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By Duke Autret Many, if not most people will have heard of, or may even have experienced sciatic pain or sciatica, but what is it exactly? Let’s explore. Sciatica is a term that gets thrown around alot but the fact is that it’s quite a vague term which is used simply to describe any condition where the symptoms involve pain running from the lower back down either one or both legs (potentially all the way down to the foot). Pain types can be sharp, shocking, tingly, numb, cause pins and needles, or cause pinching or catching sensations on movements.  So in fact Sciatica describes not one single condition, but rather a set of symptoms, and that these symptoms that we call Sciatica can be the result of a number of different mechanisms or conditions. To be more precise, Sciatic refers to the name of the nerves which branch out from origins in the lower spine/back and then splits into two Sciatic nerves - one for each leg, and thus innervates the muscles and structures of the legs. However this nerve can become vulnerable to irritation by pressure bearing on it from other structures, when this happens the experience is Sciatica! As mentioned before there can be a variety of reasons for this impingement on the Sciatic nerves and some examples can include pressure from a tight Piriformis muscle (which the sciatic nerve passes directly through or beneath), pressure from an Intervertebral Disc bulge/herniation of the lumbar spine (lower back), Stenosis which is the narrowing of the spinal canal, Spondylolisthesis which is the slipping of one vertebrae over the next and that can pinch the sciatic nerve, or Spondylosis, an arthritic joint degeneration at the lumbar vertebrae which may cause inflammation and subsequent pressure and irritation from that. As we can see, there are many ways in which the sciatic nerve can become impacted and the end result is the same experience and symptoms we call ‘Sciatica’. Some of these situations sound scary, but the majority of the time it is easy to get the pain under control while working with an experienced Myotherapist who can help guide you or refer you on if your condition is particularly acute or severe. Since the irritation that occurs to the Sciatic nerve is to do with some or other kind of pressure, then the priority for treatment becomes to create more space for the nerve to be free, as nerves also need to be able to slide and move with the rest of the body. Importantly, the treatment we use will be dependent on which of the various mechanisms are at play, but commonly any technique employed will be with the aim of creating more space for that nerve, and most often will involves treating the muscles of the lower back, pelvis, hips, glutes and back of the thighs and maybe even calves. Some of these techniques can include hands on options like remedial massage and myofascial release, or helpful nerve gliding movements that can help reduce the sensitivity of those nerves. And in situations where the symptoms are very acute, fresh and severe often Myofascial Dry Needling is a go-to in order to take the edge off and tone everything right down without adding any more undue pressure to the nerve/system. Myotherapists can also provide joint mobilisations to aid in better mobility of the lower back and hips. Mobilisations vary from manipulations - we won't be "cracking your bones", but gently encouraging rhythmic movement to return to your joints without any high velocity cracks or crunches. From here we would look at tailored exercises for your situation which could simply be stretches for a few key tight muscles to a full program to help build stability around the spine and support the structure for healthy nerve function. Some common exercises you might try could be deep abdominal work, diaphragm ‘weight-lifting’, the sphinx, Piriformis stretches, and Glute and Adductor strengthening. Our practitioners will demonstrate these types of exercises and how to safely do them while you're experiencing sciatica, and we can assist you in progressing them as preventative care exercises once the intensity of your pain has eased.  If you or anyone you know is currently suffering with Sciatic pain, please come and see us, we are here to help. Just call or leave a message with us at the Simple Wellness Myotherapy clinic here in Rowville, or alternatively you can see our booking schedule and make an appointment yourself for a time that best suits.
Many people are familiar with the term "bulging disc" in regards to lower back pain. It can feel like an intense, sharp, stabbing sensation that can often travel down your leg through your hips and bum, sometimes as far as your feet. This is a common diagnosis when you start to develop back pain. You get a scan which shows changes in the disc, and the pain matches the effected nerve area. It can be a scary diagnosis. But you may be surprised to know that a lot of people who don't have pain have also been found to have changes in their discs. I find this study to be really encouraging, because it shows that people who have significant changes to their disc structure can still live a painfree life. It suggests that the disc changes may have already been there for some time before any painful symptoms even began, and gives hope that even if the structure doesn't change, that the pain can change. Lets have a look at this interesting literature review, particularly in regards to the findings around disc degeneration, disc bulges and disc protrusions.  This is a literature review of 33 separate studies that investigated the imaging of spinal degeneration in painfree people ranging from their 20's to their 80's. It was published in the American Journal of Neuroradiology in 2014. In total, the review takes into account MRI and CT scan imaging on 3110 individuals with no painful symptoms. As you would likely predict, the number of findings increased with the participants age group, showing age-related degeneration occurs even in people who aren't experiencing pain. Lets have a look at the imaging results for the disc degeneration, bulge and protrusion categories: Disc degeneration - changes to the disc and surrounding vertebrae that result in loss of cushioning and support, may include signs of osteoarthritis at the joint. The Results: Disc degeneration in painfree participants was identified in:
Disc bulge - changes that alter the shape of the disc and can make portions of it "bulge" out of place, which can apply pressure to nearby nerves. The Results: Disc bulge in painfree participants was identified in:
Disc protrusion - changes to the annular membranes around the disc allows the disc nucleus to protrude and apply pressure to the nerves. The Results: Disc protrusion in painfree participants was identified in:
What does this mean for your bulging disc? It means that theres a good chance that your structural changes were already present before your back became painful. The area may be irritated or flared up right now, but these findings are a good indication that even if your scans don't change, your back pain still can settle down. It means that a scan showing disc changes doesn't have to be a life sentence of pain. Does this mean bulging discs DON'T cause pain, then? Don't get me wrong, bulging discs can be painful, and for some people it can be severe. This study just helps to show us that theres more to back pain that what shows up on MRI or CT scans. Structural changes are just one layer in the complex onion that is back pain. We can help! There are lots of ways we can change your experience of back pain through massage and myotherapy techniques like dry needling, taping and support, strengthening the surrounding muscles with exercises that are appropriate for you, and supporting your understanding of how your back functions. Book a time to come see us to talk about your back pain and creating a treatment plan to reduce it. You might be familiar with that sharp, shooting pain sensation in your lower back, hip and leg. It can also be felt as numbness, pins and needles, tingling or burning type of sensations. Whatever way the pain or symptoms present, it runs along the Sciatic nerve - which is why this is referred to as Sciatica.
But did you know theres more than one potential cause behind this pain? Often this pain can be linked to muscle tension in the glutes and hips. The Sciatic nerve runs underneath the muscles of your glutes, and when it gets compressed there it can be a real pain in the bum - literally! Because this nerve runs all the way down to your feet, the jolts of nerve pain can sometimes be felt anywhere from just localised in your buttocks and hip, to the back of your thigh, behind the knee, straight down your lower leg and even into the base of your foot. The Sciatic nerve can be impacted at the root of the nerve near the spine, however this doesn't always mean there will be pain. Often this is called a Bulging Disc or Herniated Disc, but you might be surprised to learn that even though "Bulging Disc" sounds pretty awful, studies have shown that more than 50% of people over 40 with no pain symptoms at all can have a disc bulge show on scans. Irritation or compression of the Sciatic nerve can be common after serious trauma to your leg or lower back. Things like car accidents, falls, and horse riding accidents are all common high impact incidents that can aggravate the nerve. If you've had an injury like this, its wise to seek treatment for it. Do you have Sciatic nerve pain or nerve symptoms of numbness, tingling and pins and needles? Book an appointment with us to have an assessment and treatment. If we can resolve the issue, we'll create you a treatment plan that includes manual therapies and a take home exercise program. More serious causes do exist, so if treatment of the muscles and joints is not relieving your pain, we'll refer you to see your GP to rule out any serious structural or pathological conditions. |
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