Sciatica – Lower Back Pain
First of all it’s very important to note that ‘Sciatica’ is a symptom and NOT a diagnosis. Sciatica is there because of another underlying cause. Sciatica generally refers to an irritation of the sciatic nerve that originates in the lower back (also known as the lumbar spine) or its branches lower down. There are numerous factors that can cause this symptom including:
- prolonged pressure on the nerve such as sitting for a prolonged time or sitting on a hard, uncomfortable surface
- inflammation around the nerves as seen in some cases of lower back injuries
- lumbar stenosis which refers to narrowing of the passageway through which the nerves travel that cause compression
Disc herniations are also a very common occurrence leading to pressure on nerve roots or nerve root irritation due to inflammation. Furthermore, sciatica may also arise in cases of deep gluteal (buttock) pain syndrome better known as piriformis syndrome.
Signs and symptoms:
Sciatica is characterized by sharp pain and numbness, burning and/or tingling that radiate into the buttock(s) and back of the thigh(s). Furthermore, pain may also present in the shin, calf, and foot and cause muscle weakness in the leg(s).
Aggravating factors:
The actions of bending over to tie shoe laces or bending back (arching the spine), sitting while straightening the leg, prolonged driving or lifting objects are known to aggravate the symptoms. Physical activity and exercise should be adjusted accordingly.
Treatment and prognosis:
With manual therapy such as chiropractic treatment, most cases resolve within four to six weeks. Rehabilitation exercises aim to increase blood flow, improve nerve health and modify or eliminate aggravating activities.
Disc Herniation
When the inner material (nucleus pulposus) of a spinal disc pushes out through a tear in the wall of the outer material (annulus fibrosus), a disc herniation result. Disc herniations are most commonly observed at the levels of L4/5 and L5/S1. Symptoms typically involve numbness, pain and tingling that radiate down the leg. The mechanism of injury usually involves bending over to pick up something heavy from the ground.
Signs and symptoms:
A disc herniations is characterized by pain in the lower back and down the back of one leg. The leg symptoms are typically experienced into the buttock and hamstring, but may also radiate into the front of the shin, calf and foot. Pain can range from a nagging ache to having a sharp, stabbing character along with tingling, numbness or weakness in the affected leg.
Aggravating factors:
The most common activities that trigger the pain is prolonged sitting, driving or standing, as well as bending over to tie shoe laces or to pick something up.
Treatment and prognosis:
Manual therapy such as chiropractic treatment may help restoring full function i.e. joint range of motion. Furthermore, heat or ice application on the lower back may also alleviate symptoms. Rehabilitation exercises aim to restore full function. In some cases the injury may continue showing up on imaging, however it is important to stay focused on how you feel and move, and modify your activities to facilitate healing. Most cases resolve within several weeks if aggravating activities can be eliminated.
Lumbar Stenosis
Lumbar stenosis refers to a condition characterized by narrowing of the vertebral spinal canal with possible subsequent neural compression, leading to pain in the lower back and legs. Although mostly seen in the lower back, stenosis can happen in any other region of the spine as well. This condition is caused by anything that takes up space of the nerves including joint arthritis, a herniated disc, or a bone spur. It is possible to suffer from stenosis without experiencing pain. The good news is – many patients respond well to conservative chiropractic care and rehabilitation.
Signs and symptoms:
Lower back pain may be accompanied by tingling or numbness into one or both legs. It is common to experience weakness in the leg(s) and therefore battle to walk longer distances. Pressure can be taken off the nerves by bending forward which should relieve the pain experienced in the lower back and/or legs. A foot drop may develop with more severe nerve compression.
Aggravating factors:
Extending (leaning backwards) the lower back narrows the nerve canal and therefore increases pain and neurological symptoms.
Treatment and prognosis:
Symptoms can reduce within four to six weeks by modifying aggravating activities. The patient should reduce time walking/standing and try to maintain a neutral spine posture. Manual therapy such as chiropractic care focuses on improving low back and hip mobility, and the rehabilitation exercises improve strength and endurance.