Pain in the Lower Back – Is It Sciatica?
You’ve had this on and off pain for a while now, but never as bad as recently. Something just as simple as bending over to pick something up triggered that pain in your back that feels like it might be going down your buttock or leg. Other times, there wasn’t any problem.
You wonder whether you’ll always have to live your life being careful of things like bending over or lifting items. Or if the exercise you’re doing is making it worse, but you don’t want to stop. You’ve searched on Google and saw this term called “Sciatica” and it seems like something you have, but Google isn’t very clear in giving you the clarity you need – Do you need to get it checked out? Can you leave it, and will it go away on it’s own? Is it really even sciatica?
What is Sciatica?
A common explanation is that sciatica is used to describe pain that radiates downwards along the course of the lumbosacral nerve roots, which may be from your back to the buttocks and back of your thigh to the back of your calf and foot.
Did you know?
This sciatica has been around since the time of the Ancient Greeks in 370BC!
Hippocrates described ‘ischias’ – pain felt around the hip and thigh – affecting men around 40 to 60 years old, and that young men who felt it would often have pain lasting around 40 days before resolving spontaneously!
From the 17th century all the way till the 19th century, physicians knew of sciatica but were unsure about what caused it –
Until the 20th century.
In 1931, a neurosurgeon named Elsberg described that the removal of ‘cartilaginous tumours’ from the spinal canal improved sciatic symptoms; and 3 years later in 1934, a famous paper by the New England Journal of Medicine cemented the idea that the prolapsed intervertebral disc caused sciatica.
Causes of Sciatica
The most commonly blamed cause of sciatica is this:
- A herniated lumbar disc where the nerve root is compressed by disc material that has ruptured through its surrounding annulus.
- Lumbar spine degeneration causing narrowing of the foraminal spaces, again causes nerve root compression.
We NOW know that imaging scans (like MRIs) show that disc pathology (disc bulges and herniations), and stenosis with neural compromise (when the lumbar spine degenerates and causes narrowing of the tunnel where the nerve comes out from) is actually a relatively common finding in people WITHOUT any symptoms of sciatica, or back pain! (Brinjikji et al., 2015; Boos et al., 2000).
Patients with pain AND a disc herniation seen on MRI may experience marked improvement in symptoms WITHOUT any changes in your spine or disc, whereas the removal of herniated disc material or other causes of nerve root compression DOES NOT ALWAYS relieve pain.
So why does sciatica actually happen?
Evidence suggests that it is not so much just pressure on the nerve root that causes sciatica, but a COMBINATION of immunological responses in the body – inflamed, stretched, and/or compressed nerve roots causes sciatic pain.
This CAN be because of an injury causing a disc bulge and pressure on the nerves, a muscle spasm that causes temporary pinching of the nerve, and other lifestyle factors which increase inflammation in the body like excessive alcohol, smoking, poor diet, inadequate sleep, and mental stress.
That being said, having a “diagnosis” of “Sciatica” is JUST identifying a symptom.
There needs to be an assessment of your complete history, and a physical assessment to identify what activities may need to be modified for the time being to help your active recovery. Eventually, you should be getting back to what you were doing before, and more.
Check the box if you feel pain over the back when you
If you’ve ticked at least 2 of these boxes, it indicates a possible disc issue.
(a) Sit on the edge of your chair. Slouch all the way down, as much as you can, including the head and neck.
McKenzie’s Repeated Test
(a) Bend forward slowly, attempting to touch your toes, slowly come back up, and repeat for 10 times. Does your pain get worse as you repeat?
(b) Now put your hands on your hips, and slowly bend backwards 10 times. Does your pain get better?
・Pain that gets better as you repeatedly bend backwards could indicate a disc issue.
📱 WhatsApp us on +60193417572 after you’ve done these tests with a picture OR video of the movement that you’re having pain with, and get a FREE 15-minute video consultation to analyse the photo or video that you’ve sent in to get started on getting back to work and life without pain.
How Do I Know If I Have Sciatica?
Wait – what’s this “Red Flags”? 🚩 Do I have it?!
Red Flags indicates:
- Severe pain going down BOTH legs
- Sudden weakness over the legs, causing problems with walking
- Numbness over the genital area
- Issues with urinating or defecating (either unable to hold, or unable to release)
- Sudden sexual dysfunction
How Long Does It Take to Heal from Sciatica?
Without the presence of red flags, treatment of sciatica in the first 6–8 weeks should be conservative.
In patients with severe symptoms who fail to respond following 6–8 weeks of non-surgical treatment, imaging might be useful to identify if a herniated disc with nerve root compression is present. Surgery may only be indicated if imaging findings correspond well with the clinical symptoms, there was no success with conservative care, and/or the patient develops red flags.
WITHOUT surgery, 80% of the patients recover within 8 weeks and 95% within 1 year. (Valat et al., 2010)
If you’re unsure of your home diagnosis, do visit your nearest chiro and physio clinic for professional advice. You may also easily make a booking with us online. Visit the link below to book your first consultation with Spinefit.