Treatment For Sciatica In Cardiff

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Sciatica, aka, a pain in the a**!

Sciatic pain is pain that can start from one side of the lower back that can travel into the buttock area, back of the thigh, and all of the way to the calf and foot. It may cause groin pain in some people also. It is an unpleasant issue that can vary in severity from mild to excruciating. There are many causes of sciatic pain and most cases can be helped with chiropractic, exercise, medication, lifestyle adjustments, and in some cases surgery. It can be insidious meaning it can start for no reason. Traumatic such as sudden pain when picking something up from the floor, or disease driven. Whether that is a systemic issue like diabetes or diseases of the spinal structures. Most cases are traumatic with joint issues following behind. This is a long but hopefully in-depth explanation of sciatica. Grab a cup of tea, take a deep breath, and educate yourself on the diverse nature of sciatica.

What causes sciatic pain?

Sciatica is an umbrella term for a host of symptoms rather than a diagnosis. Sometimes there is one cause and other times there are multiple causes. It is estimated that 5-10% of people with back pain have sciatica symptoms. It is also estimated that 90% of people with sciatica have a disc herniation. The sciatic nerve is a long nerve that exits the spinal cord and forms different branches. This large nerve is responsible for the movement of muscles and the sensation of the skin. Injury to the nerve can cause sciatic symptoms, some diseases and even some muscles can cause these symptoms. Next, we are going to go through all of the causes that cause this unpleasant issue.

Disc herniation: A spinal disc is a robust rubbery structure that pads the spinal segments and allows movement and stability. It creates a space between the joints which also gives the freedom of the lower back nerves to travel out of the spine. When this disc has an injury or age-related wear and tear then the sciatic nerve can become compressed or injured. The disc can either lose its height and become dehydrated causing compression of the sciatic nerve. It can also create a bulge, like squeezing a balloon putting pressure onto the sciatic nerve. When this happens chemicals are released that aggravates the nerve causing sciatic-like symptoms. Chiropractic treatment here in Cardiff can make a dramatic difference to pain levels. An in-depth examination will test the nerves and joints to see what is causing sciatica. Treatment may involve acupuncture, muscle relaxation techniques, joint mobilisation, and specific exercises are given to reduce symptoms and strengthen the area that could be causing the issue. Left untreated it can become chronic, it is important to be seen if symptoms have not resolved on their own in 6 weeks. Often medication is given to mask the symptoms while a disc heals but this can cause other problems like drug addiction. 30% of people with sciatica will get persistent symptoms, 5-10% will go on to have surgery. It is reported that 90% of people have relief from surgery but a percentage will have symptoms return after 4 years. In rarer cases, a disc herniation can compress both sides causing sciatica on both legs. Most disc issues can be diagnosed here at the clinic but sometimes a referral for an MRI is needed which is the most specific imaging technique to diagnose a disc herniation. The good news is the majority of disc issues resolve on their own, it is important however to get it looked at in good time to stand the best possible chance of recovery.

Degenerative disc disease (DDD): Is another cause of sciatica. When the spinal discs narrow there is an increased chance of nerve compression. DDD sounds like a nasty disease where in fact, it is simple age-related wear and tear. It is what happens to all of us as we get older. The same as getting grey hairs and wrinkles. Movement and keeping active is the single most important thing we can do for this issue. In fact, recent research shows that taking up running can help DDD. But, we need to start gradually and build up so that the body can adapt to change and get stronger. Our Cardiff chiropractic treatment can help with this issue by releasing joint tension. Giving the right exercises and advising on home care. Bed rest is out of the window sadly. The longer we stay static the worse the pain can get. Most of the pain is muscular in nature and muscles need movement for optimal health. Motion is lotion!

Piriformis syndrome: Piriformis syndrome is often missed in the medical world because it can mimic a disc herniation and other causes of sciatica. Here at our Cardiff clinic, piriformis syndrome is a fairly common cause of sciatic pain. The benefit of going to a manual therapist is that much of our education is about being thorough. A full examination looks at all of the areas that can cause sciatica and we can then compose a course of treatment for that specific diagnosis. The piriformis is a muscle deep in the buttock area. Underneath the piriformis muscle, directly lies the sciatic nerve. An injury, repetitive strain, and an anatomical anomaly (primary cause) where the sciatic nerve pierces through the muscle can cause sciatic pain. Macro trauma can cause inflammation and irritate the nerve. An overly tight piriformis can cause sciatic pain also (secondary cause). “A total of 2910 patients with the complaint of low back/buttock pain with sciatica attended outpatient department (OPD) of Orthopedics and PMR Department, RIMS, Imphal between September 2010 and August 2012. Age range was 15-81 years. A total of 182 cases were clinically diagnosed as piriformis syndrome.” It is thought that women are affected more than men due to wider hips and biomechanical differences in walking (gate) and there can be an increased risk during pregnancy. In rare cases, a mass or lesion can cause compression in this area causing sciatic pain. Symptoms are aggravated with sitting for longer than 20 minutes as the increase in pressure heightens sciatica symptoms. Pain and numbness around the pelvic area on one side, buttock, and back of the leg are common. Weakness and numbness of the foot occur in more severe cases or if left untreated. Some women may feel pain during intercourse (dyspareunia) and pain may be felt with both men and woman when emptying their bowels. The buttock area may feel tender to touch, hot, and increase with certain hip movements. Burning pain is common too. This issue is related closely to the sacroiliac joint. Torsion of the pelvis can cause a muscular imbalance resulting in piriformis syndrome. Hip stiffness can also be a contributing factor. If this issue becomes chronic then lower back, mid-back, and neck pain can result due to compensation patterns. This is the beauty of chiropractic, in that knowing the body and how it moves and reacts to the trauma we can try and prevent a cascade of issues in the future. Treatment is to find the main causative factor. Some cases may be sent for imaging to investigate further but in most cases, we see resolve after 4-8 treatment sessions. Manual manipulation of the piriformis muscle helps reduce pressure and sciatic symptoms. We will most likely look at compensation patterns and work on the body globally. Exercise therapy is also essential. Strength training of the gluteal area has been shown to dramatically help and resolve piriformis syndrome. Other options are steroid injections and/or surgery to decompress the area. Home care such as ice and heat and home stretching can also bring relief. As with most musculoskeletal issues pain medication is only appropriate for short-term use. Many cases resolve on their own but when they do not, intervention is needed to bring back a quality of life.

Trigger points: Are a tight band of muscle within muscles that have become hypersensitive. The gluteal muscles are the main culprits. A trigger point can be felt by the fingers. Generally, the muscle will feel tight with certain areas making discomfort spread to other areas of the body. In this case, gluteal trigger points can cause sciatic types of symptoms. You can also find them in the lower back that refers to the back of the leg and foot. Treatment is easy for this issue. Compression and acupunture work very well to reduce and de-stimulate the trigger point. Stretching and strengthening also work wonders to reduce pain. Home care is given to prevent them from coming back in the future. Physical and emotional stress are believed to be common causes of trigger points. Learning to deal with stress in a healthy way works for most types of pain.

Posterior Facet Syndrome: The facets are part of the intervertebral joints to help aid in stability and form the structure of the spinal joints. If there is dysfunction or irritation in the facet joints they can cause lower back pain and also a referral pattern of pain into the buttocks and down the back of the thigh. Generally, the pain stays above the knee with posterior facet syndrome. A capsule surrounds these facet joints that can become stiff, swollen, inflamed, and even have micro-tears, releasing pain chemicals causing sciatic type pain by irritating the never root at that level. The most common cause is repetitive microtrauma through repetitive extension movements. Treatment involves prescribing the right amount of rest, finding a comfortable seating position, and manual treatment. Again bed rest is a no-no, and specific exercises are needed to retrain the lower back and build strength and flexibility. In its early stages X rays will show little in the way of abnormalities, MRI may still even struggle to find relevant changes that could be causing pain. A nerve block is the most effective way to show posterior facet syndrome, by a 50% reduction after the injection. This issue can come and go, but with chiropractic, treatment is effective at diagnosing posterior facet syndrome through an in-depth examination, lifestyle changes, and giving the right exercises to help reduce pain.

Sacroiliac joint (SIJ) dysfunction : SIJ pain represents 15-30% of mechanical lower back pain. The SIJ is a part of the pelvis and acts as a center point of gravity of the skeleton. It acts as a shock absorber for motion and impact such as running and jumping. The SIJ area is filled with muscles and ligaments that can all potentially cause SIJ pain. It is believed that a misalignment of the SIJ can cause pain, or hyper/hypo motion of the SIJ. Many studies show that the SIJ is in a fixed position which negates the hypo/hyper theory. People aged 50+ generally have a fused SIJ and the younger population generally do not get affected by this issue. A sedentary lifestyle is the biggest cause for pain, followed by pregnancy, followed by trauma. Here in the Cardiff clinic, SIJ pain is very common and more so in women and even more so in women who are at the end of their pregnancy or a few months post post-partum. Pain can be felt as a dull ache around one side of the lower back, into the buttocks, and also the posterior thigh through hyper-stimulated nerves (posterior sacral ramus), the groin, and the top of the foot. Pain can be sharp with movement and can feel incredibly debilitating. The pain can be constant or may come and go. SIJ pain is usually one side but has been known to switch from one side to the other. People report that long hours sitting down, extension (bending backward), and rolling over in bed at night can make SIJ pain worse. Chiropractic diagnosis and treatment is effective at normalizing movement. Often a muscular imbalance is found causing SIJ pain. We assess everything from the ankle up and from the neck down. We also look at how old a mattress is, fitness levels, mental state, and previous history of trauma. Spinal manipulation seems to have a better effect than anything else. The patient normally feels improvement after a couple of sessions. If SIJ pain has been long-standing then it may take longer. SIJ pain as mentioned can come and go so patients with this issue are recommended maintenance sessions to keep it at bay. Specific exercises are given to help balance the body with flexibility and strength. If treatment is not successful then a steroid injection may be used and in severe cases surgery.

Sacroiliitis: Vary similar to sacroiliac joint dysfunction but differs as it is an inflammatory issue rather than dysfunction. Sacroiliitis is much less common and more long-standing. It is classed as a Spondyloarthropathy, which means a disease enforced degeneration of a joint. Pain is pretty much identical to SIJ pain so it can be tricky to determine the root of the issue. We ask questions about recent illnesses and infections, changes in weight, appetite, fevers, and chills as it can be caused by a bacterial infection. An X-ray would be the first port of call if we suspect sacroiliitis. Rest, medication, steroid injections, and physical therapy is used in the first line of defense. Pain management can also help in long term cases. This issue in most cases resolves.

Cauda equina: Cauda equina should be treated as a medical emergency. I have had a few cases that have come into the clinic that I referred to A&E straight away. The Cauda equina is a bundle of nerves in the lower back that looks like a horsetail. If compressed it can cause leg pain, weakness, numbness of the buttocks, and groin and can also affect the bowels. Losing control of the bowels is a telltale sign of cauda equina. This is not an issue chiropractic should be dealing with.

Spondylolisthesis: A bit of a tongue twister, Spondy-lo-lis-thesis is a slippage of a spinal segment. If one spinal segment slipped too far forward then cord compression may cause leg pain on both sides. It can go undiagnosed for years but it is often picked up at clinic with a clinical finding of a step defect. We would send off for an x-ray to see the extent of slippage. In most cases no more is needed unless neurological symptoms are apparent. Hypermobile patients can suffer from these issues, especially gymnasts and any sport that involves extreme flexibility. We do treat these issues to help stability and mobility.

Trochanteric Bursitis: “itis” means inflammation. The bursa are small fluid-filled slippery pouches or sacs that allow tendons to run over bone smoothly as well as creating less friction and absorbing shock. The trochanteric bone is a large bony prominence located at the side of the hip where the bursa lie. There are three main bursae in and around the hip area. 1. The trochanteric, 2. iliopsoas, and 3. ischial. These bursae can become inflamed causing pain around the side of the hip and buttock area as well as the groin. There is two bursae at the greater trochanter. The subgluteus medius bursa and the subgluteus maximus bursa. There are many reasons why the bursa can become inflamed. Being overweight, trauma, repetitive strain, women are affected more than men especially during pregnancy, a tight ITB (iliotibial band), poor footwear, flat feet, muscle imbalance, osteoarthritis, infection, and hip replacements. Our assessment would give us a good idea of the cause along with a patient's case history. The sensations of pain can feel like a dull ache, sharp and burning around the hip and buttock area. Pain may radiate down the leg also causing sciatica due to hypersensitivity of the structures. People may feel a snapping sensation on the side of the hip when walking which would indicate a tight iliotibial band. Lying on the affected side will increase pain, lower back pain, and pain walking up the stairs. Assessing the hip is usually enough to diagnose this issue. A diagnostic ultrasound can also be helpful if the patient chooses to use shockwave therapy or if the issue needs looking at in more depth. Most cases will resolve with modifications in their lifestyles, stretching, strengthening, and treatment. Steroid injections can be beneficial. In some cases, surgery is needed and in very rare cases sepsis would need hospital admission and referral to a specialist.

Diabetes: Diabetes occurs when we cannot regulate the sugar in our blood very well. If blood sugar is at a raised level for an extended period then it can cause damage to nerve fibers. When the hands and feet are affected by this nerve damage it is called diabetic neuropathy. A diabetic neuropathy can have the same symptoms as sciatica but in most cases, it affects both sides. Diabetic neuropathy generally has a glove and stocking type of pattern. It is likely other symptoms would have occurred before sciatic-like symptoms such as increased thirst, unexplained weight loss, and increased urination. If you have any of these symptoms go to your GP and get a blood test. If diagnosed early, diabetes can be well managed. If left untreated it can affect most organs in the body and increases the likelihood of early death.

These are the main and most common causes of sciatica. Rarer causes are kidney stones, spinal infection, spinal tumors, spinal fractures, MS (multiple sclerosis), fibromyalgia, motor neuron disease, and anatomical irregularities. With these conditions, other symptoms would be felt first and the sciatic pain would come at a later stage, in most cases. Always listen to your gut. If something does not feel right book an appointment with your GP.

What are the symptoms of sciatic pain?

Symptoms of sciatica can vary from person to person, from mild to severe. Below are common symptoms of sciatica.

Sharp or dull pain, the ache of the lower back, buttocks, groin, and or back of the leg. On one side in most cases.
Increase pain when sitting and or bending forward.
Burning, pins and needle sensations felt at the back of the leg, calf, foot.
Pain getting up from sitting
Pain rolling over in bed at night
Back pain going up or downstairs, or pain worse with walking
Night pain, if night sweats are reported then referral is needed.
The leg can feel heavy
The leg can feel like it is dead
Loss of bowel and bladder control in rare cases (get this checked straight away)
Loss of sensation compared to the other side.
Weakness. Drop foot can occur when the strength of the lower leg muscles have reduced.

How can sciatica be diagnosed?

Many cases can be diagnosed by a qualified chiropractor, physiotherapist, and osteopath. Some GP’s have further training in orthopedics too,
MRI, MRI with radiolucence,
X rays can help but not as good as MRI’s,
CT scans
Nerve conduction test. This assesses whether the nerve is damaged or not,
Myelogram.

How can chiropractic help?

If you have read everything up till now then I’m hoping you have a good grasp of what we can do to help sciatic. Every patient is sent a form to be filled in first. This gives us some background information about their age, medical history, etc. We have a chat about how long the issue has been there for, whether there has been some sort of traumatic injury, and their health status. If they have some health issues like diabetes then along with treatment we may refer them to their GP too. An assessment is made of the nerves, joints, tendons, and muscles. We reach a diagnosis and decide together what is the best treatment going forward. A recommendation of how many sessions, and an easy to digest plan of home care. I often use acupuncture, manual stretching, and manipulation, and some pretty neat nerve hacks that help the nerve run more freely. Patients report even after a couple of sessions they feel an improvement. Some cases get worse before they get better but the key is being with the patient every step of the way. We want to get to a point where the patient can manage their sciatica by themselves.

How long will it take to feel better again?

Nothing is set in stone and everyone responds differently to a treatment plan. 2-8 sessions and patients are in most cases 90% better. Others take much longer and others a much shorter time. The healthier and active a patient is, then they are the ones who get better quicker. The elderly can respond quickly but they are also the age group that can take longer if they have other underlying health issues. It really is a lottery in how quickly a patient can recover. I want to be honest at all times so it is not in our interest to promise miracles but to undersell and over-deliver.

How much will it cost?

Our prices are very competitive and can be seen here.

How can I make an Appointment?

We have many ways to book. Send us an email at health@corbinchiropractic.co.uk

Book online here.

Ring us on 02920 786460

References:

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1895638/#:~:text=In%20general%20an%20estimated%205,from%2049%25%20to%2070%25.&text=The%20annual%20prevalence%20of%20disc,population%20is%20estimated%20at%202.2%25.

2. https://www.sciencedirect.com/science/article/abs/pii/S1521694209001417?via%3Dihub

3. https://www.ncbi.nlm.nih.gov/books/NBK99305/#:~:text=In%20the%20UK%2C%20the%20prevalence,men%20and%201.3%25%20in%20women.

4. https://www.hopkinsmedicine.org/health/conditions-and-diseases/back-pain/5-questions-to-answer-before-considering-sciatica-surgery#:~:text=Although%20most%20people%20experience%20up,coming%20back%20at%20another%20vertebra.

5. https://www.spineuniverse.com/conditions/herniated-disc/herniated-discs-definition-progression-diagnosis#:~:text=There%20are%20four%20stages%3A%20(1,radiculopathy%2C%20which%20means%20neurological%20deficit.