialist Disc Injury clinic.

• Moderated Chiropractic Care – avoiding aggressive rotational treatments.
• Instrument Assisted Adjusting – joint mobilisation.
• Spinal Decompression Therapy – regenerates discs and un-traps nerves.
• Laser Therapy – reduce inflammation.
• Neuro-Muscular Stimulation – resets peripheral nerves.
• HI-Frequency Electromagnets – enhances core stability.

Moderated Chiropractic Care – avoiding aggressive rotational treatments

When used appropriately chiropractic care is undoubtedly a game changer. However, we’re focusing on a moderated approach here.

What does this mean? Essentially, we’re avoiding those uncompromising rotational treatments that can sometimes inflame an angry disc further. Instead, we opt for gentle, controlled movements that target your specific problem areas.

The philosophy stems from research indicating a far higher percentage of bad backs relate directly to disc herniations than previously thought – approximately 42%. And that not even adding the bias that additional leg pain would add to the equation.

From this point, it is fundamental to progress with caution, if you begin your assessment and even sometimes the treatment plan on the assumption that the disc is involved then try to eliminate it as the likely cause in due course then you are far less likely to treat a patient in manor that could end up being too aggressive.

This type of chiropractic care is all about precision. Your chiropractor can use their expertise to make slight adjustments that can have a big impact on your pain levels. By understanding the intricacies of spinal discs, know exactly how to coax it into a more harmonious state, that can lead to stronger treatment in due course.

A big part of this thinking is knowing you have other technology available to supplement the energy of a twisting adjustment without the potential drama.

Instrument Assisted Adjusting (IAA) – joint mobilisation

Instrument Assisted Adjusting involves the use of special tools designed for precise joint mobilisation. These tools, often resembling small hand-held devices a bit like massage gun but designed for joint mobility rather than muscle. They allow the chiropractor to apply specific forces to the targeted areas.

The beauty of this technique lies in its ability to offer a more refined adjustment than what can be achieved by hand alone. It’s particularly helpful for reaching deeper tissues without applying excessive force. Plus, it can be tailored to suit your individual pain threshold and condition, making it a highly personalised form of treatment. Instrument Assisted Adjusting can be particularly effective for those who might feel a bit anxious about the traditional ‘cracking’ sounds associated with chiropractic adjustments. With this method, the focus is on gentle, targeted pressure, which can be a lot more comforting, for others IAA merely acts as the warmup tool prior to adjustments.

Instrument Assisted Adjusting provides a safety net to sciatica patients who can begin care in a gentle stress-free environment, ensuring we are confident they are not reactive before potentially beginning more traditional techniques later in care.

Spinal Decompression Therapy – regenerates discs and un-traps nerves

The Ace up our sleeve, by far the biggest component to any sciatica treatment program.

Spinal Decompression Therapy is like a holiday from your nerve pain. Imagine your vertebrae being gently pulled apart, creating a bit of breathing space for those compressed discs. This space not only helps regenerate the discs but also releases the pressure on any trapped nerves – like your sciatic nerve.

This traction-based therapy is performed using a specialised table where you’ll lie down, and the machine uses corset like straps to apply a controlled traction force. It’s controlled and monitored by a skilled therapist who ensures that the stretching is just right for your specific condition. The goal here is to create negative pressure within the disc, which can help pull back any bulging or herniated disc material away from the nerve.

But it’s not just about the immediate relief. Over time, this negative pressure also encourages the flow of water, oxygen, and nutrient-rich fluids into the discs, promoting healing. It’s a gradual process, but patients often report significant improvements in their pain levels and mobility.

Laser Therapy – reduce inflammation

Laser Therapy, though it sounds like something from a sci-fi movie, is a highly effective treatment for reducing inflammation throughout the body, making it known as the firefighter of our clinic ready to put out any reactive components of healing.

It uses light-emitting diodes to alter cellular function. Don’t worry; it’s completely painless. You won’t feel anything apart from perhaps a slight warming sensation.

This therapy works by emitting specific wavelengths of light that penetrate the skin and underlying tissues. This light energy helps to reduce inflammation, which is often a significant contributor to sciatic pain. It also promotes cell regeneration and increases circulation, helping to speed up the healing process.

One of the great things about Laser Therapy is its versatility. It can be used alongside other treatments like chiropractic adjustments or spinal decompression, enhancing their effectiveness. Plus, there’s no downtime, so you can get back to your daily activities immediately after treatment.

Neuro-Muscular Stimulation (NMS) – resets peripheral nerves

Neuro-Muscular Stimulation is a bit like hitting the reset button on your nerves. When you have sciatica, sometimes your peripheral nerves can become hypersensitive, and this treatment helps to calm them down and restore normal function.

The therapy involves applying electrical impulses to the affected area. These impulses mimic the action of signals coming from the central nervous system, encouraging the muscles around your sciatic nerve to contract and relax. This can help alleviate pain, reduce muscle spasms, and improve the overall function of the nerve.

But it’s not just about symptom relief. Neuro-Muscular Stimulation also plays a role in rehabilitation. It can help strengthen the muscles that support your back, improving your posture and reducing the likelihood of future sciatica episodes.

We have even had great success with this therapy, returning function in patients with post-surgical drop foot, which is where patients have been previously told they have permanent nerve damage affecting their ability to control the muscles around the foot.

Hi-Frequency Electromagnets (HiFEM) – enhances core stability

Finally, let’s explore HI-Frequency Electromagnets. Again, this treatment may sound a bit out there, but rest assured we have scoured the world to bring you the best in tried and tested scientific techniques that add value to your care program. It involves the use of high-frequency electromagnetic fields to stimulate muscles deep within your body.

The electromagnetic fields generated by this therapy aid rehab by providing a muscular contraction in either your abdominal, glute or pelvic floor muscle. Measured at 20,000 contractions in a session this equipment is a rehabilitation powerhouse, and by using magnets as the stimulant, is far less painful that electrical equivalents.

This therapy is known for its ability to improve core stability. A strong core is essential for spinal health, as it takes some of the load off your back muscles, reducing the strain on your sciatic nerve. By enhancing core stability, you’re not just treating sciatica; you’re preventing its recurrence.

Each of these treatments offers a unique approach to managing sciatica, and it’s often a combination of these therapies that yields the best results. As always, it’s crucial to discuss these options with your chiropractor to determine the most suitable plan for your specific needs. Here’s to finding relief and getting back to living your life to the fullest!

Chapter 8: Home Care and Self-Management

1. Should I be Resting?

The age-old advice of bed rest for back pain is obviously outdated, but when it comes to sciatica, there is somewhat of a reprieve. After all, when you’re in intense pain, your first instinct is to stop all activities that cause discomfort, and our subconscious often knows best.

However, it’s essential to understand the difference between rest and inactivity. While short periods of rest can help reduce the swelling associated with acute sciatic pain, prolonged inactivity will do more harm than good.

Extended periods of bed rest can lead to stiffness in the joints and muscles. This, in turn, can pressurise the nerves further exacerbating sciatica symptoms and slowing down your recovery. Instead, aim for a balanced approach. Listen to your body and rest when needed but try to stay as active as your condition allows.

The key is to avoid activities that trigger or worsen your leg pain, while keeping your body moving; don’t worry these tactics are explained below.

2. Directional Preference for Sciatica Relief

Directional preference, a term coined in the McKenzie method of physical therapy, refers to a specific position or movement that provides relief from sciatica pain. This concept is critical because it empowers you to manage your pain effectively and independently.

For some, bending forwards (flexion) may provide relief, while for others, bending backwards (extension) may be more beneficial. Identifying your directional preference involves experimenting with different movements and noting their impact on your sciatic pain.

It’s a process of trial and error but remember that it’s the leg that takes priority. The muscles of the back will likely moan and groan due to stiffness, but our focus is the effect the movement has on the leg pain. Often, one common example is in disc injury cases flexing forward, stretching the back might feel good at the time but effectively pushes the disc back into the injured nerve making leg pain worse when you straighten up.

Once you’ve identified your directional preference, you can incorporate these movements into your daily routine. For example, if extending your back reduces pain as expected in disc injuries, regular back extension exercises can be helpful. These exercises might include lying on your stomach and gently pressing up with your arms, which can help relieve pressure on the sciatic nerve.

However, it’s crucial to approach this process with caution. Always start with small, gentle movements and gradually increase their range of motion and intensity.

3. Mobility Drills

Mobility drills play a crucial role in managing sciatica. These exercises aim to improve the range of motion in your lower back, hips, and legs and are often the next steps in rehabilitation once the initial flare of sciatica has begun to subside.

Start with simple exercises like pelvic tilts, which can help loosen up a stiff back. Lie on your back with your knees bent and gently rock your pelvis upwards, flattening your back against the floor. This gentle movement can provide immediate relief for some people.

Advancing this drill into more of your activities can continue your rehabilitation throughout the day, pelvic tilts can be performed standing, sitting, even kneeling on all four in what is known as a cat/camel exercise.

Remember to listen to your body and stop any exercise that causes pain. The goal of mobility drills is to find movements that feel good and help alleviate your symptoms, not to push through pain.

Practicing a gentle hip hinge is our second favourite drill, purely because its one of the most functional manoeuvres we have in life, standing with your hands on your hips, push your buttocks backwards (sometimes having a wall behind you to act as support can help) hinging your upper body slightly forward whilst maintaining a neutral pain free lower back – think of this whenever you have to bend forward instead of rounding your back and opening it up to further damage.

4. Extension Protocol

The extension protocol is often recommended for those who find relief in arching their backs (extending the spine). This method, based on the principles of the McKenzie Method, can be particularly effective for certain types of sciatica.

The most common exercise in this protocol is the McKenzie press-up. Lie flat on your stomach with your hands placed under your shoulders, as if you are going to do a push-up. Gently press your upper body up, extending your spine, while keeping your hips and legs relaxed on the floor. Hold this position for a few seconds before returning to the starting position. This exercise helps in pushing the disc material away from the nerve root, which can alleviate sciatic pain.

It’s important to start these exercises slowly and increase the number and intensity of repetitions gradually. Some people may only be able to achieve a small range of motion initially, which is perfectly fine. The key is consistency and gradual progression.

As with all exercises, if the extension protocol increases the pain that radiates down your leg, then caution is advised, these things normally take a few reps to ease into but if giving sharp shooting pains then stop immediately and consult your chiropractic team. It’s crucial to find exercises that suit your specific condition.

5. To Stretch or Not to Stretch

The decision to include stretching in your sciatica treatment plan depends largely on how your body responds to it. For some, stretching can provide significant relief, while for others, it might exacerbate the pain.

But, put simply, nerves don’t stretch, so the idea of stretching your hamstring or calf to elevate sciatica is a non-starter; id go as far as saying that if either of these is helping your leg pain then by deduction that pain is in fact not sciatica but more likely a referred pain.

6. Pain Management Techniques

Effective pain management is a cornerstone of sciatica treatment. While it’s essential to address the underlying causes of sciatica, managing pain is crucial for maintaining quality of life during this process. There are several techniques you can explore.

Over-the-counter pain relievers like ibuprofen or paracetamol can be effective in managing mild sciatica pain. They not only reduce pain but also help in decreasing inflammation around the sciatic nerve. However, it’s important to use these medications as directed and consult with a healthcare professional, especially if you’re taking them regularly.

Heat and ice therapy can also be beneficial. Ice packs can help reduce inflammation and numb the area, providing temporary pain relief. Heat, on the other hand, can relax muscle tension and improve blood flow, which can aid in healing. Try alternating between heat and ice to see which provides more relief for your symptoms.

Alternative therapies like acupuncture or massage therapy are not recommended on acute sciatica. Acupuncture involves the insertion of thin needles into specific points on the body, which can help in reducing muscle tension, similarly massage therapy, especially deep tissue massage, can help release muscle knots but crucial here is understanding those muscles are I spasm for a reason… to protect you.

Again, we are prioritising the cases of acute disc related sciatica and so if that doesn’t sound like you then these options might be more viable and are most certainly used in our Surbiton clinic as part of a long-term strategy. Remember, while these techniques can provide relief, they should be part of a broader treatment plan that addresses the root cause of your sciatica.

7. Importance of Regular Activity and Movement

Once firmly in the recovery phase, regular physical activity is vital in managing and preventing relapses of sciatica. It helps in strengthening the muscles that support your spine, improving your posture, and increasing your flexibility.

Incorporate low-impact exercises like walking, swimming, or cycling into your daily routine. These activities are gentle on the back and can help in building endurance and strength without putting too much strain on your spine.

Yoga and Pilates can also be beneficial as they focus on core strength, flexibility, and mindful movement. However, be cautious with certain poses or movements that might aggravate your sciatica. Always inform your instructor about your condition so they can provide modifications.

Settling back into your old habits and expecting a different outcome to your first experience is the definition of insanity.

Conclusion

Treating and managing sciatica is a journey that involves understanding your body, finding a specialist who understands your needs and can offer the latest treatment options.

Ultimately finding what works best for you and incorporate these strategies into your life, whilst listening and respecting your body more.

If you don’t like the advice or support, you have been given then a second opinion can be an invaluable exercise and we hope this report helps guide you through those options.

With patience, persistence, and the right approach, the vast majority of sciatica can effectively be managed without the need for surgery, whilst it may seem an uphill journey the outcomes an advanced centre like ‘The DISC Chiropractors’ can provide has a far better satisfaction rating than orthopaedic surgical procedure we know of.