Sciatica
Sciatica is an inflammation of the sciatic nerve causing pain down the back of the leg. The sciatic nerve is a large nerve made up of 5 different nerve fibres which come from the lumbar spine and sacrum in the low back. The sciatic nerve travels out through the back of the pelvis and down the back of the leg to the heel and sole of the foot. It branches off into smaller nerve fibres on its journey.
Possible causes
Intervertebral disc herniation or prolapse (slipped disc)
When the disc protrudes out between the levels in the spine it may press onto the sciatic nerve so disrupting the nerve signals down the leg causing pins and needles and numbness. This can also cause pain. There can be sciatic pain even with mild disc irritation where there is no impingement on the nerve but merely the nerve has become irritated or inflamed. This can result in a loss of reflexes in the knee and ankle, weakness in the leg and in some cases an inability to move the foot in certain positions eg foot drop.
Osteopathic treatment can involve manipulation and mobilisation. It can also involve deep tissue work or massage to release the muscle spasm. Advice is given as to how to reduce pressure on the discs and how to relieve the pain by performing tasks in a certain way. Back exercises are given to strengthen the back and help prevent recurrence of the condition.
Facet irritation of the lumbar spine
This can occur after a sudden twisting movement when parts of the spine come out of alignment. Often people don't remember how or when the pain came on and it may have resulted from a series of movements which eventually result in irritation in the spine. There may be a referral of pain down the back of the leg.
Osteopathic treatment usually involves mobilisation and manipulation to re-align the spine and exercises and postural advice to prevent it's recurrence.
Piriformis syndrome
The piriformis muscle is one which runs in a transverse manner across the buttock from the sacrum (or tail bone) towards the back of the hip. In some cases the sciatic nerve is located between the piriformis muscle and can be impinged causing pain and numbness in the buttock and radiating down the leg. This can occur when the piriformis muscle is very tight.
Osteopathic treatment involves assessment of the body as a whole and rebalancing structures, where possible. It may also involve deep massage into the affected muscles to reduce tightness and muscle energy techniques to increase muscle flexibility. Exercises may be prescribed to enhance the treatment.
Sacroiliac dysfunction or inflammation
The sacro-iliac joint can cause pain to travel down the leg but often only as far as the back of the knee. The pain is often very noticeable when getting up from sitting and can be eased by walking It may have resulted from a sudden movement or have come on gradually.
Osteopathic treatment can involve mobilisation and manipulation, stretching and strengthening exercises. Postural advice is usually given.
Spinal stenosis
This condition occurs when the spinal canal, nerve root canals and/or intervertebral exits from the spine becomes narrow or reduced due to arthritic changes, disc prolapses or from damage to the spine through accident or by degeneration. It causes back pain, leg weakness, tingling, and leg pain in one or both legs. It tends to get worse when standing or walking and can be relieved by sitting.
Osteopathic treatment can involve postural advice to reduce lordosis (curve) in the lower back and exercises to increase mobility and strengthen the back.
This is not an exhaustive list of the causes of sciatica.