Ask the Osteopath: Sciatica

By Chart Clinic Osteopath, Pavlos Pavlidis MOst.Med.

Hello everyone,

My name is Pavlos and I am a new member of the Chart clinic. I am a qualified Osteopath and have received a Masters degree in Osteopathic Medicine with First class honours.

In this article I will attempt to provide some insight for “Sciatica”, a term commonly used between clinicians as well as patients. However, it is also being commonly misused, especially by the latter.

In this article I will describe the meaning of this term in order to promote a better understanding. I decided to write this after many cases of patients that presented to our clinic thinking that they have “Sciatica” while in fact they did not.

To begin with the origin of the word “sciatica”, it derives from the Greek Ischialgia, with Ischio: Hip and Algos: Pain, and literally translates as Hip pain. In clinical practice it is commonly used to describe pain that radiates along the Sciatic nerve, usually as a result of compression at the lower back.

Now let’s get a closer look at the anatomy. The roots of the sciatic nerve exit from the space between the last two bones in the lower back vertebrae and the first three of the “tailbone” or sacrum as it is known to us, clinically referred to as nerve roots of lumbosacral plexus L4-S3.

                                       

It then travels to the buttock and back of the thigh area and divides into two branches at the back of the knee that goes all the way to the leg and foot. The Sciatic is the longest nerve in the human body and along with its branches supplies the majority of muscles at the back of the thigh, leg and foot. Furthermore, its branches provide sensation to the skin at the back and outside portion of the leg, as well as the top and bottom aspect of the feet.

Therefore, when this goes wrong or you get a  dysfunction of this nerve can lead to weakness of the above-mentioned muscles as well as burning pain, pins and needles or numbness to the back of the leg and foot.

(Note that any symptoms at the groin, front of the thigh or leg ARE NOT associated with the sciatic nerve and Sciatica would be completely inappropriate to describe them)

The term “Sciatica” describes any of the symptoms caused as a result of injury or compression to the nerve and therefore it represents a group of symptoms and NOT a diagnosis.  There are numerous causes of impairment of this nerve and its brunches, anywhere from its roots exiting the lower back to the lower limb. Some of the common causes include severe arthritis of the lower back, a “slipped disc” – a protrusion of the discs in the spine that compresses its roots, or tight muscles at the buttock (such as the piriformis muscle) and back of the thigh, as the nerves passes through them. Nevertheless, there are also some rare but potentially life-threatening causes of sciatic nerve impingement. 

Therefore, it is extremely important for anyone presenting with such symptoms to be properly examined by a clinician so a specific and appropriate diagnosis can be made.

Due to the variety of symptoms caused by dysfunction of this nerve and the numerous causes of it, it is often misused by patients that tend to use it to describe any low back pain that radiates downwards. However, self labeling must be avoided before a proper examination and diagnosis by a qualified practitioner, as it can be associated with diagnostic errors, misdiagnosis and therefore mismanagement.

Nowadays, the term has been labeled as “Archaic”, as it is non-evidence based and inaccurate as it literally translates to hip pain. The literature suggests that it remains from an era of poor understanding of the physiology of back pain.

To conclude: “Sciatica” is a generalised and non-descriptive term, as various conditions might lead to irritation of the sciatic neural tissue, in multiple anatomical sites with different presentation of symptoms.

Patients must avoid using this term and self-labeling themselves, especially if appropriate examination and diagnosis has not been carried out. Patients that experience any of the symptoms described are highly advised to seek help from a clinician with experience working on the musculoskeletal system to exclude any dangerous causes for that and provide appropriate diagnosis and management plan. This includes Osteopaths, Physiotherapists, Rheumatologists, Orthopaedic surgeons etc.

Please do not hesitate to contact me or any of my colleagues for any further information or advice concerning “Sciatica” or any other condition. 

Pavlos Pavlidis MOst.Med

Pavlos qualified in 2017 and received a Masters Degree with First class honors from the University of Surrey. During his time as a student he demonstrated a great passion for the profession, both in academic and clinical settings and was awarded with the Rising Star Award from the Institute of Osteopathy. 

In practice, he follows a multidisciplinary and personalised treatment approach, tailor-made for the needs of the patient. Pavlos has undertaken additional qualifications in Kinesio taping and Medical Acupuncture. Those extra skills have been found to be extremely useful in practice, as they provide additional treatment options, especially useful for pain management and rehabilitation. 

 References:

• Beers, M., Porter, R., Jones, T., Kaplan, J. And Berkwits, M. (2006). The Merck manual of diagnosis and therapy. 18^TH ed. Whitehouse Station, N.J.: Merck Research Laboratories.
• Bogduk, N. (2009). On the definitions and physiology of back pain, referred pain, and radicular pain. Pain Journal, 2009 Dec 15;147(1-3):17-9.
• Fairbank, JC. (2007). Sciatic: An archaic term. British Medical Journal, 2007 Jul 21;335(7611):112.
• Helianthus Holistic Health Clinic. (2017). Acupuncture Balance Method for treating lower back pain and sciatica. Helianthus Holistic Health Clinic, IMAGE. Available at: http://helianthusclinic.com/wp-content/uploads/2016/12/sciatica.png
• Koes, B. W., van Tulder, M. W., and  Peul, W. C. (2007). Diagnosis and treatment of sciatica. British Medical Journal, 334(7607), 1313–1317.
• Matsumoto, Y., Matsunobu, T., Harimaya, K., Kawaguchi, K., Hayashida, M., Okada, S., Doi, T. and Iwamoto, Y. (2016). Bone and soft tissue tumors presenting as sciatic notch dumbbell masses: A critical differential diagnosis of sciatica. World Journal of Clinical Oncology, 7(5), p.414.
• Valat, J.P., Genevay, S., Marty, M., Rozenberg, S. and Koes, B. (2010). Sciatica. Best Practice & Research Clinical Rheumatology, Volume 24, Issue 2, April 2010, Pages 241–252.

Spinal Health – The 5 pillars of a happy, healthy back

Article by Chris Lawlor, Chart Clinic Osteopath

In the UK alone up to 2.5 million people experience back pain every day of the year, here at the Chart Clinic we want to give you some tips to overcome your pain or to keep it at bay if you’re not to suffering.

1)    Maintain good muscular tone and strength

Lower back and core muscles are vital players when it comes to lower back pain, it’s important to keep these muscles in shape in order to provide stability and protect your lower back and pelvic region.

Personalised treatment sessions with an Osteopath can massively help; we are specifically trained to spot imbalances or weaknesses in people’s bodies and have a wide array of treatment techniques to help counteract these issues.

Your Osteopath will also give you tailored exercise/strengthening routines in order to maintain strong muscular health.

2)    Maintain Flexibility

Getting the right combination of flexibility and strength is key; too much of one and not enough of the other doesn’t tend to do the body much good. Some light daily stretching exercises should be done regardless of pain in order to keep your body mobile and supple. Again your Osteopath will design the most effective rehab/stretching programme that suits your specific needs and will be checking up on you to make you’re keeping up with your ‘homework’!

3)    Get Enough Sleep

We’d all love an extra hour or two in bed, but evidence does actually show sleeping for slightly longer each night can improve the health of your back, especially with disc related injuries. This is because when lying down your spine is free from vertical compression (which builds up throughout the day, sitting/standing/exercising etc) so at night the discs in your spine have more time to replenish and can then perform their function of shock absorption and nerve protection.

4)    Stay Hydrated

Continuing with the health of your discs, these structures need plenty of water to perform optimally and so it is important to keep hydrated throughout the day. The recommended daily intake of water is 2 litres, so always try and have a bottle or glass on the go and remember if you’re actually thirsty it usually means you are already slightly dehydrated!

5)    Prevention is Better than Cure

As with most things in life, being proactive is better than being reactive, and the same is true with your spine! Generally looking after yourself and following some of the steps above is a sure fire way to keep problems at bay.

But if things do build up make sure you come and see an Osteopath before the problems get too severe.

As a rule of thumb the longer problems are left untreated, generally the more difficult they are to get back to 100%, so book an appointment as soon its starting to bother you and get on top of the problem to nip it in the bud!

To book an appointment with Osteopath Chris Lawlor call 01737 248 023

Foam rolling…. What is it?

You may have seen fitness fanatics and athletes foam rolling in the stretch area of gyms, but what exactly are they hoping to achieve? It often looks uncomfortable, so why do it?

Foam rolling is a self-manual therapy technique used by many who believe it just helps with flexibility, but that is not all. It is also thought to improve recovery, joint range of movement and performance. The well-known term ‘myofascial release’ (MFR) is the scientific wording commonly associated with foam rolling. ‘Myo’ comes from the Latin term, meaning muscle. ‘Fascia’ is a soft tissue that spans throughout the entire body, linking and surrounding muscles, bones, organs and nerve fibres. Fascia has a tensile strength similar to that of steel, works with muscles to provide tensioning and has the ability to transfer energy throughout the entire body. These points highlight the importance of fascia in the human body and any blockages in this system can then have a knock-on effect leading to injury and pain.

So why is Myofascia relevant to foam rolling?

Foam rolling is thought to have a direct effect on local areas of tightness within myofascia and it’s down to mechanoreceptors within this soft tissue telling the brain to alter muscle activity, and ultimately relax the muscle that is being foam rolled. 

What are the benefits of foam rolling?

·         Improves flexibility, both short and long term

·         Enhances joint range of movement

·         Reduces the effects of delayed onset muscle soreness (DOMS)

·         Used as part of a warm up to aid in performance

How long should I foam roll for?

Research has shown that the optimal time and frequency of foam rolling is 3-5 sets of 20-30 second repetitions for short term changes in myofascial flexibility. To have a longer term effect in flexibility, this regime should be performed 3-5 times per week for optimal results. 

Is there scientific backing behind all these claims?

The answer is yes, however, research into foam rolling has only been a very recent focus amongst the scientific community and further trials are needed to reinforce current findings. The fundamental effects of foam rolling appear very encouraging and can potentially benefit individuals who are receiving treatment for an injury, be it sporting or in the work place. It is common practice for patients to be instructed to perform exercises outside the treatment room to speed up their recovery and the use of a foam roller could be a very effective tool. 

Through recent trials, there have been encouraging results for improving hamstrings flexibility, aiding in recovery between training sessions, enhancing hip, knee and ankle range of motion and performance. Unfortunately, foam rolling on its own is not the be all and end all of injuries but it is shown to have a true benefit to help patients on their journey to recovery whilst they are being helped by a health care professional. 

Treating patients who are suffering with sporting injures is a true passion of mine. The biomechanics of their injury is hugely important in knowing how to approach the patient with their injury. With the use of hands on therapy (massage, manipulation, acupuncture, ultrasound, kinesio-taping) and home rehabilitation, the patient will bounce back to fitness in no time.

Article written by Jon Wilkinson (Osteopath) Call 01737 248 023 to book an appointment with Jon

Sciatica - A common problem seen by Osteopaths

By Colette Goveia – Chart Clinic Osteopath
 

What is Sciatica? In simple terms this is pain travelling down the leg from the lower back. Sciatica is a word used to describe symptoms caused by irritation of the sciatic nerve. These symptoms may include pain, tingling, numbness and/or weakness in the leg. You may also experience low back pain along with these leg symptoms.

 A herniated disc within the lumbar spine can cause irritation of the sciatic nerve. Piriformis syndrome (tightening/spasm of one of the buttock muscles which then irritates the nerve) or age-related joint changes can also be a causing factor of sciatic pain.

It is important to know the cause of your sciatic pain so it can be treated and managed in the correct way.

An osteopath will be able to tell you whether your pain is sciatica and will try to identify the cause of the nerve irritation through history-taking and examination.

Once the cause is determined, a treatment and management plan can be put in place to help reduce your symptoms.

Treatment typically involves use of soft-tissue massage to release tension around the area, stretches and articulation techniques to improve the range of movement within your lower back. Osteopaths will treat the related joints, muscles, ligaments and tendons to help reduce irritation of the sciatic nerve.

Osteopaths will also offer exercise and postural advice for you to take home for self-management.

As osteopaths we not only aim to reduce your symptoms and help you manage them correctly, but we also provide treatment and advice for long term maintenance to prevent reoccurrence.  

I have seen a large number of patients in clinic with sciatic pain, and osteopathic treatment is often very effective in easing these symptoms.

How long will it take to get better? This really depends on the cause as well as you as an individual, e.g. your general health, lifestyle, work and how these things may be contributing factors. Once you have been examined it easier to give you an idea of recovery time.

I tailor treatments and exercise programmes to each individual to try and minimise disruption to their normal daily life where possible.

Call 01737 248 023 to book an appointment with Osteopath  Colette