Sciatica - what is it and how to beat it!

In this article we discuss the causes of sciatica and how to reduce your pain or eliminate it completely.

Sciatic pain or sciatica is a term used to describe pain that runs down the leg, typically originating in the low back or back of the pelvis. There are a few reasons someone might develop sciatica; let's discuss what they are and how to eliminate them.

Cause No. 1

Nerve Compression

Compression of nerves can come from discs in the back (or neck in some cases), as well as narrowing of the space (foramen) where the nerve exits the spine, called foraminal narrowing. This is a common cause of sciatica but may not be the only reason for the symptoms. Pain is often reduced with sitting, as it opens the space and then can come on again after a period of standing, as the space for the nerve narrows.

Inflammation around the joint and disc can cause the nerve to become sensitive as well. This is typically diagnosed by clinical tests in combination with imaging such as X-ray, CT scan or MRI. It's important to note, that just because the imaging looks bad, it's not always consistent with the symptoms and so there may be other factors at play. We'll discuss this more later in the article.

Below is a Lumbar spine with narrowing (stenosis) of the foramen, compressing the nerve.

Cause No. 2

Trigger Point Referral

A Trigger Point is a tight band of muscle that is irritable, likely inflamed and in most cases in a degree of muscle spasm. They can be painful, cause stiffness and often cause pain locally or distant from the site. These patterns of referral have been studied extensively and many are usually quite predictable, allowing practitioners to pinpoint the trigger point causing the pain. See the image at the beginning of this article, it shows the pattern of referral associated with Gluteus Minimus - the trigger point is marked with an "X" and the area in red is the pattern of referred pain.

Why do we get trigger points? Fatigue in muscles, a build-up of waste products such as lactic acid and carbon dioxide, poor healing, often due to a lack of nutrition, and an unwell nerve which can be the result of wear and tear in the back - see Cause No.1, Nerve Compression.

Cause No. 3

Lack of healing and nutrient deficiency

Nutrition is the key to good health. This starts with the food we eat as well as the state of our digestive tract. If we can't absorb food properly because of inflammation of our digestive tract, we will start to develop pain and various diseases related to nutrient deficiency. Blood flow is crucial to delivering nutrients to the tissues as well as assisting in the removal of waste products.

However, if the nutrients in our system are low, our healing rate will be affected and our body won't be able to keep up. The most common nutrients that can affect muscle pain are calcium, magnesium, sodium and potassium. Many people either don't consume enough of these minerals or are unable to absorb enough through their digestive tract due to conditions such as IBS, Crohn's disease or gut inflammation due to food intolerances or allergies. Staying well-hydrated is also a very important part of helping the body heal.

Treatment

Reduce Inflammation

Reducing inflammation may involve anti-inflammatory medication such as ibuprofen diclofenac or steroids such as prednisone; painkillers such as over-the-counter medication, prescription medication or nerve blocks such as a cortisone or anaesthetic injection into the disc or joint causing the problem. To reduce inflammation naturally, increasing the intake of omega 3 fatty acids (fish oils, eggs, avacado), tumeric/ curcumin, bromelain (from pineapple), as well as reducing the intake of inflammatory foods such as grains, processed wheat, barley, rye and oats; sugar, alcohol, processed meats and cooked oils (including fried food). Intermittent fasting or time restricted eating can help reduce inflammation, repair the gastrointestinal tract and improve healing.

Exercise

Improving flexibility, strengthening the muscles of the spine, hips and lower leg, walking, swimming, cycling, foam rolling can all help to reduce pain, improve function and make the body more durable and resistant to future injury. As we age, flexibility/ tissue elasticity and strength decline; digestion becomes less efficient, reducing our ability to absorb nutrients and we have accumulated wear and tear in our soft tissues, joints, bones and generally heal more slowly.

Manual Therapy

The goal of manual therapy, such as Osteopathy, is to restore normal function of the blood vessels, nerves, mucles and joints. Improving movement, reducing muscle tightness, improving drainage and blood flow are all key to healing. Soft tissue massage, joint mobilisation (articulation), joint manipulation (clicking), stretching, Trigger Point Dry Needling, TENS (electrical stimulation) are all aimed at reducing the load on the lumbar spine. Often the key to improving the laow back is to get the thoracic spine, hips, pelvis and lower limb moving better, this takes pressure off the low back, allowing the affected tissues, which may be the hip or gluteal muscles, to heal.

Relieving the pressure on the spine and reducing the irritation of the trigger point is by far the most common and effective treatment for most patients. It's also important to keep working on loosening muscles at home with stretches, foam rolling and light exercises to help improve blood flow.

Addressing nutrient deficiencies is also crucial to ensure patients are taking in adequte amounts of nutrients (vitamins, minerals, amino acids, fatty acids) or healing becomes very slow and often results in poor outcomes. In most cases, supplements are required to overcome the poor quality of our soils and lack of nutrients found in our food.

Surgery

In more extreme cases surgery is required to take the pressure off the nerve, caused by the disc or bone growth (osteophyte) at the point the nerve exits the spine. This is a last resort and is something we tried very hard to avoid. Surgery may be preceded by injections into the spine to reduce inflammation (cortisone) or block the nerve from sending pain signals (nerv block). These measures usually just buy time while other treatment is prescibed such as those mentioned above.

The most common indication for surgery is usually after a long period of unsuccessful treatment or a medical emergency, where the nerve is at risk of permanent damage if not relieved. Thankfully this is not a common situation and most patients can manage the situation without this type of treatment.

Sleep

Sleep is an important part of recovery, this is when our body does most of its healing. Fatigue, caused by overworking, physical work or exercise, stress and a lack of sleep will prevent your body from repairing like it needs to at night. Allowing yourself to get run down will not only reduce your body's ability to heal, it will weaken your immune system and increase your risk of cardiovascular disease and obesity. A good night's sleep, reducing stress and eating well can help reduce inflammation and promote healthy, sustained healing at night, known as autophagy.

The correct sleep surface is improtant to provide adequate support for your spine, shoulders and hips, maintain a good posture and aligment and allow you to get four deep cycles of sleep. Restlessness, a sagging or unsupportive mattress, a surface that is too hard will likely lead to pain and stiffness, increased pressure on the hips and shoulders and rotation of the spine. If your bed and pillow are getting old, it's worth considering upating them to give yourself the best chance at a good sleep.

If you have any questions about any of the information in this article, please feel free to contact me via email: info@craigwhiteosteo.com.au or book in for an appointment.