Back pain can occur in a multitude of ways and on occasions can be debilitating. If you are experiencing piercing pain that runs down the back of your legs, this may be a sign of sciatica.
Sciatica is a term describing pressure on the sciatic nerve, the longest nerve running from the lower back down through the back of each leg. The pain often begins with a herniated disc in the lower spine (however there are many causes of sciatica).
A diagnosis of Sciatica will need to investigate the possibility of medical reasons such as benign (or malignant) tumours, shingles, diabetes amongst many other diffrential diagnoses.
And to increase the complexity of a simple cciatica diagnosis, associated musculoskeletal reason including: spondylolisthesis, lateral canal stenosis, piriformis syndrome should be considered and ruled in or ruled out.
90% of Sciatica cases in the under 45 years of age bracket, is due to disc herniation (bulge). Between each vertebra in the spine, there is a gelatinous tissue which acts as a cushioning (intervertebral disc). This can be worn down over years of use or damaged in an acute injury. When a disc becomes herniated, inflammatory fluid and the deformed disc material causes pressure on the nerves around it. Specific pattern of leg pain, numbness in the toes and other changes (examined by your chiropractor) may be experienced.
There are some clear symptoms of sciatica which include:
- Pain in leg and lower back which increases while sitting
- Throb or burning sensation that runs down the legs
- Restricted movement of feet or entire legs without pain
- Consistent pain on one side of your lower back
- Intense striking pain which makes it difficult to stand
Sciatic nerve pain can be episodic or worsen over time to become chronic. Sciatica is often triggered for various reasons including during exercise, develop insidiously (from no acute cause) or from simple movements where there is a loss of control at the spinal segment during activities like heavy lifting (with or without excessive weight), domestic chores, sit to stand and it can also occur during pregnancy.
What will my Waterloo Chiropractor do?
It starts with the excellent Clinical History taking and Examination to ensure your case will respond to conservative treatment. Depending on how your injury occurred, what your injury history is and the other signs and symptoms, we will more than likely commence conservative treatment on your first visit. However there are cases where we may need further investigations to arrive at an accurate diagnosis and treatment plan.
For example: your leg pain could be coming from a nerve trapped in your lower leg and not your back at all. One common example is a L5 Disc herniation (radiculopathy) and peroneal nerve pain (neuropathy of the lower leg nerve) can both present with weakness of the foot dorsiflexors and toe extensors. However, L5 radiculopathy may present with weakness during foot inversion versus weakness with foot eversion associated with peroneal neuropathy. Additionally, reflex changes at the patella, medial hamstring and Achilles tendon can distinguish a L4, L5 or S1 disc herniation (radiculopathy) from a peripheral nerve injury. As you can see, it can get technical!
Your chiropractor will take your history, examine your lower extremities and low back to ensure the treatment plan matches the diagnosis however we may need an MRI scan or other interventions to assist you.
Read more about the subtle differences in musculoskeletal and sciatica nerve injury in this article relating to foot drop here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662609/#:~:text=L5%20radiculopathy%20and%20peroneal%20neuropathy,with%20peroneal%20neuropathy%20%5B14%5D.
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