What is Sciatica?
The sciatic nerve is the largest nerve in the human body; it runs from each side of the lower spine, down the buttock, back of the thigh and into the foot. Sciatica is not a true diagnosis but is actually a symptom that describes pain felt along the course of the sciatic nerve.
When the sciatic nerve is irritated, symptoms may be experienced anywhere along the course of the nerve. This means that pain may be experienced in the lower back, buttock, back of the thigh, back of the leg or into the foot. Symptoms may also be described as: burning, numbness, tingling, pins and needles or cramping. Since the sciatic nerve supplies muscles in the lower limb people may also experience weakness or tension into these areas.
Causes of Sciatica:
Sciatica occurs most often as a result of a disc injury which may be described as a disc herniation, disc bulge or disc derangement. When the disc is injured inflammation around the disc can irritate the sciatic nerve leading to sciatica. Learn more about disc derangement and disc herniations below.
Degenerative Joint Disease & Degenerative Disc Disease (DJD/DDD):
Degenerative joint disease or osteoarthritis is an age related condition that can affect any joint in the body. The spine is made up of vertebrae, which are connected to one another by facet joints. The joints allow for movement and stability of the spine. In a young healthy spine the facet joints are covered in cartilage and are well lubricated by fluid. All of the joints, including the facet joints, are susceptible to wear and tear, degeneration and inflammation. Over time the cartilage may start to wear down and spurs of new bone may form at the edge of the joints.
The discs are cushion-like shock absorbers that lie between each vertebrae and are made up in large part by water. As we age the discs loose water and therefore thin and loose height. These changes narrow the space between the vertebrae where the nerves exit the spinal cord and branch to supply the limbs. This narrowing can lead to inflammation and irritation of the sciatic nerve leading to sciatica/pain. This narrowing may also be referred to as lateral lumbar spinal stenosis.
The piriformis muscle is a triangular muscle that runs from the side of the thigh and inserts onto the sacrum (the large triangular bone at the bottom of the pelvis). It is a deep muscle located underneath the gluteus maximus and in the majority of people the sciatic nerve runs underneath the piriformis muscle. In piriformis syndrome the sciatic nerve becomes irritated by tension in the muscle or due to direct trauma to the area. This is a much less common cause of sciatica. Other conditions may also create symptoms that are similar to sciatica. Lumbar or sacroiliac joint irritation along with trigger points in the buttock muscles can also create pain that may seem similar in character and location but are true sciatica.
Sciatica Relief & Treatment Options:
As indicated above, sciatica may be a symptom of various muscle, joint or disc related conditions. Treatment at Mountain Health & Performance is based on a specific diagnosis and findings from an examination. Treatment should never be based around one specific symptom such as sciatica.
Avoid articles online that claim to provide quick fixes or simple exercises to cure sciatica. Exercises for disc hernation, piriformis syndrome, lumbar facet irritation or trigger points will differ. Diagnosing yourself with sciatica based on online information and then performing general exercises could lead to increased injury and pain. For example, sciatic nerve pain may create a feeling of tension in the hamstring muscles. When the hamstrings feel tight it is common to want to bend forward to stretch them in order to ease the tension. However in cases of disc herniation bending forward may put increased pressure on the disc and tension or irritate the nerve. For specific patients hamstring stretching should be avoided and a different approach to rehabilitation and exercise will be taken.
What is a Disc Herniation?
The intervertebral discs are connective tissue structures that lie between each vertebrae in the spine. They are composed of macromolecules and water and act like cushions to help the spine absorb shock. They also help to hold the vertebrae together and allow for slight movement of the spine. The discs consist of two parts. The tough, outer portion is called the annulus and the soft inner portion is the nucleus pulposis. The configuration is like that of a jelly doughnut; the nucleus being the softer, jelly-like substance on the inside.
As we age the discs undergo changes in size, shape, structure and composition. During adulthood degeneration may develop in the outer portion of the disc. Small fissures and cracks may begin to form and the water content of the disc also starts to decrease.
When cracks form in the outer disc it may allow for part the inner portion of the disc to travel outwards. In this case the inner portion of the disc is still contained inside the disc itself. It’s kind of like if you were to squish a jelly doughnut. The jelly may no longer be limited to the middle of the doughnut but none of the jelly has actually come to the outside of the donut. Because the outside of the disc is pain-sensitive this type of disc injury may create localized lower back pain without symptoms that travel into the buttocks or legs. We would call this discogenic lower back pain. If the inner material breaks through the annulus and moves outside of the disc it is considered a disc herniation. In this case you have squished the jelly donut to the point that the jelly actually comes out of the donut.
What are the Symptoms of a Herniated Disc?
There are pain-sensitive nerves around the spine and disc. Inflammation created by a disc injury can lead to some or all of the following symptoms:
Lower back pain- central, right or left sided:
Localized or diffuse.
Deep, dull, achy or sharp.
May involve muscle spasm or muscle tension.
Nerve symptoms (radiculopathy) – irritation of one or more of the spinal nerves as they exit the spinal cord.
Sciatica is a type of radiculopathy.
Radiculopathy (nerve injury/irritation):
The symptoms of radiculopathy may occur anywhere along the course of the affected nerve (front or back of the thigh, buttocks, groin, front or back of the legs and or feet, soles of the feet). When patients present with radiculopathy the pain may be worse in the buttock, thigh or leg than in the back. Most radiculopathies involve the lower lumbar nerve roots (L4-S1).
How do the Discs get Injured?
Normal spinal movements load and change the shape of our discs. When we have healthy discs they are pliable and can deform but will return to their normal shape. The disc is sensitive to load and pressure. Disc injuries occur most frequently after improper gradual and progressive loading of the spine in flexion (forward bending) and rotation (forward bending and twisting). Less commonly they occur suddenly after a traumatic event (forward bend with twist –while lifting a heavy object).
Bearing down to use the washroom
Prolonged sitting or standing
Transitioning – Rolling over in bed, moving from sitting to standing
Herniated Disc Treatment and Prevention:
The Chiropractors at Mountain Health and Performance will perform in depth history and physical examination to determine the cause of your symptoms. Based on a clinical history and the examination we will determine if the severity of symptoms warrant a referral for an orthopedic or neurologic consult.
During the initial stages of disc herniation treatment will be focused on controlling inflammation and on education. Laser therapy, ice, and gentle mobilization techniques will be utilized to decrease pain and control inflammation. Education on how to sit, stand, transition etc. is also very important during this stage to decrease irritation on the disc and nerves. When inflammation and pain have settled treatment will focus on restoring normal joint and soft-tissue mobility, along with rehabilitation to strengthen the core, back and hips. Treatments employed at Mountain Health and Performance include: spinal manipulation, mobilization, myofascial release (ART) and (FR) and traction. Spinal traction involves a specialized table, which stretches the spine and helps to decrease pressure on the disc and nerves, also known as spinal decompression therapy.
No specific condition or injury can be completely prevented as injuries involve a complex interaction between emotional, lifestyle and genetic factors. We can however decrease the chance of injuries with proper nutrition, exercise and preventative treatments. Some great ways to help decrease your chance of disc injuries are listed below:
1. Strengthen Your Core and Learn Proper Breathing Techniques:
A strong core will decrease load on the spine and help protect the lower back. There are specific core exercises that will place less load on the spine and will be more appropriate for those already suffering from lower back pain. It’s important to seek advice from your chiropractor prior to starting a core program when dealing with lower back pain. Learning to belly breathe and activate the diaphragm is also an important protective measure. When you inhale and fill your belly with air this creates intra-abdominal pressure, which helps to stabilize the low back.
2. Learn proper bending and lifting techniques and then start to add weight to these movements in a safe manner.
Learning how to hip hinge properly is extremely important for the long-term health of your low back. When we hinge at the hips to bend over we decrease the amount of load that is placed on the spine. If we can also start to use these patterns at the gym (i.e.: the deadlift) and add progressive weight it will also strengthen these movements so that we are better prepared to bend and lift heavy objects in everyday life.
3. Optimize Mobility and Joint Function:
In order to decrease the risk of any injury it’s important to include mobility exercises into your daily routine along with other forms of exercise. At Mountain Health & Performance we utilize Functional Range Conditioning (FRC) to guide a lot of our rehabilitation plans because it focuses on improving strength and flexibility in the joints and tissues. When the body is flexible and strong it is prepared to better handle the activities and loads we place on our body on a day-to-day basis. An initial examination at Mountain Health will include a comprehensive assessment of the spine and extremities to identify any areas of dysfunction. Even if you do not have pain it is still worthwhile to get assessed, understand the improvements you can make and start on a long-term mobility plan as a preventative measure.