What is sciatica and do I have it?
Sciatica is a word to describe the pain felt when the sciatic nerve is compressed, inflamed or irritated. The sciatic nerve is the biggest and longest nerve in the body, running from your sacrum (lower back) down the back of your thigh then branching off into your lower leg and foot.
Sciatica is a symptom often caused by disc injuries or from during pregnancy. Disc injuries = disc sprain, bulge, herniation, rupture, prolapse or a slipped disc. If this occurs the disc may cause increased pressure on the root of the sciatic nerve where it attaches to the spinal cord.
During pregnancy, sciatica is caused by the growing baby taking up space and putting pressure on the sciatic nerve. However, referral pain in pregnancy can also be from pelvis instability – which has nothing to do with the sciatic nerve.
Home remedies that help
We often get asked if there’s any quick fixes or home remedies that help with sciatica. I’ve heard of all sorts of weird and wonderful theories such as putting your feet in boiling hot water… Unfortunately, there’s no quick fix!
Alternating a hot/ice pack, using each one for no more than 10mins, switching out 4 times (hot for 10mins, cold for 10mins, hot for 10mins, cold for 10mins) can help with pain relief and promote healing in the area – this can be done 2-3 times a day.
What do disc injuries feel like?
Pain = sometimes people feel pain in their lower back, sometimes not. Sometimes people have neuropathic pain down their thigh, into the calf muscle, ankle and foot, and sometimes they don’t. Neuropathic pain is often referred to as ‘sciatica’, which is actually a symptom/result of nerve irritation and feels like tingling, numbness or diffuse/hard to place pain.
Onset = most of the time a disc will become painful with a minor, seemingly insignificant movement such as bending down to tie your shoe. However, this isn’t something that has happened ‘suddenly’ but is rather a result of long-term movement dysfunction. Often people are dehydrated or fatigued when they hurt themselves, changing the functionality of your muscles and discs. Disc injuries can also happen after a traumatic injury like a car/bike/ski accident.
Can Discs heal by themselves?
Yes. In the UK, studies have found up to 82.94% of disc herniations spontaneously reabsorb, prompting the recommendation of conservative treatment over surgery (1). “Conservative treatment” involves a combination of things that are specific to the patient:
1. Modified everyday movement – this means taking some time off work – and gradually returning. No lifting, twisting, bending for a while to help settle things down. Follow our active rest regime to reduce inflammation and pain. The timeframe around this stage varies greatly from person to person depending on adherence and injury.
2. Physical therapy – can help reduce nerve irritation, increase local blood flow which encourages healing, get your pelvis and mid-back moving efficiently to offload your lower back and provide pain relief to help you carry out your exercises effectively. And definitely no lower back clicks!
3. Specific exercises – there’s no ‘quick fix’ or ‘magical back healing exercise’ that works for everyone. This is body/pain/lifestyle specific and needs to be guided by your practitioner as you heal.
Can I have a disc removed?
Discectomy and spinal fusions have varied results, which depend on the different surgical approaches, patient rehab adherence and individual spinal health. One review of the available research that included 90 studies found that 22% of patients had worsening back pain at their one-year review and up to 23% had a reoccurring disc herniation (2).
In our clinic, we see spinal fusions place more load on the joints above, over time leading to more disc injuries, this is called adjacent segment disease and provides even more reason to make changes to your movement habits.
The osteopathic approach looks at addressing why your disc injury occurred. We encourage specific exercises to help increase mobility in hips, mid-back and shoulders to reduce the strain placed on the lumbar spine. We also teach individual muscle activation and hip hinging to techniques to improve the efficacy of movement. At appropriate times in the rehab process exercises such as Pilates, yoga, swimming and weight lifting.
Physical inactivity is linked to poor spinal health and low back pain
There are so many great gyms and fitness clubs in Queenstown and Wanaka – find one that suits you and get moving! Boxing, weight-lifting, Pilates, yoga, swimming, whatever you enjoy and makes you feel good! This will help to prevent disc narrowing, high-fat content of back muscles making them weak and reduce the recovery time if you do hurt yourself.
NB: if you are lifting weights and performing squats/deadlifts etc, remember to take your time, get your form and breathing sorted and gradually increase the weight.
Disc injuries can cause debilitating pain and have a costly, drawn-out healing time.
But disc injuries can also be totally painless.
Scans on people with and without back pain have found spinal degeneration and disc damage present in both groups (4). Similarly, those in pain can have a disc injury at a different spinal level to what their symptoms would indicate. Confusing indeed.
After a scan, conservative management is usually recommended initially, with surgery being a last resort.
What’s the benefit of a scan?
Scans should be reserved for the obscure pain presentations that your health practitioner is struggling to identify, or for serious presentations/injuries. Most disc injuries present clearly and are easily diagnosed by your osteopath/physio without needing a scan. However, we find that patients don’t take their rehab seriously until their pain is confirmed by a scan. Resulting in unnecessary scans, clogging up the system and increasing wait times.
Where do I start?
Initially, you’ll likely be too sore to do much. Follow our active rest regime to help reduce pain and inflammation.
Then work on increasing your flexibility in your hips and mid-back and strengthening your core and glutes. If you feel any increased pain in certain movements, stop the exercise and consult your practitioner. The sheets supplied are best guided by a practitioner or trainer.
Be patient! Disc injuries can take up to 18months to heal depending on the extent of the injury.
1. Zhong M, Liu JT, Jiang H, Mo W, Yu PF, Li XC, et al. Incidence of spontaneous resorption of lumbar disc herniation: A meta-analysis. Pain Physician. 2017;20(1):E45–52.
2. Parker SL, Mendenhall SK, Godil SS, Bs S, Cahill K, Ziewacz J, et al. Incidence of Low Back Pain After Lumbar Discectomy for Herniated Disc and Its Effect on Patient-reported Outcomes. Clin Orthop Relat Res. 2015;473:1988–99.
3. Teichtahl AJ, Urquhart DM, Wang Y, Wluka AE, O’Sullivan R, Jones G, et al. Physical inactivity is associated with narrower lumbar intervertebral discs, high-fat content of paraspinal muscles and low back pain and disability. Arthritis Res Ther [Internet]. 2015 Dec 7 [cited 2019 Dec 31];17(1):114. Available from: http://arthritis-research.com/content/17/1/114
4. Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. Am J Neuroradiol [Internet]. 2015 Apr 1;36(4):811 LP – 816. Available from: http://www.ajnr.org/content/36/4/811.abstract
Osteopath, Herbalist, Western Acupuncturist & Psychosomatic Therapist.
Jin is an intuitive therapist with 12 years of clinical experience. Her passion is the mind-body connection and how our physical body is a manifestation of our emotional state. She loves to get to the root of people's issues by delving deeper.
Jin's areas of special interest are frozen shoulder, jaw pain, sacro-iliac joint pain and pregnancy related issues.
Favourite technique: Jin uses a variety of treatment modalities but her favourite for getting results is dry needling and psychosomatic therapy.