Sciatica – Symptoms, Causes and Treatments

Sciatica is painful and can be debilitating.  Up to 40% of the population will experience sciatica at some point in their lives.  But, what is sciatica, really?  Is the cause always the same?  Do other conditions mimic sciatica’s symptoms?  Is there help?

We’ve all heard of it.  If you’ve ever experienced it, you don’t want it back.  Sciatica is painful and can be debilitating.  Up to 40% of the population will experience sciatica at some point in their lives.  But, what is sciatica, really?  Is the cause always the same?  Do other conditions mimic sciatica’s symptoms?  Is there help?

What is sciatica?

Sciatica is a term that describes symptoms of pain, numbness, and/or weakness that radiate along the sciatic nerve from the lower back to the buttocks and leg. The medical term is lumbar radiculopathy.

The vast majority of sciatica symptoms result from lower back disorders between the L4 and S1 levels that put pressure on or cause irritation to a lumbar nerve root.

Most commonly, sciatica is caused by a disc problem, such as a herniated disc that is pressing against a nerve root.

It can also occur when a disc degenerates, which releases inflammatory proteins that irritate the adjacent nerve. There are many additional causes of sciatica.

Causes of Sciatica

Lumbar radiculopathy is a separate disorder from piriformis syndrome, although the symptoms may be practically identical.  The most common cause of sciatica is a disc problem, such as a herniated disc pressing against a nerve root.

sciaticaOther causes include degenerative disc and/or joint disease; spinal stenosis (a narrowing of the spinal canal); sacroiliac joint dysfunction; spondylolisthesis – a medical condition characterized by the slipping of a vertebra forward over the vertebrae found below; ankylosing spondylitis – an uncommon type of arthritis that can affect the vertebral column and the pelvis in which the bones of the spine tend to fuse together leading to a rigid spine; muscle strain; piriformis syndrome; pregnancy; poor posture,  spine trauma in the past, as well as remaining in certain positions for many hours during the day while working are all predisposition factors for back problems, including sciatica.

Because the causes of sciatica are different in every patient, the treatment for this muscle straincondition will also be different.  Regardless of the cause, however, sciatica will affect the surrounding musculature, which can worsen the symptoms.

Treatments

Some cases of sciatica resolve themselves within about 18 months.  But, don’t wait to see if that will happen.  It’s important to know what the cause of your sciatica is – a herniated disc is much more likely to resolve, for instance, than spinal stenosis or spondylolisthesis.

Clinical tests for sciatica

Examples of clinical tests for sciatica may include:

  • Straight leg raise (SLR) test. This test includes the patient lying on his/her back and lifting one leg at a time with the other leg flat or bent at the knee. A pain encountered while lifting the affected leg usually indicates sciatica.
  • Slump test. This test includes the patient seated upright with hands behind the back. The patient bends (slumps) forward at the hip. The neck is bent down with the chin touching the chest and one knee is extended to a degree possible. If pain occurs in this position, sciatica may be present.

These tests, however, may be positive only when the sciatic nerve is mechanically compressed at any point along its origin, such as from a herniated disc. Other causes of sciatica such as inflammation or chemical irritation of the nerve may not cause pain in these tests, so it’s important not to self-diagnose the cause of your pain.

spondylolisthesis

Your doctor may recommend various invasive therapies, injections, physical therapy, even traction or surgery depending on the cause of your sciatica.  And, that may be the route you choose.

There are less invasive alternative therapies that may also help.  The National Institutes of Health state that acupuncture is significantly more effective than conventional medication in the treatment of sciatic pain.  Manual therapies can also help you heal.

In some cases, sciatica can be controlled in just a few sessions.  Other more severe causes may require ongoing treatment, or even multiple therapies.  Adding functional and corrective exercises will give you the techniques necessary to help you control your sciatic pain.

The most important consideration is to get you comfortable again, and that’s what I do best.  Regardless of whether you choose traditional massage or the advanced techniques of bodywork therapies, the goal is to get you back to living your best life!

Scar Tissue Affects How Your Body Works

After releasing the scar tissue, I reset her pubus, rebalanced her muscles and watched her awe at being pain free in 8 years.

Last week, I wrote about how “little” injuries can affect your stress levels.  This week, is a twist on that theme.  But, before we start, let me take a moment to remind you that “stress” is not limited to emotional or mental stress, but includes physical stress.

Last week, I saw two clients presenting with dysfunction stemming from the scar tissue of having had c-sections.

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Client I:  Was referred from her chiropractor when adjustments failed to really impact her groin and leg pain.  Her medical doctor had diagnosed her with bulging lumbar discs, and everyone had assumed her pain was “sciatic” related.

Her intake had me questioning whether the disc problem was contributing to her pain, and I was right to do so.  By the time we were done discussing her medical history, I was convinced that much of her pain was due to scar tissue.  Consider for a moment where the incision is generally made for a “bikini” c-section.  Both of this client’s children were delivered by c-section.  Client I is a race-walker and has competed across the country in marathons and half-marathons.  She had to quit due to the pain she was experiencing in her groin and leg.

What I found was the scar tissue from two c-sections was impacting her obliques, medial hip rotators which rotate the hip toward the centerline, hamstrings and peroneals which both point the foot and flex the ankle, lift the outside of the foot and assist in preserving the arch.

Wondering how scar tissue in the lower abdomen could be affecting her lower leg?  Think of ripples in a pond.  I used to be fascinated as a child to watch the ripples in a pond grow after throwing in a pebble:  “When it first starts, you may not even notice how that “little” injury is affecting your stress levels, but over time if not properly dealt with, the effects of that “little” injury grow . . . and grow . . . and grow . . .  Before too long, that “little” injury turns into stress manufacturing pain.”

After releasing the scar tissue, I reset her pubus, rebalanced her muscles and watched her awe at being pain free in 8 years.

Client II:  Has been a massage client for several years.  A nurse, this client often discounts her discomfort as part of the aging process.  She never mentioned having had a c-section, regardless of the numerous intakes we’ve done over the years.  This week she had a new complaint which was a result of a new workstation.  But, it made me wonder . . .

After asking some very pointed questions, I discovered she had a c-section on delivery, and all the puzzle pieces fell into place for me.

The complaint she came in with was in her butt.  Her gluteus maximus, hip flexors, transverse abdominals and rectus abdominals all tested “off-line” or not functioning, while her obliques, gluteus medius and minimus were all taking up the slack of the non-functioning muscles.

After releasing the scar tissue the “off-line” muscles turned back on.  I released the obliques and glutes, then activated the abs, hip flexors and glute max and loved her reaction to feeling the best she ever has!

Both clients had the same underlying reason for their complaints, even though those complaints were very different.

Both clients must do their homework to maintain the improvement.

Is discomfort or pain part of aging?  It doesn’t have to be . . . But, that is a subject for another time.

Lessons from a Broken Ankle: Lesson #1

Our bodies are incredible – truly. They are hard wired for survival. They have automatic responses to prevent and heal injuries. Some of those automatic responses tend to drive us a bit nuts these days, such as mucus buildup; but that is one of the automatic responses our bodies have against pathogens.

In my lifetime, I’ve been sickly as a child, I’ve been injured multiple times, I’ve been a chronic pain patient and a functional quad – and through all of that my body has never failed me. And, it’s not failing me now with my latest injury, my broken ankle.

This aging body of mine still has some lessons to teach me, it seems. And, I’m very grateful that my mind is still willing to learn.

I found it very interesting that when my ankle broke, I felt no pain . . . none at all. I was even able to set my ankle and keep it in place until I got to the hospital and felt remarkably little pain – until the ankle was reduced and properly reset. Wowzer! I felt that right through anesthesia!

The next few days were very uncomfortable while I waited for the swelling to go down. But, within a short period, just a few days, really, I was up and about on my crutches, scooting up and down the stairs on my butt, taking short walks on the crutches outside getting my Vitamin D. I was trying really hard to listen to my body during those days, elevating the ankle when it said “Enough!”, and felt like I was healing well.

And, then . . . <drumroll, please> came the surgery . . . My ankle was healing well, it did not need resetting, and only two of the three fractures needed some help. So my medial and lateral malleolus were plated and screwed (inner and outer ankle bones) – when this heals, I’ll have a bionic ankle. And my surgeon was great – she loaded me up with local, so coming out of general anesthesia I felt pretty good. Until the next morning! And, that’s when I could tell I’d been cut on, drilled into, plated and screwed. Ouch! I took my pain pills and stayed as quiet as I could with my leg elevated for a couple of days.

After my stint as a chronic pain patient, I’d thought I’d learned most of what there was to know about pain, both chronic and acute. Possibly, another of our automatic protective mechanisms kicked in and allowed me to forget some of what I’d learned, or possibly I still had some learning to do . . .

This experience has reminded me how much we are able to disregard discomfort in our bodies. It’s reminded me how sneaky stress and discomfort are. It’s taught me that if you can’t move your body like you did at, say 30 or 35, you’ve got some work to do!

This series of blog articles will be about what this experience is teaching me.

Lesson #1: Slow down!

While I’m not very competitive, I’ve always been an over-achiever. I tend to move quickly and accomplish lots in a short period of time. I might even take a short-cut now and then; as I did the night I broke my ankle – instead of taking the time to put on real shoes, I slipped into flip flops to rush outside to take care of something. Poor choice of footwear . . . they’ve been relegated to dog chew toys . . . Yup, those $100 orthopedic flip flops were donated to Bear and Nala (some of the rescue dogs I work with).

First lesson: Slow down.

Yes, I meditate – not as often or regularly as I used to, or should. Yes, I do Yoga – not as often or regularly as I used to.

We’re all human. We’re flawed. None of us is perfect. We get busy and let things slide. We try to be in too many places at one time. Guilty as charged! And, now I have a couple of months to get back into meditation, and other forms of self-care, while I consider how to move forward from this injury.

One of the best ways to slow down is by keeping a gratitude journal. It makes us focus on the things that feed our souls, keeps us focused on the positive aspects in our lives. From Greater Good in Action, Science based practices for a meaningful life (Berkeley):

TIME REQUIRED
15 minutes per day, at least once per week for at least two weeks. Studies suggest that writing in a gratitude journal three times per week might actually have a greater impact on our happiness than journaling every day.

HOW TO DO IT
There’s no wrong way to keep a gratitude journal, but here are some general instructions as you get started.
Write down up to five things for which you feel grateful. The physical record is important—don’t just do this exercise in your head. The things you list can be relatively small in importance (“The tasty sandwich I had for lunch today.”) or relatively large (“My sister gave birth to a healthy baby boy.”). The goal of the exercise is to remember a good event, experience, person, or thing in your life—then enjoy the good emotions that come with it.

As you write, here are nine important tips:
1 Be as specific as possible—specificity is key to fostering gratitude. “I’m grateful that my co-workers brought me soup when I was sick on Tuesday” will be more effective than “I’m grateful for my co-workers.”
2 Go for depth over breadth. Elaborating in detail about a particular person or thing for which you’re grateful carries more benefits than a superficial list of many things.
3 Get personal. Focusing on people to whom you are grateful has more of an impact than focusing on things for which you are grateful.
4 Try subtraction, not just addition. Consider what your life would be like without certain people or things, rather than just tallying up all the good stuff. Be grateful for the negative outcomes you avoided, escaped, prevented, or turned into something positive—try not to take that good fortune for granted.
5 See good things as “gifts.” Thinking of the good things in your life as gifts guards against taking them for granted. Try to relish and savor the gifts you’ve received.
6 Savor surprises. Try to record events that were unexpected or surprising, as these tend to elicit stronger levels of gratitude.
7 Revise if you repeat. Writing about some of the same people and things is OK, but zero in on a different aspect in detail.
8 Write regularly. Whether you write every other day or once a week, commit to a regular time to journal, then honor that commitment. But…
9 Don’t overdo it. Evidence suggests writing occasionally (1-3 times per week) is more beneficial than daily journaling. That might be because we adapt to positive events and can soon become numb to them—that’s why it helps to savor surprises.

Here’s the link if you’d like more information.

 

Slow down, breathe deeply and be grateful for all the wonderful things and people in your life.
I look forward to hearing how you get on with your journal.