Sciatica

Sciatica is the name given to any sort of pain caused by irritation or compression of the sciatic nerve. The sciatic nerve runs from the back of the pelvis, through the buttocks, and down both legs ending at the feet. Symptoms of sciatica include pain, numbness, a tingling sensation radiating from the lower back and travelling down one of the legs to the foot and toes, and weakness in the calf muscles or the muscles that move the foot and ankle. Pain can range from mild to very painful.

Warning: Complications of severe disk problems that irritate the sciatic nerve may include cauda equine syndrome (compression of the nervous system resulting in bladder and bowel dysfunction). If you experience loss of control of your bowel or bladder, have a loss of sensation when wiping your bottom or reduced sensation during sex, associated with back or leg problems, this can indicate a surgical emergency and you should go to A&E immediately.

 

Diagnosis

Diagnosis of lumbar disk problem with radicular signs (including sciatica) is derived from the patient’s history and no indicators of potentially serious pathology. Imaging is only indicated in patients with a positive neurological exam or presence of a “red flag” [64-67].

As regulated health professionals specialising in the diagnosis, treatment and management of musculoskeletal disorders, chiropractors are educated and qualified to diagnose and treat intervertebral disc disorders, which may include sciatic symptoms of pain, sensory change and muscle weakness. Chiropractors perform a thorough history of complaint and examination (orthopaedic, neurological and chiropractic testing). Diagnostic imaging such as X-Rays or MRI scans may also be requested.

 

Evidence Base

Papers have shown support for the chiropractic management of sciatica [162-163].  One  included a meta-analysis which showed manipulation to be superior to inactive control, conventional care and intradiscal injections in terms of global effect. The evidence did not show strong support for the effectiveness of manipulation in terms of pain intensity alone.

 

Back-in-Action Clinical Comment

The chiropractic approach to rehabilitation of spinal disc problems is to proceed to active forms of exercise as quickly as possible to avoid dependency on passive treatment. Usually shorter duration of signs and symptoms may signal a quicker response to manipulation. The number of prior episodes may increase the number of treatments required to restore pain-free range of motion.

For patients with sciatica, we use a combination of highly specific manual techniques, followed by a rehabilitation exercise programme. Chiropractors utilise a range of treatment and management interventions for intervertebral disc disorders and sciatica including manipulative therapy, mobilisation, massage, flexion-distraction, acupuncture techniques, exercise prescription (individually tailored self mobilisation, stretching and strengthening), therapeutic advice, patient education strategies and onward referral where indicated. Our approach often incorporates muscle and nerve release techniques, cranial work, diet and nutritional advice, functional neurological exercises, breathing techniques, acupuncture, cryotherapy (heat and/or ice), postural improvements, foot orthotics, ergonomic advice and relaxation counselling.

The treatments used depend upon the severity of the condition and any associated neurological symptoms. Chiropractors are educated and qualified to assess patients using orthopaedic, neurological, palpation and other physical assessment tools. Assessment may also include the use of diagnostic imaging including x-ray and MRI.

Chiropractors frequently work with orthopaedic and neurosurgical colleagues in managing disc injuries and may refer back to the general practitioner for appropriate pain relief prescriptions. Some evidence has shown that even chiropractic treatment is not sufficient to improve disc related injuries, people who have surgeries after chiropractic intervention where found to have more favourable  outcomes. Chiropractors also recognise that not all disc injuries are suitable for spinal manipulation and, although rare, adverse events have been described in the literature. However, there is evidence to support this approach as a safe and effective treatment intervention for mild-moderate disc lesions.

We also find that to get the best results with people we not only need to free the mechanically restricted areas but help deal with the underlying causes – i.e. helping reduce the stress on that area of the body.

From the Preston Chiropractor Team
Getting You Back in Action & Enjoying Your Life Again
Serving the people of Preston and surrounding areas including Southport and Lytham St Annes