Have you heard this phrase? Have you used this phrase? Do you really know what it means and what you can do about it?
Sciatica is characterised by pain going down the leg – along the route of the sciatic nerve – which is the back and side of the leg. It should not be used to describe pain in the front or inside of the leg as these areas are supplied by different nerves.
Just because you have pain in the back or side of the leg is always sciatica – NO there are many different conditions that can present with similar pain. Genuine nerve pain is usually shooting and sharp and often associated with numbness or weakness of the area/function it supplies.
The diagnosis matters because the treatment and management is different depending on what is causing the pain.
The nerve can be compressed in several places but most commonly, some 90%, is caused by an intervertebral disc prolapse in the bottom 2 segments of the spine (commonly called a slipped disc).
If you imagine the disc like a jam doughnut, the nucleus (jam) squeezes out through the annulus (dough part) and goes into the space where the nerve exits the spine.
There are other causes, nearly all are musculoskeletal but very occasionally there can be a more serious cause and so it is important to see a doctor, osteopath or physiotherapist to get an accurate diagnosis before a treatment plan is started.
Is it common – yes, does it need surgery – mostly no.
It is most common between the ages of 20-50 – younger than you might think. The nucleus of the disc (the jam of the doughnut) is made up of a jelly like hydrated substance that dries up and becomes desiccated over time so as you become much over 50 it’s not mobile any more so can’t bulge out. That doesn’t mean you don’t get sciatica over that age but degeneration and bony compression cause it rather than the disc, the pain is however much the same.
How can we prevent it and what to do if you’re unlucky enough to suffer?
Some elements of disc prolapse may be hereditary – so choose your parents wisely!! Keeping strong and stable around the pelvis/lower back and good posture all reduce pressure on the disc. Lift carefully and preferably not repetitively but particularly don’t lift and twist at the same time – move your feet. As with most of the problems we talk about at Walnut Grove, general health is important. Maintain a sensible weight, perform regular exercise at least 5 days a week, eat well, sleep well to help repair and keep well hydrated.
When you first have sciatica, it can be terrifying but try not to panic, relax as much as possible. Take enough pain relief to stop the leg pain – speak to your GP if you need stronger medication than available over the counter and try to keep moving – you need a good blood supply. Try not to sit – sitting puts 200% more pressure on the disc than standing – so sit to eat and otherwise potter around and lie down with a pillow under your head and knees or with your legs up on a chair or sofa. Hot packs might help too.
Treatment can help in the early stage and later if you have waited to see if it will get better!! – Ring up and get advice even if you can’t move, we can give you confidence and make sure you are doing the right thing.
Very few patients go on to have surgery but those that do it’s because the nerve is getting more compressed and more at risk of permanent change – usually the nerve will bounce back to normal function with the right management.
At Walnut Grove osteopathy, physiotherapy and acupuncture can help with sciatica, so give us a call to get the best advice.
