SOME MEDICAL FACTS
Description:Sciatic Nerve and Sciatica
The Sciatic Nerve is the largest single nerve in the body and is made up of individual nerve roots that start by branching out from the spine in the lower back and then combine to form the “sciatic nerve.” Sciatica symptoms occur when the large sciatic nerve is irritated or compressed at or near its point of origin.
- The sciatic nerve starts in the lower back, typically at lumbar segment 3 (L3).
- At each level of the lower spine a nerve root exits from the inside of the spinal canal, and each of these respective nerve roots then come together to form the large sciatic nerve.
- The sciatic nerve runs from the lower back, through the buttock, and down the back of each leg.
- Portions of the sciatic nerve then branch out in each leg to innervate certain parts of the leg—the thigh, calf, foot, and toes.
The image to the right shows the main sciatic nervous system pathways. This combination of nerves runs from the Brain directly to your feet. The sciatic nerve runs from the base of the spine to the back of the lower leg and acts like a interchange connecting several nerve branches from your head to the soles of your feet. This explains how your feet can cause pain anywhere from the soles of your feet to your lower back and even you neck.
When the skeletal frame work is out of alignment, the sciatic nerve can be pinched between joints or cartilage. Where the nerve is pinched is dependent on the way the skeletal frame is distorted. Your feet have a disproportionate effect on your skeletal framework in that they are the foundations on which your whole body stands. If your feet are not properly aligned, it has the effect of putting your whole skeletal framework out of alignment, from your ankles, knees, hips, lower back, and on to your spine, shoulders & neck.
The following lower back problems are the most common causes of sciatica.
NOTE: These problems root cause is the misalignment of the bone structure of your body. This structural deformity is most often caused by the misalignment of the feet during a normal walking gait and standing stance. If you can repair the walking gait and stance of your body you can significantly reduce if not eliminate sciatic nerve pain. This can be achieved by the use of custom made Orthotics which realign the bone structure and pass the compression forces of the body to the ground through the correct centre of gravity paths.
- Lumbar herniated disc
A herniated disc occurs when the soft inner material of the disc leaks out, or herniates, through the fibrous outer core and irritates or pinches the contiguous nerve root. Other terms used to refer to a herniated disc are slipped disc, ruptured disc, bulging disc, protruding disc, or a pinched nerve. Sciatica is the most common symptom of a lumbar herniated disc.
Degenerative disc disease
While some level of disc degeneration is a natural process that occurs with aging, for some people one or more degenerated discs in the lower back can also irritate a nerve root and cause sciatica. Degenerative disc disease is diagnosed when a weakened disc results in excessive micro-motion at that spinal level, and inflammatory proteins from inside the disc become exposed and irritate the nerve root(s) in the area.
This condition occurs when a small stress fracture allows one vertebral body to slip forward on another; for example, if the L5 vertebra slips forward over the S1 vertebra. See All about L5-S1 (Lumbosacral Joint) With a combination of disc space collapse, the fracture, and the vertebral body slipping forward, the nerve can get pinched and cause sciatica.
Lumbar spinal stenosis
This condition commonly causes sciatica due to a narrowing of the spinal canal. Lumbar spinal stenosis is related to natural aging in the spine and is relatively common in adults older than age 60. The condition typically results from a combination of one or more of the following: enlarged facet joints, overgrowth of soft tissue, and a bulging disc placing pressure on the nerve roots, causing sciatica pain. Lumbar spinal stenosis commonly occurs along with spinal arthritis, and arthritis can also cause or contribute to sciatica symptoms.
The sciatic nerve can get irritated as it runs under the piriformis muscle in the buttock. If the piriformis muscle irritates or pinches a nerve root that comprises the sciatic nerve, it can cause sciatica-type pain. This is not a true lumbar radiculopathy, which is the clinical definition of sciatica. However, because the leg pain can feel the same as sciatica or radiculopathy, it is sometimes referred to as sciatica.
Sacroiliac joint dysfunction
Irritation of the sacroiliac joint—located at the bottom of the spine—can also irritate the L5 nerve, which lies on top of the sacroiliac joint, causing sciatica-type pain. Again, this is not a true radiculopathy, but the leg pain can feel the same as sciatica caused by a nerve irritation.
Sciatica is often characterized by one or more of the following symptoms:
- Constant pain in only one side of the buttock or leg (rarely in both legs)
- Pain that is worse when sitting
- Leg pain that is often described as burning, tingling, or searing (versus a dull ache)
- Weakness, numbness, or difficulty moving the leg, foot, and/or toes
- A sharp pain that may make it difficult to stand up or walk
- Pain that radiates down the leg and possibly into the foot and toes (it rarely occurs only in the foot)
Sciatic pain can vary from infrequent and irritating to constant and incapacitating. Symptoms are usually based on the location of the pinched nerve.
While symptoms can be painful and potentially debilitating, it is rare that permanent sciatic nerve damage (tissue damage) will result, and spinal cord involvement is possible but rare.
First, a 2ft specialist will ask about your current symptoms and remedies you have already tried. He or she will also ask some typical questions, such as:
- When did the sciatic nerve pain start?
- Where do you feel pain? Is it all the way down your leg? Is it in both legs? Does it stop at your knee?
- On a scale from 1 to 10, with 10 being the worst pain imaginable, rate your pain.
- Are you experiencing weakness or tingling in your legs and/or feet?
- What activities did you recently do?
- Does walking uphill or downhill increase pain?
- What have you done for this sciatic nerve pain? Have you tried particular medications or exercises?
- Does anything reduce the pain or make it worse?
Our specialist will also perform physical exam.
In the physical exam, a specialist will observe your posture, range of motion, and physical condition, noting any movement that causes you pain. Our specialist will feel your spine, note its curvature and alignment, and feel for muscle spasm.
To diagnose the cause of your sciatica, you may need to have some imaging tests. You may have an x-ray or a computed tomography (CT or CAT) scan. If it’s possible you have a herniated disc or spinal stenosis that’s causing your sciatica, your doctor may order a magnetic resonance imaging (MRI) test.
A 2ft custom made Orthotic puts an end to your foot pain caused by this painful condition.
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Your custom made 2ft Orthotic supports all three of your foot arches not just one. It is designed to realign the ankle joint so the centers of gravity correctly transfer the compression forces of your body down to the ground correctly. This ensures that your standing stance and walking gait normalize and work as designed. The inbuilt torsion & compression bars take the strain off of the Plantar Fascia and assist in putting a spring back intro your every step making it easier to walk and run. Our Orthotic is a marvel of engineering and it can significantly change your life. Try it on and you will never look back.
Alternative Treatments (Temporary Relief)
In addition to standard medical treatments, several alternative treatments have also been shown to provide effective sciatica pain relief for many patients. Some of the more common forms of alternative care for sciatica include chiropractic manipulation, acupuncture, cognitive behavior therapy, and massage therapy.
- Spinal adjustments and manual manipulation performed by appropriately trained health professionals, such as chiropractors and osteopathic physicians, are focused on providing better spinal column alignment, which in turn is designed to help address a number of underlying conditions that can cause sciatic nerve pain. Manual manipulation by appropriately trained health professionals can create a better healing environment and should not be painful.
This practice is centered on the philosophy of achieving or maintaining well-being through the open flow of energy via specific pathways in the body. Hair-thin needles (which are usually not felt) are inserted into the skin near the area of pain. Acupuncture has been approved by the U.S. Food and Drug Administration (FDA) as a treatment for back pain, and the National Institutes of Health has recognized acupuncture as effective in relieving back pain, including sciatica.
- Cognitive behavior therapy
This therapy for taking control and changing self-defeating behaviors can be helpful in managing sciatica pain, particularly in the short term. Sessions with a therapist may be face-to-face or online.
- Massage therapy
Certain forms of massage therapy have been shown to have a number of benefits for back pain, including increased blood circulation, muscle relaxation, and release of endorphins (the body’s natural pain relievers). The above list represents the most common treatments but is by no means comprehensive. There are many more options, and patients will often need to use a process of trial and error to find what works best for them.
Epidural steroid injections
If the pain is severe, an epidural steroid injection can reduce inflammation. Unlike oral medications, an injection goes directly into the painful area around the sciatic nerve to address the inflammation that may be causing pain.
While the effects tend to be temporary (providing pain relief for as little as one week or up to a year), and it does not work for everyone, an epidural steroid injection can be effective in relieving acute sciatic pain. Importantly, it can provide sufficient relief to allow a patient to progress with a conditioning and exercise program.
Invasive Surgery “Should be Avoided”
Typically, it is reasonable to consider surgery for sciatica in the following situations:
- Severe leg pain that has persisted for four to six weeks or more
- Pain that is not relieved after a concerted effort at non-surgical sciatica treatments, such as oral steroids, non-steroidal anti-inflammatory medication, manual manipulation, injections, and/or physical therapy
- Limitations on the patient’s ability to participate in everyday activities
Urgent surgery is typically only necessary if the patient experiences progressive weakness in the legs or sudden loss of bowel or bladder control, which may be caused by cauda equina syndrome.
Depending on the cause and duration of the sciatica pain, one of two general surgeries will typically be considered:
Microdiscectomy for Sciatica
In cases where the sciatica pain is due to a lumbar disc herniation, a microdiscectomy—a small open surgery using magnification—is the most common surgical approach. In this surgery, only the portion of the herniated disc that is pinching the nerve is removed—the rest of the disc is left intact.
A microdiscectomy is generally considered after four to six weeks if severe pain is not relieved by nonsurgical means. If the patient’s pain and disability are severe, surgery may be considered sooner than four to six weeks.
As a general rule, approximately 90% of patients will experience relief from their sciatica pain after this type of surgery.
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