Leg Pain/Sciatica
Overview
Sciatica is a shooting pain that begins the lower back, radiates into the buttock and down the back of one leg. The pain is often caused by pressure on the sciatic nerve from a herniated disc, bone spurs, or muscle strain (Fig. 1). You play an important role in the prevention, treatment, and recovery of leg pain. It typically improves with rest, and other self-care measures. Chronic pain may require a trip to the chiropractor for further review, evaluation, and treatment as required.
Figure 1. The sciatic nerve is formed from the spinal nerves L4 to S3. The two sciatic nerves travel through the pelvis and down to the back of each leg. Each nerve divides into a peroneal and tibial nerve to provide feeling and muscle control of the legs and feet.
Types of leg pain
Leg pain ranges from mild to severe and can be acute or chronic.
Acute sciatic pain occurs suddenly and usually heals within several days to weeks. The severity relates directly to the amount of tissue injury. The source of pain may be in the spinal joints, discs, nerves, or muscles and ligaments.
Chronic sciatic pain persists for more than 3 months and its source may be hard to determine. Chronic pain may be felt all the time or worsen with certain activities. Contributing factors may include nerve damage, tissue scarring, arthritis, or mental effects of pain.
What are the symptoms?
Classic sciatica pain starts in the low back and buttocks. It affects one leg, travelling down the back of the thigh, past the knee, and sometimes into the calf and foot. The pain feels worse in the leg than in the back. It may range from a mild ache to severe burning or a shooting pain. Numbness or tingling (pins-and-needles) can occur in your leg and foot. This usually is not a concern unless you have weakness in your leg muscles or foot drop.
Sitting usually causes the most pain because of the weight this position puts onto the discs. Activities, such as bending or twisting, worsen the pain, whereas lying down tends to bring relief. Running or walking may actually feel better than sitting or standing for too long.
Seek medical help immediately if you have extreme leg weakness, numbness in the genital area, or loss of bladder or bowel function. These are signs of a condition called Cauda Equina Syndrome.
What are the causes?
Sciatica can be caused by a number of conditions that irritate or compress the sciatic nerve:
• Piriformis Syndrome: Tightening or spasm of the piriformis muscle can compress the nerve.
• Trauma: A sports injury or fall can fracture the spine or tear a muscle and damage nerves.
• Herniated Disc: The gel-like centre of a spinal disc can bulge or rupture through a weak area in the disc wall and compress nerves.
• Stenosis: Narrowing of the bony canals in the spine can compress the spinal cord and nerves.
• Osteoarthritis: As discs naturally age, they dry out and shrink. Small tears in the disc wall can be painful. Bone spurs can form. The facet joints enlarge, and ligaments thicken.
• Spondylolisthesis: A weakness or stress fracture in the facet joints can allow a vertebra to slip out of position and pinch the nerves.
Leg pain can also be caused by a joint problem in the hip or sacroiliac joint. This type of referred pain is quite common but is not sciatica.
How is a diagnosis made?
Careful examination will attempt to determine the type and cause of your spine problem and the treatment options. A diagnostic evaluation includes a medical history and physical exam. Sometimes imaging scans (e.g., x-ray, CT, MRI) and tests to check muscle strength and reflexes are used.
What treatments are available?
Healing begins with self-care and nonsurgical strategies (Fig. 2). The goal is to correct the problem, restore function, and prevent re-injury.
Figure 2. Exercise, strengthening, stretching and ideal weight loss are key elements to your treatment. Make these a part of your life-long daily routine.
Self-care: Sciatica often resolves with rest, ice or heat, massage, pain relievers, and gentle stretches. Reduce muscle inflammation and pain using an ice pack for 20 minutes several times a day during the first 48 to72 hours. Thereafter, a warm shower or heating pad on low setting may be added to relax the muscles. A short period of bed rest is okay, but more than a couple of days does more harm than good. If self-care treatments aren’t working within the first couple of days, see your doctor.
Medication: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, or naproxen, can bring relief. A muscle relaxant may be prescribed for spasms. If pain is severe, an analgesic may be prescribed that can be taken with the NSAID or muscle relaxant.
Steroids can reduce the swelling and inflammation of the nerves. They are taken orally, tapered over a five-day period or by injection directly into the painful area (see epidural steroid injections and facet injections). Steroids may provide immediate relief within 24 hours.
Surgery: Surgery is rarely needed unless you have muscle weakness, a proven disc herniation, cauda equina syndrome, or severe pain that has not resolved after a reasonable course of nonsurgical treatment. Surgery for a herniated disc, called a discectomy, removes the portion of the disc compressing the spinal nerve. People with stenosis may benefit from a decompression of the nerves.
Recovery and prevention
A positive mental attitude, regular activity, and a prompt return to work are all very important elements of recovery. If regular job duties cannot be performed initially, modified (light or restricted) duty may be prescribed for a limited time.
Prevention is key to avoiding recurrence:
• Proper lifting: avoid sitting for long periods
• Good posture during sitting, standing, moving, and sleeping
• Regular exercise with stretching and strengthening
• An ergonomic work area
• Good nutrition, healthy weight, and lean body mass
• Stress management and relaxation
• No smoking
Glossary
Acute: a condition of quick onset lasting a short time, opposite of chronic
Cauda equina syndrome: compression of the end of the spinal cord (cauda equina), causing low back pain, numbness in the saddle area (groin), extreme leg weakness, difficulty controlling bladder or bowel function; an emergency condition – if left untreated can cause paralysis.
Chronic: a condition of slow progression and continuing over a long period of time, opposite of acute.
Sciatica: pain that courses along the sciatic nerve in the buttocks and down the legs. Usually caused by compression of the 5th lumbar spinal nerve.
Radiculopathy: refers to any disease affecting the spinal nerve roots. Also used to describe pain along the sciatic nerve that radiates down the leg.
Acknowledgements
Mayfield Clinic
Banita Bailey, RN
Cannington Chiro Services
Patients attending Cannington Chiro help us by first filling out a “New Patient Questionnaire”, followed by a thorough consultation, examination, and assessment. This helps us help you.
Beginning treatment ASAP is a priority to us, with the aim of, in most cases, commencing treatment from day one. Healing, repair and rehabilitating the body after being injured is a process – and processes take time – so with understanding and patience a positive long-term outcome can be expected.
We look forward to helping you and demonstrating that we may be the missing link in your recovery.
