Sciatica Coventry & Birmingham

The sciatic nerve is the longest nerve in your body. It runs from your pelvis, through your hip area and buttocks and down each leg. The sciatic nerve branches into smaller nerves as it travels down the legs providing feeling to your thighs, legs, and feet as well as controlling many of the muscles in your lower legs. The term sciatica refers to pain that radiates along the path of this nerve.

What causes Sciatica?

Sciatica is actually a sign that you have an underlying problem putting pressure on a nerve in your lower back. The most common cause of this nerve compression is a bulging or herniated lumbar disc. Piriformis syndrome is another common cause of sciatica. The piriformis is a muscle that lies directly over the sciatic nerve. If this muscle becomes tight or if you have a spasm in this muscle, it puts pressure directly on the sciatic nerve. Occasionally, sciatic pain in men is caused by sitting on a wallet.

How do I know if I have sciatica?

Pain that radiates from your lower (lumbar) spine to your buttock and down the back of your leg is the hallmark of sciatica. Sciatica may be accompanied by numbness, tingling, and muscle weakness in the affected leg. This pain can vary widely, from a mild ache to a sharp, burning sensation or excruciating discomfort. Sometimes it may feel like a jolt or electric shock. Sciatic pain often starts gradually and intensifies over time. It's likely to be worse when you sit, cough or sneeze.

How is Sciatica Treated?

The vast majority of the time, sciatic pain can be relieved through a combination of stretches, deep tissue massage of the piriformis muscle and chiropractic care. Occasionally, in cases where chronic spasm of the low back or piriformis muscles is causing the sciatic pain, it may be necessary to do a procedure called a trigger point injection, where a medical pain specialist injects a small amount of anaesthetic directly into a spasmed muscle to break the spasm cycle.

Complementary and alternative medicine

Complementary and alternative medicine (CAM) refers to medical and health care systems, practices, and treatments that aren't currently part of conventional medicine, i.e. the care you receive in your primary care doctors surgery. Many of these therapies and treatments are being studied intensely, and some have proved to help alleviate back pain.

Chiropractic

Chiropractic is a system of treatments which is based on the philosophy that restricted movement in the spine may lead to reduced function and pain. Spinal adjustment (manipulation) is one form of therapy chiropractors use to treat restricted spinal mobility. The goal is to restore spinal movement and, as a result, improve function and decrease pain. Chiropractors manipulate the spine from different positions using varying degrees of force. Manipulation doesn't need to be forceful to be effective. Chiropractors may also use massage and stretching to relax muscles that are shortened or in spasm. Some studies done on spinal manipulation have found it to be as effective and safe as standard treatments, especially for initial pain relief, though the optimal number of treatments depends on individual case. Recent research has shown that 75% to 80% percent of patients suffering with chronic sciatica benefit from chiropractic treatment.

Massage

To conduct an objective clinical trial in massage can be difficult due to variances in practitioners and in massage types however, studies that have been conducted suggest that massage may ease low back pain symptoms by reducing muscle spasm.

Risk factors

The greatest risk factors for sciatica include:

Age

Age related changes in the spine are a common cause of sciatica. You're likely to have some deterioration in the discs in your back by the time you're in your late 20s, and most people who develop herniated discs are in their early 30s and 40s and Previous injuries from sport and work related, activity are also common factors.

Occupation

Jobs that requires you to twist your back, and carry heavy loads, driving a motor vehicle for extended periods makes you more prone to develop sciatica.

Prolonged sitting

People who sit for prolonged periods or have a sedentary lifestyle are more likely to develop sciatica than people with active lifestyle.

Diabetes

This condition, which affects the way your body uses blood sugar, increases your risk of nerve damage.

When to seek medical advice?

Seek immediate medical treatment if:

• You experience sudden, severe pain in your low back or ether or both legs and numbness or muscle weakness in either or both of the legs
• The pain follows a injury, from a traffic or work related accident
• You have trouble controlling your bowels or bladder.
• Seek medical advice urgently.

Screening and diagnosis of sciatica

To help diagnose sciatica and pinpoint which nerves, if any, are affected, your chiropractor will ask about your medical history and perform a thorough physical exam, paying special attention to your spine and legs.

You're also likely to have some basic tests that check your muscle strength and reflexes. For example, you may be asked to walk on your toes or heels, and, while lying on your back, lift your legs one at a time straight in the air. Pain that results from sciatica will usually become worse during this examination.

If your pain lasts longer than four weeks or is very severe, or you have another serious condition such as cancer, you may have one or more imaging tests to help identity why the sciatic nerve is compressed and to rule out other causes for your symptoms.

These tests include:

Spinal X-ray

Because ordinary X-rays can't detect herniated disc problems or nerve damage, they're not usually helpful for pinpointing the cause of sciatica. A spinal X-ray can show most cancers affecting the bony structures of the spine, narrowed discs and spondylolisthesis, however, and can help rule out other causes of nerve root impingement.

Magnetic resonance imaging (MRI)

This is probably the most sensitive test for assessing sciatic nerve pain. Instead of X-rays, MRI uses a powerful magnet and radio waves to produce cross-sectional images of your back. The test can detect damage to your discs and ligaments as well as the presence of tumors. MRI is non-invasive and has no harmful side effects. During the test, you lie on a movable table inside the MRI machine, which is essentially a large magnet. If you have a hard time lying still for the required period of time or you're anxious about the enclosed space, you may be given a sedative. Some MRI units may be wider, shorter or open on all sides, which may be more comfortable for you, although the quality of images taken with these systems may vary.

Computerized tomography (CT) scans

This test uses a narrow beam of radiation to produce detailed, cross-sectional images of your body. When CT is used to image the spine, you may have a contrast dye injected into your spinal canal before the Digit - X-rays are taken a procedure called a CT myelogram. The dye then circulates around your spinal cord and spinal nerves, which appear white on the scan.

Complications of Sciatica

Although people recover from sciatica, it can potentially cause permanent nerve damage. Depending on what's causing the nerve to be compressed, other complications may occur, including:

• Loss of feeling - may affect one or both or legs.
• Loss of movement - may affected one or both legs
• Loss of bowel or bladder function

Treatments for Sciatica

Physical therapy

For many disc injuries, including “Slipped”, Prolapsed, Bulging or herniated disc, physical therapy can play a role in your recovery. Once acute pain is reduced and range of movement improves a physical therapist or Chiropractor can design a rehabilitation program to help prevent further injuries.

Exercise

Rehabilitation includes exercises to help correct your posture, strengthen the muscles supporting your back and improve your flexibility. Physical therapy, exercises should be Started as early as possible.

Medication

Doctors may prescribe an anti-inflammatory medication along with a muscle relaxant. Narcotics also may be prescribed for short-term pain relief. Antidepressants and anticonvulsant drugs can be used in easing chronic pain. They may help by blocking pain messages to the brain or by enhancing the production of endorphins, the body's natural painkillers.

More invasive treatment

In some cases, doctors may inject a corticosteroid medication into the affected area. Corticosteroids mimic the effects of the hormones cortisone and hydrocortisone, which are made by the outer layer (cortex) of your adrenal glands; Corticosteroids suppress inflammation around the irritated nerve thus giving pain relief.

Their usefulness in treating sciatica remains a matter of debate. Some research has found that corticosteroids can provide short-term symptom relief, but that these medications aren't a long-term solution. In addition, corticosteroids can have side effects, so the number of injections you can receive is limited usually no more than four per joint.

Surgery usually occurs when the compressed nerve causes significant weakness, bowel or bladder incontinence, (when this occurs seek medical advice urgently) or you have pain that gets progressively worse or does not improve.

Surgical options include lumbar laminectomy and microdiscectomy. In lumbar laminectomy with discectomy, surgeons remove a portion of a herniated disc that's pressing on a nerve. Most of the disc is left intact to preserve as much of the normal anatomy as possible. Sometimes a surgeon will perform this operation through a small incision while looking through a microscope (microdiscectomy).

Success rates of standard discectomy and microdiscectomy are about equal, but you may have less pain and recover more quickly with microdiscectomy. Discuss which option might be best for you with your doctor, and carefully weigh the potential benefits of surgery against the risks as surgery is not always successful. Remember - Always get a second opinion.