Lower back pain can be localised to only the low back area or the pain can travel down the leg also. Localised lower back pain is often less complicated and usually has a more favourable prognosis for complete recovery. During your Chiropractic consultation, a large portion of the history and examination is focused on this differentiation between back pain and leg pain. This week's article aims to explain the different types of leg pain that can occur with different lower back conditions.
We’ve all heard the word “sciatica”. It is loosely used to describe everything from lower back pain coming from the facet joints in the back, from the sacroiliac joints, from the muscles of the low back, and even from compressed nerves caused by a ruptured disc in the lumbar spine.
For the sake of accurcy, the term “sciatica” should really only be used when the sciatic nerve is being compressed. The sciatic nerve is comprised of five nerves (L4, L5, S1, S2, S3) that come from the spine and sacrum and join to form one large nerve called the sciatic nerve. True sciatica occurs when any one of the five small nerves or the larger sciatic nerve itself becomes irritated or compressed. There are many causes for this irritation, such as a lumbar disc herniation, a mal-positioned vertebra aka "a spondylolisthesis", pressure from an arthritic bone spur growing off the vertebrae where the nerve exits aka “spinal stenosis”.
"Pseudosciatica" is caused by compression of the sciatic nerve by the piriformis muscle where the nerve passes under the buttocks. Other “pseudosciatica” causes include pain referred from the facet joints of the lower back which the patient often describes as a deep ache felt inside the leg.
Some direct trauma, like a bruise to the buttocks from a fall or pinching the nerve during an injection into the buttock area, can also trigger “sciatica.”
The most common symptoms of sciatica include: leg pain, buttocks pain, low back pain and foot or leg numbness and tingling. If the nerve compression is there for a long enough time, muscle weakness and wasting can occur. This weakness is noted during the Chiropractic examination by the Patient struggling to stand up on their tip toes leading to a limp when walking.
In the examination, your Doctor may raise your straightened leg and if the sciatic nerve is compressed, then a sharp pain can occur. If the pain occurs between 30 and 70° of elevation, this indicates a positive test for sciatica.
Testing the lower limb reflexes and skin sensation with a sharp object can give your Chiropractor clues where the is nerve damage is occuring.
The good news for patients in Belfast is that Chiropractic techniques can resolve this problem, thus helping you to avoid unnecessary surgery or the nasty side effects of prescription medication! So, check with your Doctor of Chiropractic first, before consulting the surgeon.