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Sciatica isn’t really a diagnosis but more a term used to describe a symptom – pain down the back of the leg (following the path of the sciatic nerve.) There are therefore many potential causes of sciatica, today we will go over three of the most common:
The spinal discs sit between and separate each segment (or vertebra) of the spine. They act as spacers, allowing the vertebrae of the spine to move freely. The discs are built a little like a jam donut – they have a strong fibrous outer layer, the annulus, which surrounds a jelly-like centre, the nucleus (see right).
If the outer portion of the disc weakens, the jelly-like nucleus can start to seep out. If it travels far enough it can start to compress the nerves exiting the spine. As the nerves from the lower back travel down to the legs and feet, compression from a disc herniation often gives rise of the typical ‘shooting’ sciatic pain down the legs. Compression of the nerves of the lower back can also cause numbness and weakness into the leg(s) and, in severe cases, patients may have difficulty walking.
Increased time spent sitting, working with vibrating machinery and repetitive motions (especially repeated forward bending) are all associated with an increased risk of lower back disc injury. Fortunately, injections and surgery are rarely needed for the treatment of disc herniation and it can be successfully resolved with conservative care (such as spinal mobilisation, repeated movements, soft tissue work, traction and exercise rehabilitation) in 95% of cases.
The joints of the lower back and pelvis are also common sources of sciatic pain, mimicking the symptoms of disc herniation. The picture to the right shows the typical referral pattern for the sacroiliac joint (the joint that links the spine to the pelvis). As you can see, if irritated, the sacroiliac joint can refer pain all the way down to the feet.
Joint irritation can result from a number factors such as chronic poor posture, muscle imbalance or weakness, repetitive strain or following lower back injury (such as a fall onto the buttocks). Spinal manipulation / mobilisation is an extremely effective initial treatment option for this form of sciatica.
Similarly to the joints, particular muscles of the lower back and pelvis can refer pain down the leg. One of the most common culprits is the gluteus minimus muscle. Hip or back problems can irritate this muscle which will then commonly refer pain down the side or back of the leg (see image). Stretching this muscle effectively can be difficult so direct approaches such as dry neelding or massage tend to be the best first–line treatment options.
This post was written by Steffen Toates. Steffen is a chiropractor at Dynamic Health Chiropractic in Jersey, Channel Islands. For more information about Steffen click here.