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Sciatica

January 4, 2021

Sciatica/disc herniation/slipped disc is a disorder that causes pain in the lower back and hip with radiation down the back of the thigh into the leg and foot. Research has shown that an estimated 5-10% of those with low back pain will develop sciatica. Prognosis is favourable with most pain and related disabilities resolving within weeks. At the same time a substantial group (30%) may continue to have pain for one year or longer.

Sciatica occurs due to compression or irritation of spinal nerves in 90% of cases. Less common causes of sciatica include pregnancy, piriformis syndrome, spondylolisthesis, facet joint hypertrophy, spinal instability. Spinal nerves are most likely to become irritated at the space where they exit the spinal cord, known as the intervertebral foramen. In patients under 50 years, a herniated disc is the most frequent cause. After the age of 50, radicular pain is often caused by degenerative changes in the spine. As we age, the discs located between each vertebra shrinks and becomes dehydrated reducing their capacity to tolerate loading. This increased amount of loading can cause the gel like material located with the centre of the disc to become displaced and cause compression on the surrounding spinal nerve. Further, shrinking of the vertebral discs causes increased loading on the resulting in the ligaments becoming lax decreasing the size of the intervertebral foraminal space. If our core muscles do not have the capacity provide sufficient support and stability to the spine then this can further reduce the foraminal space and predispose us to nerve root compression and irritation

There are several risk factors which predispose us to sciatica, these include:

Personal factors

·        Age (peak 45-64years)

·        Increasing height

·        Smoking

·        Mental stress

·        Strenuous physical activity—for example, frequent lifting, especially while bending and twisting

·        Driving, including vibration of whole body

While the hallmark symptom of sciatica is back pain with radiating leg pain. The type of pain can vary it may be sharp, feel like electric shocks, discomfort or numbness

Associated leg symptoms are dependent on which nerve is compressed or irritated and the extent of that compression.

  • When the L4 nerve is affected pain, tingling and numbness is felt in the thigh. You may also feel weak straightening the leg
  • When the L5 nerve is affected pain, tingling and numbness may extend to the foot and big toes.
  • When the S1 nerve is affected pain, tingling and numbness is felt on the outer part of the foot. There may also be weakness when elevating the heel off the ground and standing on tiptoes.

Sitting, bending, prolonged standing or rising from a sitting position can aggravate or increase the pain

Conservative treatment for sciatica is primarily aimed at pain reduction, either by analgesics or by reducing pressure on the nerve root. Little difference in effect on pain and functional status has been shown between bed rest and advice on staying active. As a result, bed rest for a long time is no longer recommended. Corticosteroid injections and traction have limited evidence and are therefore not recommended for the treatment of sciatica

Initial treatment is primarily geared towards reducing the pressure on the trapped nerve by combinations of graded manual therapy. As the severity of symptoms improve the emphasis of treatment can shift to restoring range of movement and functional capacity. A dynamic lumbar stabilization program is recommended. Helps to improve our sense of awareness of the lumbar spine and reduce excess motion at the spinal segments. This reduces the amount of irritation at these segments, relieving pain and protecting the area from further damage