Sciatic_nerve_injury Sciatica is an intense, deep pain that usually affects the whole leg. It can be burning in nature and is usually accompanied by numbness and painful pains and needles. It is caused when the nerves are compressed or stretched locally, either by a disc or by an inflammed joint when there is significant loss of space for the nerve due to degeneration of the disc and facet joints.

Chiropractic treatment looks to reduce stress at the disc by restoring movement to the facet joints at the back of the spine. This reduces stress and shear that gradually makes your disc become weaker and prone to prolapsing. Chiropractic manipulation also helps the muscles to start working properly again to support and protect your spine.

In a study by McMorland et al in 2010 it was shown that patients who are candidates for microdiscectomy of a disc prolapse and have failed to improve with non-operative medical management would benefit by having a trial of Chiropractic spinal manipulative treatment. 60% of cases would get better without the need for surgery and to the same degree as the surgery group. The 40% who didn’t would still have the same outcome once surgery was performed. Therefore in 60% of cases, surgery was avoidable if Chiropractic care was used.

It is possible to treat most mechanical sciatica through Chiropractic care and rehabilitation. However severe cases do require emergency surgery to save the nerves from permanent damage and ease the intense pain associated with this condition. Obviously it’s better to look after your spine and therefore prevent the catastrophe of spinal nerve damage.

What is Sciatica?

Sciatica is pain caused by pressure or inflammation of one of the nerve roots that join up in the pelvis to make up the sciatic nerve. These are the lower lumbar and upper sacral roots. The causes of sciatica are usually mechanical and due to a disc prolapse where material from the lumbar disc leaks out and either squashes the nerve or causes aggressive localised swelling that traps the nerve. Or it can be due to long standing wear and tear changes that cause a narrowing of the canal for the nerve to exit.

A disc problem will typically be worse if you bend forwards or sit, as this puts pressure on the disc. In later life wear and tear narrows the space for the nerves and they can be trapped causing sciatic pain. Symptoms then will typically be worse if you stand upright and reach for a top shelf, or if you walk downhill. It will be eased by bending forwards. Chiropractors are trained to determine which is the cause of your pain and treat accordingly.

70% of disc prolapses will respond to Chiropractic care, the rest will need medical intervention in addition to manual therapy. Usually caudal epidural is sucessful in 60% of cases that aren’t responding. The remainder unfortunately may require surgery. Disc problems are slow to develop and are progressive over time. Gradually the layers of the disc, which are like rings in an onion separate and the disc de laminates and becomes unstable. This process is usually painfree as the disc has no nerve endings or blood supply when healthy or young, the pain starts when the middle of the disc leaks out or the outer disc causes the nerve to stretch around the bulge.

Manual therapy treatment is aimed at getting the bulge to centralise in the disc thereby taking pressure off the nerve. Unfortunately in the same way discs take time to develop they also take time to heal. This is due to the poor blood supply. When a disc has healed there will be an increased likelihood of having pain in later life from the disc itself as blood vessels and nerves can grow into a damaged disc and cause pain. People with this problem find it hard to stand at a sink or ironing board as the pain builds in a dull nature in the lower back.

Years down the line the disc will have thinned and possibly bulged backwards and forwards. This loss of height of the disc means the ligaments kink and this can lead to a narrowing of the spinal canal or lateral canal that the nerves exit from. This leads to pain and cramps in the lower legs when walking or reaching up. It can also show as twitching of the muscles of the calf. If you have these signs you would be best advised to seek treatment and advice as prolonged pressure can lead to permanent damage to the nerves affecting balance and strength.

If you think you may have sciatica call the clinic for advice on 01202 733355, we are here to help you.

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Manipulation or Microdiscectomy for sciatica? A prospective randomised clinical study. McMorland GSuter ECasha Sdu Plessis SJHurlbert RJJ Manipulative Physiol Ther. 2010 Oct;33(8):576-84. doi: 10.1016/j.jmpt.2010.08.013.