Back Pain or Sciatica

Do you suffer from Back pain and Sciatica?

Lower back pain causes more disability, worldwide, than any other condition (3) and is the single largest cause of disability in the UK. Lower back pain alone accounts for 11% of total disability of the UK population (2). In addition, the  prevalence of sciatica ranges from 1 to 5% (3) in the UK.

What is back pain and sciatica?

Most people will either know someone or have personal experience with back pain and/or sciatica, but what is it exactly? Simply put, Sciatica is when the sciatic nerve, is pinched, irritated or inflamed causing a pain and/or numbness and tingling in to the back of the leg.  The sciatic nerve branches out of the lower back and sacrum and travels all the way down the leg into the foot.  It is commonly caused by inflammation or compression of the lumbosacral nerve roots (L4-S1) forming the sciatic nerve (1). The severity of symptoms can vary from mild discomfort to severe pain and associated with extreme limitation in movement. It can have a significant impact on your day to day activities and quality of life.

How do people feel with back pain and sciatica?

Back pain and sciatica are a common reason to visit a Chiropractor and people can present with aching and/or sharp pain that radiates into the leg, which can be below the knee into the foot and toes. When someone has pain that travels into the back of the leg into the foot and toes, commonly a disc between L5 and S1 has been injured (8) (disc herniation). If someone has pain that is more on the front and side of the leg with the similar symptoms as sciatica then it is likely the femoral nerve that has been injured. Symptoms such as numbness and/or tingling with or without loss of muscle strength would suggest a nerve injury. The symptoms can slowly develop over time or they can appear suddenly, with the severity of pain varying too.  It is not uncommon to  have existing lower back pain before the leg symptoms appear, however, this is not always the case.

What causes back pain and Sciatica?

There can be many causes to back pain and sciatica ranging from trauma from an accident, to micro-trauma from physical work or sitting too much on a daily basis. This stress and injury, if too much or repeated regularly, can be the cause of your back pain and sciatica. This is how the back and sciatica nerve most commonly get injured. Another cause could be by degenerative changes (arthritis) in the low back. This tends to be more of a gradual onset, with a typical long history of recurring back problems. Over time the spine adapts to the reoccurring injuries or wear and tear to the back and eventually results in a more sustained injury and compression to the spinal joints in the low back and sciatic nerve. Some less common causes can be cysts, tumours, infection and other diseases. This is why it is important to get to the root cause of the problem to rule out any serious diseases.

How can Chiropractic help with back pain and Sciatica?

Identifying the cause of your back pain and sciatica should be your first step. This will allow you to find the right solution to get you better as soon as you can. A full assessment on your lumbar spine (lower back), which should include range of movement testing of your spine, specific orthopaedic tests to assess the function of the lower back and sciatic nerve and an x-ray may be required based on your history and your exam results.  This will give you a better understanding of what is causing your symptoms. Once the cause has been identified, then the best treatment will be recommended to get you better. Based on the national institute of clinical excellence (NICE) guidelines, manual therapy (Chiropractic) along with exercise is recommended to best treat and improve back pain and sciatica (3).

A Chiropractor is trained to fully assess the spine to identify any abnormalities, which could be causing your back pain and sciatica. The aim of Chiropractic is to relieve any pressure and stress to your spine by adding motion (adjustment) back into specific spinal joints. Adding motion back into the spine will then allow the site of injury to heal and restore itself back to normality. This will reduce your symptoms and improve your mobility in the spine. It will be encouraged that you continue with your daily activities and movement as best you can but this can be different in each case. In some instances , a referral out to another Doctor will be recommended if the Chiropractor thinks if may need further investigation.

References:

1. Valat JP, Genevay S, Marty M, Rozenberg S, Koes B. Sciatica. Best Pract Res Clin Rheumatol 2010;24:241-52.
2. https://www.england.nhs.uk/blog/charles-greenough/
3. National Institute for Health and Care Excellence (NICE):Low Back Pain and Sciatica in Over 16s: Assessment and Management NICE Guideline, No. 59 2016 (Nov): 1-18
4. Ailianou A, Fitsiori A, Syrogiannopoulou A, etal .Review of the principal extra spinal pathologies causing sciatica and new MRI approaches.Br J Radiol 2012;85:672-81