The Tribune

By Hannah Foster-Middleton,

BSc (Hons) Physiotherapy, MCSP, SRP

Sciatica is the medical term describing severe pain experienced in the legs. This pain is caused by compression, irritation, or inflammation of the sciatic nerves, which are the largest and longest nerves in the body. They are about the size of your thumb in diameter and run down the back of each leg. Each sciatic nerve is composed of five smaller nerves attached to the lower spinal column and which travel to the thigh, knee, calf, ankle, foot and toes. When these nerves are irritated or affected by inflammation of nearby soft tissues, this what we refer to as sciatica.

Sciatica pain is not the same for everyone. The pain may occur in one or both legs or change from side to side. Some people may experience constant and severe pain whilst others may feel only a dull ache or some numbness which perhaps may last for days but then goes away. For others it may be a ‘shooting’ pain of varying intensity, travelling all the way down the legs into the feet and toes.

Many factors can contribute to, or exacerbate sciatic pain, such as: sitting in one position for long periods of time in routine situations such as driving or working at a computer; working-out or running; even simple things like walking, bending, turning or standing up awkwardly may cause pain; tennis or golf and other activities involving a twisting motion can cause sciatica pain to flare-up. For a number of people, back pain may occur before the sciatica itself. In the most severe cases, sciatica can damage reflexes, or even cause foot drop.

Not only is there the potential for more than one identifiable cause of sciatica, but as the sciatic nerve is so long, irritation can occur at many different points along its length. Very often the first place where pain is felt, is in the lower back commonly caused by a misalignment of one or more of the lumbar vertebrae which in turn causes pressure on the sciatic nerve. Sometimes the source of pain can be attributed to disc involvement; discs are the ‘cushions’ made up of cartilage with are positioned between each vertebra (the bones which make up your spinal column). These discs act as shock absorbers and allow the back to bend, turn or twist through a normal range of movement. Trauma sustained from falls or car accidents can cause a disc to rupture and bulge and slip to one side which in turn causes pain. This is commonly referred to as a ‘slipped disc’. The correct term for a ruptured disc is ‘disc herniation”.

Sciatica can also be linked to various non-spinal conditions such as: arthritis, advanced diabetes, tumours, constipation, and even vitamin deficiencies have been reported as causes.

Age-related or other degenerative symptoms of the spine, often the result of existing chronic or neglected back problems, are also a potential source of irritation. Some cases of sciatica have even been reported during or following childbirth, usually due to the additional pressure on the spine.

But there is good news. This painful condition is treatable and there are a variety of treatment options available. The general therapeutic approach for managing sciatica is to treat the symptoms which may include the use of any of the following: painkillers, muscle relaxers or anti-inflammatory drugs to gain relief. Alternatively, or as well as, there is the use of traction (which is decompression therapy); physical therapy and rehabilitation and administering epidural injections directly into the nerve roots. As a last resort, in the most severe cases, if none of the non-invasive procedures has been effective, surgery may be recommended, but this should only be contemplated as a last resort.

• For questions and comments, call Hannah Foster-Middleton at 356 4806, e-mail genesisphysiotherapy@gmail.com, or visit www.physiotherapybahamas.com.