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Sciatica
Name Sciatica describes pain caused by irritation of the thickest and largest nerve in the human body - the sciatic nerve, in Latin, nervus ischiadicus. It originates from the anterior branches of the lower lumbar and upper sacral spinal nerves (L4-S3) and runs alongside the hip joint and down the lower limb.
What causes sciatica is a frequently asked question. Sciatica can be triggered by a herniated or bulging disc in the lower back, spinal stenosis or spondylolisthesis. These conditions can cause sciatica pain due to irritation, inflammation, pinching or compression of a nerve in the lower back.
Sciatica symptoms debilitate patients every day all over the world. An article by Davis et al. (2022) shows a lifetime prevalence of up to 40%. Patients with sciatica present mainly with unilateral leg pain more significant than low back pain, pain radiating to the foot or toes, numbness and paresthesia. Sciatica pain due to a bulging disc is often worsened by coughing, sneezing and other activities that increase intra-abdominal pressure.
Is it or is it not?
Sciatica is a frequently misdiagnosed condition. One of the main reasons for misdiagnosis is the so-called ‘pseudo-sciatica’. Pseudo-sciatica is the term used to describe the situation when the sciatic nerve's peripheral regions are compressed. It can usually be compromised due to tension of gluteal muscles such as the piriformis muscle, which is the most common cause of sciatica misdiagnosis, leg or gluteal pain and disability.
Piriformis syndrome is characterised by a combination of symptoms including buttock or hip pain. Pseudo-sciatica doesn’t meet the crucial criteria for diagnosis of sciatica. The pain does not travel below the knee, neural tension tests are usually negative and there is no neurological deficit.
The second common cause of pain similar to sciatic-like pain can be also painful spots within weak, overloaded muscles - trigger points. A patient with active trigger points in the gluteus maximus, gluteus medius or piriformis muscle may present with pain in the back of the leg.
Treatment options
In about 90% of cases, sciatica is caused by a herniated disc with nerve root compression. That is why we will discuss the herniated disc treatment options. Sciatica surgery carries many risks, side effects and post-surgical limitations. The overall failure rate of lumbar spine surgery was estimated to be up to 50% (Thomson, 2013). Considering spine surgery should always be the last resort option to relieve sciatica pain.
Conservative treatment for herniated discs should become the first choice. Many people don't realise that many herniated discs, 66.66% according to a meta-analysis by Zhong et al. (2017), reabsorb with time and conservative care. Sciatica physical exercise focusing on core exercises, hip and pelvic stability, gluteal strength and sciatica stretches should always take part in the rehabilitation process of herniated disc treatment. Neurodynamics exercises reduce nerve mechanosensitivity, achieve sciatic nerve relief and improve limb movement and function.
All conservative treatments aim to achieve therapeutic effects such as reduction of disc protrusion, pain relief and postural realignment. All this can be completed in less than 10 sessions of spinal decompression therapy.
What is spinal decompression therapy?
BTL Spinal decompression is a non-invasive treatment for acute and chronic sciatica pain triggered by a herniated or bulging disc in the lower back or spinal stenosis.
The term spinal decompression means taking pressure off and releasing the neural structures and soft tissues of the spine. The goal of the therapy is to relieve pain and promote an optimal healing environment for disc pathology by the mechanical distancing of two vertebras. Apart from significant pain relief within the patient with sciatica, the clinicians can also observe postural realignment and reduction of disc protrusion in magnetic resonance imaging.
