Hello and welcome to Chiro Corbin’s Chiro Blog!

This next instalment is all about leg pain, what can cause it, when you need help, how you can help yourself and what we at Corbin Chiropractic can do to help.

As a Chiropractic physician, patient’s coming to see me because they have leg pain is a regular occurrence, especially with associated back pain. In fact patients often come in and say to me Dr Corbin I have sciatica. I will always ask Ok so what is causing your sciatica? and every time without fail they will say well it’s an entrapped nerve isn’t it? And well yes it often is but its important to know where and why the nerve is entrapped.

The problem with the word sciatica is that it is an umbrella term used

to describe leg pain, it can be caused by many different things which it is often a nerve entrapment but can be somewhere located anywhere between the lower back and the buttock area. Sciatica can be debilitating, it can sometimes be a dull and mild ache or can be something more serious in rarer cases. The idea of this blog is to educate you on when you should see someone and the steps you can take to get all the information you need to get the best help that you can get. Below are 5 potential causes of sciatica that can cause leg pain, this is a general overview as it is a large subject area. We use an in depth physical analysis and case history to try and pin point what is exactly causing the pain and develop a treatment plan to suit the diagnosis and the patient. Sometimes surgery is needed but more often than not we treat most patients successfully in a safe and effective way.

Disc herniation

These are not uncommon at all in a chiropractor’s office, and although it is not a very common cause of sciatica chiropractors seem to see it quite a lot. What happens is the disc between two spinal bones called vertebrae are damaged (can have many different damage sites). Within the disc itself is a toothpaste like substance called the nucleus pulposus, when the outside of the disc splits from either injury or age related degeneration it releases or squeezes out this toothpaste like substance, which can cause a chemical irritant to affect a nerve called the sciatic nerve. The disc can also narrow causing the two spinal bones to become close together which can also entrap this large sciatic nerve. This nerve controls leg movement and allows us to sense our environment, and it is that same nerve that causes the intense pain often associated with sciatica. There are other reasons why the disc can be damaged such as degenerative disc disease (DDD) but this will be covered in another blog as it is another large area to be covered. This blog like I said is a quick(ish) overview.

Signs and Symptoms?

• Radiating pain from the buttock area to the back of the leg and sometimes to the bottom of the foot, sometimes also felt in the groin

• Pins and needles on the effected side along with sensation loss

• Tightness within the muscles and weakness of some leg muscles

• Sharp pain followed by a constant dull ache and back to a sharp pain

• Lower back pain

• Loss of lower leg reflexes

• Loss of bowl and bladder control in more serious cases (read cauda equina).

Treatment?

• Flexion/distraction – This is a technique to open up the joints to take pressure off of the nerves being trapped, it also mobilises the spine to increase function and joint health. This technique also stretches the structures around the joint to help reduce pain.

• Acupuncture – The needles used can help pain levels by stimulating certain nerves, releasing pain combating chemicals while at the same time relaxing the muscles that can become tight through tensing from pain and the body tensing as a protective mechanism.

• Stretching – Muscle energy techniques can be used to relax muscles also getting the patient to be active in their care by gentle stretching and keeping them as active as possible.

• Chiropractic adjustments – Applying a low amplitude high velocity thrust can put the joint back into the right position taking pressure off of the nerves.

Facet syndrome

This is not an obvious cause of sciatica but an important one none the less. This is a problem within the joints of the spine again but this time within the facets. As you can see from the diagram this is where two vertebral bones of the spine articulate or join together (zygapophysial joints). These joints allow movement but also help us from moving too much. Although it is less comon to get leg pain from facet syndrome it does and can happen. You could compare it to twisting an ankle except it is like a sprain in the spinal column. Once these joints go beyond their normal range of motion the joint capsule is over stretched as too are the muscles causing pain and irritation. The facet joint can also be set out of place which places more strain on the spinal column, muscles and the nerves. This

twisting motions and movements.

Signs and symptoms?

• Sudden pain from a quick movement like twisting

• Increased pain from sitting or standing in the same position for a long time

• Pain extending backwards and to the side

• Stiffness in the mornings

• Referred pain to the buttocks, groin and back of the leg of the side effected, not usually to the foot

• In more extreme cases nerve damage

Treatment?

• Chiropractic adjustments – this will help put the joint back to its correct position taking strain off the muscle and nerves

• Posture correction – often spinal injuries are occur from poor posture leaving the spinal column at an increased risk of injury

• Strength exercise – By increasing strength, the spine becomes more protected, exercise has also shown to reduce pain.

• Dry needle techniques – As mentioned before the needles entering the skin, fascia, muscles and nerves stimulate a pain reducing response.

• Stretching – Stretching increases the function of the muscles, injuries can occur from muscles being tight alone and we all know that when a muscle is stretched too quickly it increases the risk of a tear.

• Prevention – Educating the patient on how to get out of bed in the mornings, warming up before exercise and eating for a healthy life.

Sacral iliac joint dysfunction

Again this may be a cause not many people would think of and is in a way similar to facet syndrome except it involves the sacroiliac joints of the pelvis. The sacrum is a wedge shaped bone that allows the pelvis to attach to and lock together, it is very much like a keystone with gravity and upward forces helping to lock this joint together with the muscles and ligaments binding it together with extra protection and function. These joints can be affected from pregnancy, falls on the buttock, age related degeneration, hyper/hypomobility and muscle imbalances. Once these joint become out of balance it can cause a cocktail of other dysfunction within the body. There is a minimal amount of movement in this joint but just enough for it to become locked up, twisted and

sprained.

Signs and symptoms?

• Buttock pain

• Lower back pain

• Pain when walking up a hill or stairs

• Prickly leg pain (back of thigh)

• Insomnia and sometimes depression

• Sharp stabbing pain to a dull ache

Treatment?

• Chiropractic adjustments – Correcting the position of the pelvis will dramatically help with pain

and more importantly function.

• Muscle balance – Often the muscles surrounding the pelvis need a lot of attention, whether correcting a leg length problem or weak muscles that need rehabilitating it can take time to correct the cause of the problem.

• Posture correction – As mentioned before poor posture affects the whole spine, if the pelvis is rotated forward too much and for a long period of time it strains the sacral iliac joint, fatigues the muscle quicker and eventually leads to micro damage which in time turns into noticeable pain and dysfunction.

• Spinal stabilization – This may sound fancy but really we just want the spine working in the right way, once this is achieved pain will be less and there will be less chances of reoccurrence in the future.

• Prevention – The whole idea of chiropractic is to help people not be in pain in the first place, this is why you do not need to be in pain or injured to see us. We could point out weaknesses that suggest injury in the future is possible so correcting any dysfunction before the signs and symptoms happen would be a great way to serve the community.

Piriformis syndrome

It is believed in 17% of people have this problem whether it causes sciatica symptoms or not. A muscle situated on the back of the pelvis under the buttock muscle lies the piriformis. This muscle helps your leg rotate outwards and helps you bring your legs together when in a seated position. It is believed that the large sciatic nerve pierces through the piriformis muscle when it should lie underneath. This can cause pain if the piriformis muscle is causing the sciatic nerve to be trapped and unhappy. It is also believed that a tight piriformis muscle can still have the same effect even if the sciatic nerve does not pierce through the muscle. Either way this muscle should be treated on both sides to create balance.

Signs and symptoms?

• Buttock pain that can radiate down the leg

• Leg tightness

• Tingling on the back of the thigh

Treatment?

• Massage and muscle release – Helping the piriformis muscle to relax is the most important in the first phase of care as it is the primary cause

• Acupuncture – This will decrease the tone of the muscle taking pressure off the sciatic nerve

• Correcting posture – if one leg is longer than the other then muscles on one side will be working harder and the other side less. You can imagine where problems can occur and it usually occurs in the upper leg muscles and buttock area.

• Adjustments – These help correct the pelvis which in turn can help the legs be of equal length which in turn will help muscles to work symmetrically together. This would take pressure off of the piriformis muscle in turn reducing pain.

Trigger points

I don’t see it every day but it does happen when a trigger point refers pain like a sciatica pattern. What is a trigger point? Well it is a much discussed and investigated and researched topic. Imagine a muscle with the skin taken away, you will see 100’s of not 1000’s of muscle fibres that make up the belly of the muscle. Sometimes the muscle can become weak, overused, injured, diseased or dysfunctional. This is when a trigger point can appear. Some fibres of a muscle can become contracted or tied up, as this happens blood supply is restricted and our amazing brain sees this as pain. Trigger points are fascinating and there are many different types. The worst ones can cause a constant pain and even though a trigger point is located in the buttock muscle it can refer pain down the leg causing a sciatic type pain. These tiny little knots can cause much bigger problems as they can be hard to treat and sometimes hard to find. The beauty of chiropractic is that we are trained to hunt these down because of there importance, in fact many patients reporting of joint pain have been miss diagnosed when all along a trigger point was referring pain to this area. A better prognosis for a patient but it is imperative to do an exhaustive examination to get the most accurate diagnosis.

Signs and symptoms?

• Burning, hot, cold or prickly pain

• Feeling of weakness in a muscle

• Feelings of pain outside the body

• Pain in the buttock that refers down the back of the leg

Treatment?

• Trigger point therapy - By applying pressure to the area they will often dissipate

• Acupuncture – a great and effective way to release the fibres in the muscle belly to relax

• Ice – Ice would be used in all of these conditions which helps reduce inflammation.

• Stretching – By stretching the muscle the muscle fibres elongate, so if some fibres have become contracted a good stretch will help iron out the muscle.

• Ultrasound – The evidence is weak but many professionals swear by ultrasound as it is believed the sound waves are used help restart the healing process of the soft tissues.

• Exercise – Yep we always come back to exercise as it stimulated bodily functions including the nervous system. Exercise releases the happy chemicals, combats pain and it is believed trigger points are often caused from a sedentary lifestyle.

Cauda equina syndrome

This is one of the more serious causes of sciatica and is something that needs immediate attention. There are a variety of causes from urgent to very urgent. Cauda equina occurs when there is damage or impingement to a group of spinal nerves in the lower back. This is called the lumbar plexus and is a complex network of nerves that supply all of the lower body. In serious cases it can be the formation of a tumour compressing the nerves, in other cases it can be severe spinal degeneration where bone growths can pinch and damage the nerves causing cauda equina. Other cause like spondylolisthesis where a malalignment of the vertebrae squeeze the spinal cord cutting off nerve supply or spinal stenosis when the canal that the spinal cord sits in grows extra bone causing damage to the nerves and again cutting off nerve supply. Now this condition is again an umbrella term which has many causes, you see how confusing just one word sciatica can be? It can be caused by many different things and those different things can have other different things, get your brain around that one! Luckily this is much rarer than the previous causes of sciatica but we do treat it as a medical emergency.

Signs and symptoms?

• Progressive leg weakness – As the nerve(s) become more damaged the legs become weaker until they no longer work or able to hold you up.

• Loss of reflexes – Often the legs lose reflexes (where the Dr taps your knees with a rubber hammer) either on one side or both.

• Pain in the legs – unlike the previous conditions leg pain can affect both sides rather than one

• Incontinence – Loss of the ability to control urination or defecation

• Erectile dysfunction/sexual dysfunction – Loss of the ability to gain an erection, for females loss of sensation.

• Saddle anaesthesia – Numbness and loss of feeling of the buttocks and groin area. Pins and needles in these area too

• Sever back pain – Increasing back pain with sciatic type pain usually on both side

Treatment?

• We treat this as a medical emergency and would refer straight to hospital

• Depending on the cause, operation, radiotherapy, extraction, decompression or medication may be used.

As we reach the end of this leg pain blog I really do hope you have gained some valuable information and have the knowledge and power on what to do next. In most cases sciatica is treated to a very successful rate with chiropractic and other physical therapies. We study for a long time to be able to know what to do, and for you as the patient to get the most out of this by gaining the knowledge and learning about your condition(s). This is the power of prevention. Living in a pain free life is a happy life but let’s hope you understand that pain is the last sign of a condition like sciatica. Generally people get a twinge here and there and think well it’s gone now it must be better. Well yes sometimes this is true but your body is very cleaver indeed, your body often tells you when something is wrong whether it’s a few seconds of feeling faint, a sharp pain that comes and goes as quickly as you can eat a biscuit, or that dull ache in your back that lasts a week but then disappears for a few months. It all builds up until something gives and then you arrive in the Dr’s office. I recommend you see someone before it gets to that point, in the long run it saves you a lot of money, in the long run you get a healthier you, less days off work and in pain and you help fund us on researching more on how the human body works which tells us what we can do next in the evolution of chiropractic!

Until next time

This is Corbin’s Chiro Blog

McMorland, Suter, Casha et al. (2010). Manipulation or Microdiskectomy for Sciatica? A Prospective Randomized Clinical Study. Journal of Manipulative and Physiological Theraputics, Volume 33, Issue 8, Pages 576-584

#sciatica #backandlegpain #radicularpain #Discherniation #discbulge #radiculopathy #tinglinginthelegs #buttockpain #footpain #incorrectposture