GENUINE SCIATIC NERVE PAIN IS "SCIATICA"

Sciatica is the sciatic nerve pain caused by damage to the Sciatic nerve itself. This is called neuropathic pain.

The Sciatic nerve comes from the very bottom of the spine, where it can get squashed by a prolapsed inter-vertebral disc.

The bony space for the exiting nerve may be narrow, predisposing us to this problem if the nerve becomes swollen or is pressed on by disc material.

Leaking disc material is chemically irritant on the nerve root, increasing its swelling.

The nerve can also get pinched by a tight Piriformis muscle in the buttock, with a similar result.

What you feel

You can tell accurately where it runs down the leg, generally close to the back or side surface. It generally reaches to the foot.

Sciatic nerve pain is quite different to the “deep referred pain” which also can originate in the back, but without anything pressing on a major nerve.

Referred pain is vaguely inside the leg, hard to say exactly where. It tends to be more of a constant ache.

It is quite common for people to have both these types of pain, so it is always worth hunting for sore low back and pelvic girdle muscles.
Stretch them as you find them - it's likely to help your pain.

People with sciatica may give a history of previous attacks of pain only extending into their buttock.

Treatment for sciatica

Generally I try to get a neurosurgeon rather than an orthopedic surgeon. A lot of orthopedic surgeons no longer treat back problems, although some specialize in this area of practice.

They will generally only consider operating if the pain is severe and there is objective evidence of nerve damage on examination. This is muscle weakness, tendon reflex weakness and numbness.

There are now lots of radiologists who carry out injections of nerve roots, using CT scans to aid placement of the needle in the hole where the nerve comes out of the spine.

Cortisone injected here can reduce the swelling of the nerve root and relieve the sciatic nerve pain. Cortisone is our most potent anti-inflammatory drug. Quercetin and Bromelain are good options also, used as a systemic proteolytic enzyme.

A colleague of mine, a musculo-skeletal specialist, always had a CT scan done immediately he diagnosed sciatica.

Every so often he would discover something which needed urgent surgery. These were people who were able to get to his consulting rooms, so not the most severe cases.

He prescribed a Lumbar brace made of aluminium with plastic coating, avoiding actions which hurt badly and cortisone by mouth for a few days.

The dose of cortisone, as prednisolone, can range from 5mg three times a day to 25mg twice a day, with meals.

Back manipulation and mobilization for sciatic nerve pain

One cannot use the “million dollar roll” as this can definitely aggravate the situation. (This is the manipulation done on the side, involving rotation of the trunk.)

When I started using rotation manipulation treatment in the early 1970’s, one of my patients went away happily relieved of her lower back pain, only to return some hours later with nasty sciatica.

My manipulation had been the “final straw” that tore the damaged disc. This was not so easily fixed. She was very kind to me, and philosophical about the development.

I have more recently mobilized many people’s Lumbar joints in the presence of acute sciatica, without causing many aggravations (none serious) and often with some benefit.

The technique I use mostly involves distraction of the joint, combined with a very gentle rotation.

The spinal joint which requires mobilization is commonly at a different level to that with the disc prolapsed - where the sciatic nerve pain is from.

Any stiff joint in the vicinity, may increase the local muscle spasm and so the pressure on the disc and nerve.

Traction for sciatic nerve pain.

He had cut short his training in surgery in Edinborough, not wishing to see out a war in Europe. He was an excellent surgeon. I found his advice to nearly always be spot on.

Traction for sciatica had a poor reputation, he said, because it was not continued long enough. A few days was not enough. He had come to this conclusion from experience over thirty years.

I don't remember now whether he advocated 2 weeks or 3. People laid on their back, with a harness around their waist and straps to a pulley on the foot end of the bed, and weights hanging there.

The curve of the low back was straightened out, separating the backs of the vertebrae and making more room for the nerves leaving the spine.

Over the space of a couple of weeks, the inflammatory swelling of the nerve roots diminished, reducing the sensitivity to pressure from surrounding structures.

One can get the right amount of traction without the harness, pulley and weights, by laying on a sloping surface. The angle is that of a flush panel door with one end resting on two chairs. A rubber bath mat to prevent ones top end slipping, and a sheet of plastic under hips and legs, completes the equipment. One couldn't spend a fortnight on this, probably only an hour or two at a time.

PIRIFORMIS SYNDROME

The Piriformis muscle is found deep in the middle of the buttock. It is a small muscle underneath the largest muscle in the body, so you can’t actually feel it.

It passes horizontally from the edge of the tail bone (“Sacrum”) to the top of the thigh bone.

The Sciatic nerve sometimes leaves the pelvis through the middle of Piriformis, and can get pinched here if the muscle is tight.

This (“Piriformis syndrome”) is a relatively common cause of sciatic nerve pain and deep referred pain in the limb. It can co-exist with pressure on nerve roots by a prolapsed disc.

Stretching for piriformis muscle on the right side.

At the same time, push your right buttock down into the bed, using both your hands and your back muscles. This is the difference from the usual rotation stretches of the back, where the buttock is allowed to rise.

If it hurts, hold it there.

After perhaps two to five minutes, when the pain of the stretch eases, deliberately use your leg muscles to move the knee down closer to the left hip. You could also think of this action as relaxing your leg and letting it move down.

Keep your pelvis level by pressing your buttock on the side you're stretching down into the bed, to stop it rising.

Attempt to move your pelvis sideways towards the side being stretched.

If you do all this with your bedclothes over you, it is easier to feel the movement of your leg, against them.

This will probably bring the pain on again, and then your just repeat the same process, even multiple times, until either your hands give up or the pain eases.

Someone can help you by pushing the knee towards the other hip for you.

The nasty way to do it

You will need an assistant with strong hands for this task.

Lay face down, flat on a table from the waist up, with legs dangling over the side and feet on the floor.

Then have your assistant press into the buttock with fingertips, over the most tender soft point between the bones.

The pressure is kept up until your assistant feels their fingers moving inwards, as the muscle relaxes.

This is distinctly unpleasant treatment, only to be used if it is the only one possible because of a very stiff hip joint.

A lot of buttock pain, but in a good cause. A real pain in the A.., to help get rid of sciatic nerve pain in your leg.

Cramping, tight pain in your calf when walking?

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