INTRODUCTION

Sciatica is one of the most common complaints today. It refers to a set of symptoms that includes one or more of the following:

• BACK PAIN,
• BUTTOCK PAIN,
• PAIN IN VARIOUS PARTS OF THE LEG OR FOOT

Symptoms are usually only on one side of the body but can occasionally be on both.

The pain comes from the siatic nerve, which starts in the lower back and travels through both buttocks and down both legs to the feet.

CAUSES OF SCIATICA

Siatica is a set of symptoms rather than a specific disease and is caused by abnormal pressure on the siatic nerve, either at its root (bottom of the spine) as in a prolapsed disc or spinal tumour, or somewhere along the upper part of the nerve such as in piriformis syndrome or sacroiliac strain.

The causes of siatica include:

• Prolapsed Disc: Between each spinal vertebra lies an intervertebral disc (see Figure-1). In a young person each disc consists of a ball of jelly surrounded by a tough casing composed of a ring of fibres. It is possible for this disc to rupture as a result of lifting, twisting or bending and the jelly-like contents to leak out. If this puts pressure on ligaments or nerves such as the siatic nerve it can give rise to pain, and the person is said to have a prolapsed disc. Symptoms include low back pain, muscle spasms, shooting pains down the legs and into the buttocks and possibly numbness. The symptoms tend to be one sided. As we age the internal jelly hardens and the thick casing becomes stronger so that a prolapse is less likely to occur. Treatment: Acupuncture or electroacupuncture is a safe and effective intervention for this type of back pain, otherwise it is bed rest and pain killers. Do not alow any physical manipulation as this may cause more damage. Your doctor may recommend physiotherapy. If the pain remains severe after 6 weeks then further investigations and surgical intervention may be necessary in the form of a 'discectomy'.

• Spinal Stenosis: Occurs when the central spinal canal through which the spinal chord travels begins to narrow. This can be caused by compression of the intervertebral discs or osteoarthritis. The symptoms include pain radiating down both legs and into both buttocks and numbness when walking. Rest and bending forwards often helps. Treatment: Pain can be treated by acupuncture or drugs (see your doctor). Surgical intervention may be necessary to widen the canal in the case of unremitting pain.

• Piriformis Syndrome: The piriformis is a muscle that lies deep within the buttocks and the siatic nerve has to pass through this muscle on its way down the leg. The muscle can become tight and so squeezes the siatic nerve resulting in shooting pains down the leg. Treatment: This type of muscular siatica is best treated with acupuncture or massage (ostepath; masseur) and does not need manipulation.

• Sacroiliac Strain: The sacroliliac joint lies at the base of the back between the sacrum and ilieum (hips) and often gets strained with the wear and tear of life or as a result of an injury. If this is strained it can aggravate the sacroiliac nerve and cause pain. Treatment:

• Trigger Points: These are knots in the muscles of the back or buttock that form as a result of strain or injury and can cause muscle tightness surrounding the siatic nerve. Treatment: Acupuncture is the best treatment followed by massage.

• Intraspinal Tumour: This is a very rare cause of siatica. You should suspect this only if you have already had cancer or believe you are at particular risk of getting cancer. Treatment: Specialist hospital care. An MRI scan of the lower back is required to confirm diagnosis followed by surgery and/or chemotherapy.

TREATMENT

Because siatica has so many causes there is no single approach to treatment that will resolve it. A good approach is to persuade your doctor to arrange an MRI scan of your lower back to check out for a prolapsed disc, spinal stenosis and a tumour. The remaining causes are less serious and can be approached via a number of methods, I have included some preferred treatment options above under the specific headings and there is much more information on this in the link below (see Links).