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including sciatica advice, advice on sciatica treatment

fromqualified Osteopaths and Physiotherapists.

WE ARE THE ONLY TELEPHONE HELPLINE IN THE UNITED KINGDON OPERATED BY QUALIFIED, PRACTISING CLINICIANS (OSTEOPATHS & PHYSIOTHERAPISTS) SPECIALISING IN BACK PAIN, SCIATICA AND RELATED CONDITIONS.

WE BELIEVE PATIENTS SHOULD HAVE EASY ACCESS TO INFORMATION ON ALLTHE

TREATMENT AND MANAGEMENT OPTIONS AVAILABLE TO THEM.

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Definition of Sciatica and siatica

Sciatica refers to the pain normally felt in the buttock and the back of the leg, usually as a result of a trapping or compression of one or more of the "nerve roots" in the lower back that form the sciatic nerve (nerve root compression).

Common Causes of Sciatica and siatica

The most common cause of this type of nerve pain is a bulging or slipped disc or similar degenerative conditions of the lumbar (lower) spine that put pressure on a nerve root. In addition to the pain, these sorts of problems will often cause numbness, pins and needles and weakness as far down as the foot.

Diagnosing Sciatica & MRI scans

Diagnosis of the cause of sciatica is usually performed by taking a detailed case history and performing specific tests such as testing sensation in the leg, testing the strength of individual muscles, testing reflexes and performing special nerve stretch tests such as "the straight leg raise test". This often enables accurate identification of the exact level of the spine where the compressed nerve exists.

Confirmation of the exact cause and level of the spine that is causing sciatica is normally made by performing an MRI scan (Magnetic reasonance imaging scan). If an isolated disc bulges is found to be causing significant nerve root compression and if this is deemed to be inappropriate or has not responded to a course of physical therapy then minimally invasive spinal surgery techniques have been shown to have a good success rate.

MRI Scan May Not Always Show The Cause of a Patients Symptoms

Sometimes an MRI scan is performed and nothing out of the ordinary is found, or only minor wear and tear changes are discovered that are not severe enough to account for the patients symptoms. Patients can be left in limbo and made to feel that they are malingering especially if there is lack of "hard neurological signs" such as altered reflexes and sensation in the leg. However there may be more than one explanation to account for apparent lack of objective evidence for a patient's sciatic pain.

Upright (weight bearing) MRI Scans

Firstly, one has to remember that MRI scans are commonly performed with the patient lying down, a position in which they are often at their most comfortable. In a lying position there is very little weight or compression exerted on the spinal column, it may be possible that a patients disc only bulges and touches on the adjacent nerve root whilst they are in a weight bearing position such as standing or sitting. In this instance the disc bulge would only be seen on MRI if the scan was performed with patient in an upright position. Although they are not common UPRIGHT MRI SCANNERS do exist, they are increasing in popularity and can reveal problems with the spinal discs that conventional scanners will not.

Piriformis Syndrome or Piraformis Syndrome

Another phenomenon that can mimic symptoms from a slipped disc pressing on a nerve is "PIRIFORMIS SYNDROME". "Piriformis" is the name of a muscle in the buttock. In approximately 20 % of the population the sciatic nerve passes right through the middle of this muscle. If these individuals develop excessive tension in their Piriformis muscle the sciatic nerve can become compressed. As well as causing a sciatic type pain this can result in other symptoms associated with a trapped nerve from a slipped disc, for example pins and needles in the leg. The possibility of Piriformis Syndrome as a diagnosis can be overlooked by GP's and spinal surgeons. This may be because it is not covered in training or due to the facts that Piriformis Syndrome rarely causes altered reflexes, it does not directly involve the spine and very rarely requires surgery. Another reason for under appreciation of this syndrome is that fact that with any low back problem the buttock muscles, including the Piriformis muscle, will very often tighten up in a guarding reaction. Therefore a patient may have a low back problem that is presumed to be causing their sciatica but the buttock tension is be regarded as an effect rather than a cause of their sciatica. The low back problem may not be severe enough to explain the full extent of the patient's sciatica and hence can be the reason for a surgeons reluctance to operate on the spine, the patient may be left to consider spinal injections and pain killers as a way of coping with their pain. However the co-existance of a low back problem in combination with Piriformis Syndrome as a reason for the person's sciatica can be disregarded. Piriformis syndrome can also exist in isolation, without any associated low back problem, this can occur due to overuse and imbalance of the hip muscles perhaps because of poor posture, incorrect sporting technique or as a result of a knee or foot problem. This highlights the need for assessing the biomechanics and muscle balance of the whole body. Certain deep tissue manual therapy techniques, special types of intramuscular acupuncture and muscle re-education exercises can provide very effective relief for Piriformis Syndrome.

Referred Pain May Mimic Sciatica and siatica

A third possible explanation for a person's sciatic pain in the absence of a slipped disc or compressed nerve is referred pain. Referred pain essentially means that the pain is felt in one place but emanating from another. The most common example of referred pain that most people have heard of is pain from a heart attack that is felt in the left arm. Leg pain similar to sciatic pain can be referred from various structures, for example trigger points in the small muscle of the lower back, buttock muscles, spinal joints (facet joints), the sacro-iliac joints and the hip joints. When there are lack of signs of an obvious slipped disc or compressed nerve root examination should include assessment of all these joints.

The truth is that the human spine and the causes of back pain and sciatica are very complex . Even when a distinct cause for sciatica is identified there can be several treatment and management options. Considerable variation even exists within the professions and treatments aimed at tackling back pain and sciatica, such as different types of massage, manipulation, acupuncture, injections and surgery.

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