How does sciatica develop?
The spine has a motor function, but also supports and protects the spinal cord, which is a bus that transmits all information from the nervous system to our brain. It consists of vertebrae with discs between them. Their mission is to ensure the flexibility of the spine and the ability to absorb shock. As a result of gradual degeneration and deformation of the discs, they may move away from the axis of the spine, i.e. discopathy. When a displaced disc presses on the sciatic nerve or the nerve roots that join to form the sciatic nerve, an attack of sciatica occurs. It is estimated that 13-40% of the population suffers from this disease.
What causes an attack of sciatica?
Sciatica can be caused by various activities we subject our body to. From sudden exertion to which our backs are not accustomed, through the triggering of a herniated intervertebral disc, to the tightening of the muscles around the nerve roots leaving the spinal cord. It may be caused by dehydration of the intervertebral discs and their degeneration, it may be caused by long-term sitting and non-anatomical positioning of the spine, sometimes it may appear when the back is suddenly loaded, and sometimes after waking up, when getting out of bed we trigger the sciatica mechanism.
How is this gunshot diagnosed?
To determine that the pain in the lumbar region is definitely sciatica, a thorough interview with a doctor or a rehabilitator and imaging diagnostics, X-ray, MRI or computed tomography will be necessary, which will clearly confirm the cause of the pain.
Depending on a person's pain threshold, the sensation of pain may appear in different places and with different intensity, so precisely determining during what movement or in what position of the body the "pinch of pain" appears will make it easier for the rehabilitator to continue working.
What are the effects of sciatica?
Most often, absenteeism from work is because the pain is so severe that it does not allow you to think about anything else except for the pain to stop. If this is a recurring condition, it may happen that the intervertebral disc protrudes so far towards the spinal cord that it begins to shape the dural sac in which the spinal cord is located. Then spine surgery is necessary.
Sciatica triggers a mechanism that protects the painful area by locking the joints around the painful area. The muscles contract to protect the painful area as much as possible. In case of sciatica, it will be felt in the lumbar sacroiliac joint, the transition from the thoracic to the lumbar section (sometimes the person is tilted to one side), and the knees may hurt.
Treatment of sciatica
Depending on who you ask for advice on treating sciatica, you may get answers like these:
The doctor (Neurologist, Orthopedist, First Contact) should take painkillers and relaxants and it should go away on its own. If the condition is acute, you can use stereoid injections or local painkillers.
Physiotherapist - only massage and work with body movements, relaxing the muscles around the pinched nerve, reducing muscle tension around the painful area, deep massage of the piriformis muscles and relaxing the skeletal muscles.
Chiropractor/Osteopath - manual therapy, spine decompression in the L4-L5/S1 section. Work on undoing the cause of the pressure and very carefully relaxing the sacroiliac joint. If the condition is acute and does not improve despite manual therapy, support yourself with Kinesio Taping to relieve the painful areas and give it a chance to regenerate.
Any of these methods can provide pain relief. Some will require 2-3 weeks of time, others 4-5 visits, and still others only two.
What does a manual therapy treatment for sciatica look like?
First of all, the first stage is a thorough interview with the patient. Determining the cause of this injury and the time when the first symptoms appeared. The next step is to determine the contraindications to the procedure; if there are none, you can proceed to checking the patient's condition. By touching the back, the tension of the back muscles, piriformis muscles, and thigh muscles is assessed. Through touch and gentle mobilization of individual sections of the spine, the place where the pain begins and the direction and range of its effects will be determined. The next stage will be to check the range of motion of individual joints that are affected by pain.
Once you have this knowledge, you can now proceed to perform a precise treatment, which aims to achieve high-volume relaxation of muscles, muscle fascia and unblocking of joints in order to restore the natural functionality of the body.
The procedure ends with checking the patient's mobility and intensity of pain. If the pain does not go away, the source of the pain is secured with kinesio tapes and the patient is referred for imaging of the painful part of the back.
Finally, the chiropractor shows a set of exercises for the patient to perform in the comfort of their own home. The exercises are aimed at strengthening the muscles and maintaining the corrected figure for as long as possible.
