Pain radiating from the low back, through the buttocks and into the legs is commonly referred to as being ‘sciatic’. The sciatic nerve is the largest nerve in the body and courses down into each leg to supply many of the tissues (specifically, it controls the muscles of the lower leg and back of the knee and provides sensation to the back of the thigh, part of the lower leg, and the sole of the foot). Therefore if the nerve is inflamed or compressed it can lead to the pain, weakness or numbness that typically affect sciatica sufferers. The structures involved may be overly taut muscles, damaged intervertebral discs, arthritic joints and numerous other causes. Sciatic-type pain can also be mimicked by many structures within the lumbar spine (low back), resulting in referred pain down into the buttocks or legs. It is therefore important to accurately diagnose the source of the pain in order to specifically tailor the treatment.

**Breaking news – Recent research showed good evidence for the use of chiropractic in the treatment of the most common cause of sciatica – a herniated disc. This showed that joint manipulation (one of the techniques used at The Chiropractic Clinic) was as effective as surgery in treating chronic sciatic pain previously resistant to other treatment types (physiotherapy and GP care)**

“Manipulation or Microdisketomy for Sciatica? A Prospective Randomized Clinical Study,” (Journal of Manipulative and Physiological Therapeutics, October 2010, Vol. 33 Iss. 8, p: 576-584).

COMMON SYMPTOMS WE CAN RELIEVE INCLUDE

• Pain – acute sharp pain commonly indicates inflammation, either within joints or around nerves. This can vary wildly from mild to extremely severe, with leg pain usually exceeding back pain
• Ache – a stiff or dull pain is usually associated with muscle problems
• Weakness – muscles may feel weak if the muscle fibres are overly taut/contracted or if the region is painful. This is different to the neurological weakness which can occur with nerve involvement
• Numbness and tingling (paraesthesia) –may indicate nerve involvement, with the pattern corresponding to the affected nerve
• Restricted Movement – the movement in the low back may be limited by pain, joint stiffness or muscle spasm

CONDITIONS CHIROPRACTIC CAN TREAT:

• Disc herniation (“slipped disc”)
• Piriformis syndrome
• Peripheral nerve entrapments
• Sacroiliac joint pain
• Muscle trigger point referral
• Facet joint dysfunction

DISC HERNIATION

This is a less common presentation of back and leg pain with a prevalence of approximately 1-3 % of symptomatic herniations although recent studies have found that up to 50% of the population can have disc herniations without symptoms therefore not all disc herniations cause symptoms.

Herniations usually occur due to tearing of the outer fibres of the intervertabral disc allowing the softer central matter to bulge out irritating the adjacent spinal nerves which is characteristic of producing buttock and leg pain, weakness of the foot and often associated with numbness and pins and needles. This complaint does not always present with back pain and is often referred to as a slipped disc or sciatica.

PIRIFORMIS SYNDROME

Buttock and leg pain as stated above can occur from spinal herniation however another common cause of buttock and leg pain can be due to over tightness/injury to the piriformis muscle which is a muscle of the buttock. The sciatic nerve passes very close to this muscle and in some actually passes through this muscle which can mimic those symptoms of sciatica.

PERIPHERAL NERVE ENTRAPMENTS

Peripheral nerve entrapment occurs when a nerve suffers from chronic compression along its normal anatomical course. This can occur at various points through the leg commonly around the groin, and at the side of the knee.

SACROILIAC JOINT PAIN

The sacroiliac joints are two joints at the bottom of the spine that along with the sacrum form the pelvis. They are a common area of pain and discomfort often patients pointing to one side or the other and often associated with radiating pain into the buttock, around to the groin. Pain from the SI joint can refer into the leg but it does not often refer past the knee. Patients often report pain on sitting, from sitting to standing and pain when slightly leaning forwards as when brushing teeth.

MUSCLE TRIGGER POINT REFERRAL

Active trigger points in the lower back and gluteal muscles are areas in muscle which have become contracted which can also refer pain down the leg in a similar way to that of sciatica.

FACET JOINT DYSFUNCTION

Facet joints are small stabilizing joints located between and behind adjacent vertebrae. They are found at every spinal level (except at the top level) and provide about 20% of the torsional (twisting) stability in the neck and low back. Facet joint disorders are some of the most common of all the recurrent, disabling low back and neck problems, and can cause serious symptoms. Acute episodes of lumbar joint pain are typically intermittent, generally unpredictable, and occur a few times per month or per year. Typically, there will be more discomfort while leaning backward than while leaning forward. Low back pain from the facet joints often radiates down into the buttocks and down the back of the upper leg. The pain is rarely present in the front of the leg, or rarely radiates below the knee or into the foot, as pain from a disc herniation often does.

This is a very common condition that many of our patients present. Evidence shows along with recommendation from the Department of Health that treatment including manipulation, home exercise given by your chiropractor is an effective form of treatment for these conditions. https://www.nice.org.uk/nicemedia/pdf/CG88NICEGuideline.pdf