Sciatica (Alain Michelotti, DC, PT)
So you think you may have sciatica?
Self-diagnosing is something we are all tempted to do.
Whether the symptoms we suffer from resemble the ones we had in the past, appear to be similar to those of a friend or a neighbour, or look very much like those described on medical website, it is easy to convince ourselves of a self-diagnosed ailment.
Do you remember “Three Men in a Boat” and Jerome’s study of the medical dictionary?
Making a diagnosis (labelling a condition) determines the management of the condition and has to be achieved by a process of elimination.
Roughly speaking, when in the presence of a patient suffering from low back pain, the practitioner has to decide if he is dealing with ordinary backache, nerve root pain or something more sinister.
To reach that decision, a careful history and examination are necessary. Sometimes even after that a doubt remains and complementary investigations are necessary.
Fortunately less than 1% of back pain is due to serious spinal disease.
Now, if we go back to self-diagnosing, it is true to say that we hardly ever see back pain sufferers entertaining the idea that their back pain can be associated with something sinister.
On the other hand, we regularly have patients consulting for what they think is a “sciatica”.
This is a word that has been in use from Greek times and is derived from “ischias” or pain around or coming from the buttock and thigh.
It then became “sciatica” and synonymous with pain in the leg and in the distribution of the sciatic nerve.
Sciatica can result from a disc prolapse (also commonly called a “slipped disc”), or the narrowing of the bony channels through which the sciatic nerve roots travel (called “spinal stenosis”).
One of the most common mistakes is to assume that all leg pain associated with back pain is “sciatica”.
The leg part of the pain is, most of the time, not caused by a “slipped disc”. It is due to the painful stimulation of the back muscles, of the little joints situated at the back of the spine, of the ligaments and of an array of other anatomical structures situated in the back.
Only when the leg pain is one-sided, extends to one foot, is constant, sharp, well-localized, and most of the time accompanied by numbness or pins and needles can it be labelled “sciatica”.
So, now that you’ve read this article, are you still convinced you suffer from sciatica?
The UK National Institute for Clinical Excellence (NICE) recommends spinal manipulation as performed by chiropractors for the treatment of low back pain and sciatica. For further information, visit NICE.