What is sciatica?
The term sciatica is used to describe the inflammation and/or compression of the sciatic nerve – the longest nerve in the body which runs from the back of the pelvis through the buttocks and down both legs to the feet.
Nowadays clinicians tend to refer to sciatica as radicular pain – a shooting or grinding pain which radiates from the lower back down the length of the sciatic nerve. Sometimes the pain can be accompanied by numbness and/or weakness in the legs and feet which is known as radiculopathy.
Sciatica can be an extremely painful and debilitating condition with sufferers finding it difficult to walk, sleep and go about their normal daily activities.
The good news is that most acute (short-term) episodes of sciatica can generally be resolved within a few weeks with over the counter anti-inflammatory drugs – alongside the continuation of normal daily activities. However, if sciatica becomes a long-term problem (for more than six weeks) sufferers need to seek medical advice from a specialist, making sure they receive the correct diagnosis and treatment.
Sciatica is commonly associated with a bulging or herniated disc. A bulgingdisc is when the whole or part of the disc bulges outside of its normal space between the vertebrae. A herniateddisc is when the inner nucleus of the disc actually ruptures out of its casing. Both conditions – which are sometimes commonly referred to as a ‘slipped’ disc– can cause compression or irritation of the sciatic nerve. Other causes of sciatica include spinal stenosis (narrowing of the nerve passages in the spine), a spinal injury or infection, or a growth or tumour within the spine.
Sometimes other conditions can mimic the symptoms of sciatica but they are not related to direct compression or inflammation of the sciatic nerve. Somatic pain in the lumbar spine can produce referred pain in the nerve endings within the discs, facet joints or sacroiliac joints. As somatic pain is not caused by compression of nerve roots, there is usually no accompanying numbness or weakness. It tends to centre over the buttock area and upper thigh but can extend to the foot.
Sciatic symptoms are also associated with Piriformis Syndrome. When the piriformis muscle (located deep in the hip/buttock) becomes tight or inflamed, it can cause irritation of the sciatic nerve. Sufferers may feel numbness in the buttocks and pain when climbing up or down stairs and while sitting. Piriformis Syndrome can be treated with strengthening and muscle balancing exercises, deep massage and/or dry needling into the muscles.
Sciatica caused by a herniated or bulging disc
The spine has 24 individual bones (vertebrae) stacked on top of each other. Discs are the protective pads of connective tissue dividing them – the ‘shock absorbers’ which protect the spine when we run or jump.
Without realising it, we cause small weaknesses in our spine every day with prolonged sitting or standing in certain positions – at workstations or hunched over the ironing board for example. If too much pressure is put on a disc, a weakness may develop and it’s possible for the whole or part of the disc to bulge out of its normal position or even rupture and the gel inside to bulge outwards – rather like a jam doughnut being squeezed!
The damaged disc can put pressure on or cause irritation to the spinal nerves or a single nerve root – most commonly the sciatic nerve. Evidence suggests that the inner gel-like substance of the disc can cause an inflammatory response in sciatic nerve roots or compression of the nerve. Sometimes it can be a combination of the two which is causing the sciatic pain.
In rare instances, the nerves at the bottom of the spinal cord can become compressed. Known as Cauda Equina (see below), this can result in urinary and/or bowel incontinence and is a medical emergency which may require immediate surgery.
In rare instances, the nerves at the bottom of the spinal cord can become compressed. Known as Cauda Equina (see below), this can result in urinary and/or bowel incontinence and is a medical emergency which may require immediate surgery.
What treatments can help with sciatica?
For most people, their sciatic episode will be acute (short-term) and they will recover naturally whilst going about their normal daily activities.
However, chronic (long-term) sciatica usually requires a combination of anti-inflammatory medicine, self-help techniques and physical therapy – which can include the targeted disc treatment IDD Therapy.
If patients have exhausted non-invasive treatments and are still in pain, they may need to consider invasive procedures such as steroid injections or surgery.
Painkillers
Over-the-counter non-steroidal anti-inflammatory drugs such as Ibuprofenare usually prescribed for sciatic pain. For patients with asthma, high blood pressure, liver disease, heart disease or stomach and digestive disorders, GPs may suggest Paracetamol as an alternative.
If symptoms are severe, your GP may prescribe a mild opiate-based painkiller such as Codeineor a muscle relaxant such as Diazepam.
Exercise and lifestyle changes
Sciatica exercises – consisting of stretching and core-strengthening in order to support the spine – can reduce pain and provide conditioning to prevent future recurrences.
Some patients may need to make lifestyle changes to avoid activities or situations which might put undue stress on the lower back and offset a bout of sciatica.
Awkward working positions such as those where the ‘trunk’ is twisted or hand is above the shoulder; heavy lifting; playing golf; excessive driving and walking (for more than 1 hour at a time) are all linked with sciatica.
Awkward working positions such as those where the ‘trunk’ is twisted or hand is above the shoulder; heavy lifting; playing golf; excessive driving and walking (for more than 1 hour at a time) are all linked with sciatica.
How does IDD Therapy help sciatica patients?
Bridging the gap between hands-on physical therapy and invasive procedures, the IDD Therapy programme offers a non-invasive targeted disc treatment for patients with sciatica or symptoms indicating a disc herniation or bulge.
Safe and gentle pulling forces are used to distract (draw apart) and mobilise specific spinal segments where discs are damaged or herniated, removing pressure and irritation from targeted discs and trapped nerves.
Patients receive a structured programme of regular IDD Therapy sessions, allowing the body to adapt to treatment whilst progressively relieving pain and improving mobility. For long-term sufferers, a series of treatments is needed to achieve long-lasting therapeutic changes.
Distracting and mobilising the disc(s) in this way is particularly relevant given the sometimes indistinct origins of sciatica: opening up the disc space promotes the flow of nutrients and oxygen, assisting the dilutionof any inflammatory toxins which may be causing irritation to the sciatic nerve whilst also relieving pressure from it.
IDD Therapy Case Study 1 – Margaret (65), retired nurse from Hereford.
“I’d suffered with lower back pain on and off for a couple of years but after a knee replacement operation in 2011, it got much worse and I also began to get a grinding sciatic pain in my leg when I’d been sitting for too long or walking for any length of time.
I ended up needing a stick and I found it very difficult to do my normal daily activities and even simple things like dressing myself and standing at the sink to wash the dishes were a problem.
My clinician, Mark Roughley (Leominster Osteopaths) recommended a programme of IDD Therapy to treat the two disc bulges in my spine. He continually assessed my progress during the programme and suggested gentle exercises to do at home to compliment the treatment.
At the end of the programme, I was virtually pain-free and able to enjoy my usual daily activities including walking with my friends – something I’d really missed. I’d definitely recommend IDD Therapy – it’s given me back my life!”
IDD Therapy Case Study 2 – Scott (38), scaffolder from Chingford
“Last year my episodes of sciatica became severe and sometimes my leg would actually go numb when I stood for too long.
I was in so much pain I could hardly walk and was only sleeping for a couple of hours a night. I needed to take painkillers every day but even with regular medication, the pain was too much for me to bear – and I’m a big strong bloke!
My doctor sent me for some osteopathy and acupuncture sessions but they didn’t help and an operation was the last thing I needed – being self-employed, I couldn’t afford the time off work for a start!”
After a review of Scott’s recent MRI scan, Dan Smith (Sports and Spinal Physio) confirmed a large disc bulge and he decided that Scott was an ideal candidate for the IDD Therapy programme.
“I finished my treatment programme in Spring of last year and I’m feeling fantastic; my pain has drastically reduced and I’m able to walk, drive and sleep properly. I still have to take care of my back and avoid heavy lifting but this is nothing compared to the debilitation I suffered before my treatment.
It’s really not an exaggeration to say that IDD Therapy has changed my life completely. Without it I’d still be in agony on a four month waiting list for a back operation…”
A clinician’s view
Sheffield Physiotherapy’s John Wood treats his chronic sciatica patients with IDD Therapy. He says:
“With the IDD programme we can help to change a patient’s outlook, setting them the realistic goal of becoming pain-free and being able to get back to their normal daily activities. Specific exercises are tailored to the progressive stages of treatment, developing the patient’s confidence in movement as both safe and constructive to their recovery.”
Research shows that IDD Therapy patients with a herniated disc – most of whom suffered sciatic radiation– showed a good to excellent improvement in 86% of cases.1 A follow-up study revealed continued pain reduction in IDD Therapy patients one year after treatment.2
When non-invasive treatments aren’t working
In some cases a patient’s sciatica can be so debilitating that they are not able to begin a physical therapy programme. There will also be patients who have tried non-invasive methods without success. In these situations their GP may feel that steroid injections or even surgery should be considered.
Epidural steroid injections
Epidural steroid injections dispense medication directly to the inflamed area around the sciatic nerve. Although the effects tend to be temporary (providing pain relief for as little as one week up to a year) an epidural steroid injection can provide relief for a short term sciatic episode or for enough time to allow a patient to progress with a non-invasive treatment plan such as IDD Therapy.
When would surgery be considered?
With the exception of emergency surgery in cases of Cauda Equina (see below), infection or cancer, surgical procedures are typically considered when the patient has exhausted non-surgical options and remains in pain and is unable to go about their normal daily activities.
Since spinal surgery carries the risk of infection, failure and a low risk that the spinal nerves will be damaged during surgery, surgeons ensure that the patient is aware of all non-surgical options as well as the relative risks and benefits of surgery.
When sciatica becomes an emergency
In exceptional cases, sciatic pain presents itself alongside other more serious symptoms such as urinaryor bowel incontinence and/or loss of sensation in the inner thighs, buttocks, back of legs.
These symptoms could be a sign of Cauda Equina Syndrome, a relatively rare but serious condition involving loss of function of the nerve roots in the lumbar vertebral canal at the foot of the spinal cord.
Caused by trauma, tumor, infection or herniated disc/spinal stenosis, it is a medical emergency which may require urgent surgical intervention.
References
1 Shealy CN and Borgmeyer V. Decompression, Reduction and Stabilization of the Lumbar Spine: A Cost- Effective Treatment for Lumbosacral Pain. AJPM 1997. 7(2):63-65
2 C. Norman Shealy, MD, PhD, Nirman Koladia, MD, and Merrill M. Wesemann, Long term effect analysis of IDD Therapy in low back pain. American Journal of Pain Management Vol. 15 No. 3 July 2005
To see more IDD Therapy patient testimonials and to find out the location of your nearest IDD Therapy Disc Clinic go to www.iddtherapy.co.uk
