- Integrative Medicine
- Health Blog
Sciatica is a neurological condition in which there is pain, tingling, burning or numbness felt down either or both legs. There may or may not be associated back pain. The cause is either irritation or compression of the Sciatic nerve or its several nerve roots.
The Sciatic nerve originates from nerve roots in the lumbar spine (low back). Virtually all the nerves that go into your legs, as well as many that go into the bowel and lower abdominal organs come from the low back. So inflammatory or degenerative conditions of the low back such as disc bulges often lead to compression or irritation of the nerve roots that exit the spinal cord and this irritation is transferred along the length of the nerves as they traverse into the legs.
Most commonly symptoms will be felt in the buttock, back of the thigh down the shins and into the foot. The whole foot may be involved, or it may only affect the sole or even just the big toe.
It’s important to remember that after just 3 or 4 days of compression a nerve will start to die off, as the choking effect of compression damages the nerve severely. If pressure is removed early enough, a full recovery is possible. But if the compression is severe, or has been present for a long time, even surgical decompression may not be enough and some leg symptoms may remain permanently.
While most Sciatic cases involve some degree of nerve root irritation at the level of the spine, many patients experience sciatica at the point in their buttock where it emerges just above the hip. Chronic postural faults, hip injuries and pelvic torsion (twisted pelvis) can cause a spasm of the buttock muscles that then compress the Sciatic nerve. In our clinic, many patients who have been booked for surgery because of “bulging discs” have been saved from unnecessary surgery by rehabilitating this commonly strained area. Chiropractors are highly trained in identifying which area the nerve is being compressed in, and how best to approach conservative treatment.
Chiropractic care aims to decompress the exit of the nerve roots, so that pressure is removed and the nerve is allowed to heal itself. It is important to stress that manipulation is usually avoided in severe cases of sciatica, with decompression, mobilisation and other less-forceful manual techniques being more appropriate in these cases. Another treatment approach that is gaining wider acceptance is acupuncture, for which there are now a number of clinical trials in support of using either needles, or electrical stimulation to alleviate the pain of sciatica. Some repetitive treatment is usually necessary over 6-8 weeks to ensure proper healing and adequate retraining of the supporting muscles. In very severe cases, there may be so much bulging disc material or arthritic bony overgrowth (osteophytes) that it cannot be decompressed adequately using physical therapy so surgical intervention may be necessary.
Surgery usually entails one of several possibilities. A discectomy may involve shaving off the bulging area. A laminectomy involves cutting away the lamina, which is the part of the vertebra against which the nerve is often compressed – thereby making more room for the bulge and the nerve to co-exist. A spinal fusion involves removing the disc altogether and and fusing the area into one solid bone, or alternatively metal spring disc replacements may be inserted to mimic the function of the disc. Other techniques also involve injecting enzymes to break down the soft gel inside of the disc.
While surgical techniques should always be considered radical and a last resort; cases where loss of bowel or bladder control occur, or where either or both legs are totally numb, have lost power, responsiveness of reflexes is gone and muscles are wasting away may require surgery to quickly decompress the roots. Nevertheless, conservative management of mild to moderate cases at least should always involve the intervention of a Chiropractor, in order to prevent surgical intervention if at all possible. Unfortunately, many medical practitioners have been reluctant to refer disc patients to Chiropractors, for fear that manipulation may stress or aggravate discs even more. However studies are now showing manipulation to be of benefit in back pain and injury rates following manipulation are statistically lower than most other types of treatment. In addition, many Chiropractors now use passive and non-manipulative techniques to manage disc bulges which has allayed the concerns of many medical doctors. At Synergy we receive many referrals from local medical doctors because of our use of these techniques, and because of our ethical, comprehensive and successful rehabilitation strategies.
Some further strategies to address sciatica involve providing supplements to help control inflammation, and to assist nerves in regenerating. Commonly, high potency B-group vitamins, Magnesium, Zinc, Glucosamine as well as herbal formulations may be of assistance in both the acute and chronic sciatic patient. We stock only the highest quality practitioner only prescription range of supplements to ensure real value for money and effective management of Sciatica. Further advice on supplements and natural anti-inflammatory medicines can also be gained from our naturopath. Please call the clinic on 9822 0588 for further information.