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.

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

"Sciatica"... Cleared Up.

Sciatica is a term that gets bounded around for a whole host of signs and symptoms, so we at Chart Clinic would like to offer our knowledge in helping to understand this.

So what is Sciatica?

Sciatica is when the Sciatic nerve (that runs from your low back/ pelvis, all the way down the back of the leg and into the foot) becomes compressed, stretched or inflamed. This leads to pain in the low back and back of the leg and foot, often accompanied by pins and needles, numbness and/ or weakness in the leg. It is important to note that the leg pain is often worse than the low back pain. Another common symptom of Sciatica is the inability to pull your foot up when you walk, giving the appearance of dragging the foot when walking.

The Sciatic nerve is one of the most common nerves to injure in the lower extremity due to the many sites of potential injury. 

What causes it?

The most common reason for Sciatic nerve pain is from trauma or surgery around the hip. It has been documented that 1-3% of all hip replacement surgeries result in Sciatic nerve injury. Hip fracture and dislocation are also reasons for potential Sciatic nerve entrapment.

Piriformis Syndrome, another term you may have heard of, is another area where the Sciatic nerve can become irritated. If the muscle, Piriformis (which is located deep to the buttock muscles), is overly tight then this can lead to buttock tenderness and pain into the back of the thigh. Prolonged sitting, bending forwards and certain hip movements can exacerbate these symptoms, often accompanied by numbness into the back of the thigh. 

The nerve then traverses down in between the hamstrings where a muscle strain here can compress the nerve. The Sciatic nerve then divides behind the knee where one branch wraps around the top of the Fibula bone. A fracture here can then lead to pain into the calf and foot, along with pins and needles, numbness and/ or weakness of the ankle and foot.

What can you do?

This is entirely dependant on the reason why the Sciatic nerve is being compressed. As physical therapists, we are trained to diagnose the reason for a patient’s signs and symptoms through special tests. This is where it is important to differentiate between nerve root irritation (where the nerves come out the spine are inflamed) and peripheral nerve entrapment (where the spinal nerve roots converge) as the signs and symptoms are similar but not the same. 

If the Sciatic nerve is being compressed by muscles or tendons, then physical therapy can be very effective in helping to alleviate these symptoms. Very specific stretches and the use of ice and/or heat can also help.

Due to the vast number of causes for low back pain and leg pain, it is best to speak to a manual therapy specialist to help diagnose and treat the area in question as it is important to identify where the origin of pain lies so it can be treated accordingly.

The above Information is not designed to replace medical advice. Serious Injuries should be managed with assistance from your Physical Therapist or Health Professional. With any symptoms that cause concern or doubt, get them checked out.