Sciatica and Leg Pain
Sciatica is leg pain caused by a low back problem irritating the Sciatic Nerve (L5 and S1) emerging from the lower back suppling skin, muscles and other components in the buttock, back of the thigh, back and outside of the lower leg and much of the foot; there are other types of similar pain including Femoral Neuralgia (L4)
What is a Trapped Nerve?
The expression ‘a trapped nerve’ is often applied to any pain which is sharp. This is incorrect.
The characteristic of a trapped nerve pain is that it covers an area distant from the causal problem in the distribution of a single nerve or nerve root. It may be a shooting pain, like a bolt of lightening, or a constant pain, tingling or numbness.
Where is the nerve trapped?
At The Spine Team we will listen to your symptoms and depending on how you describe your current pain and your history we will use examination tests to identify how and where the nerve is likely to be trapped; whether inside the spine, irritated as it leaves the spine or compromised further away from the spine.
Nerve Trapped Inside the Spine (Intra-Spinal)
If the symptoms imply that the cause could be inside the spine, the most obvious of which is that the leg pain is worse than the back pain, it could be due to an injury with anatomic change such as a disc prolapse or herniated disc. These are of course difficult to get at (being inside the spine) and may well need time to heal. In such cases treatment plans will be very different from those where it is likely that the nerve is irritated outside the spine. If a problem inside the spinal cord is suspected your options will be discussed giving a clear idea of what might be the best thing for you, which may include treatment, imaging or referral.
Although the term “slipped disc” is widely used a disc ‘herniation’ or ‘prolapse’ is a relatively uncommon condition accounting for only about 2% of back or back related leg pain; these terms should not be confused with a ‘degenerative’ disc which is common and a type of wear and tear and not associated with pain.
Nerve Trapped Outside the Spine (Extra-Spinal)
However most patients with lower back and leg pain do not have a disc prolapse but have Mechanical Back Pain, also known as ‘Simple Back Pain’ or ‘Non-Malignant Pain’. If the problem is present in a structure that is close to the emerging nerve, such as the ‘Facet Joint’, it can cause nerve irritation giving low back and leg pain, including within the distribution of sciatica, but is not caused by disc damage. Soft tissue irritation outside the spine, to the mechanical components, is a far more common cause of leg pain than disc damage.
Mechanical Back Pain and nerve pain to the leg can be treated at the Spine Team, this is the commonist type of low back and leg pain we see and can be treated the same as Acute Low Back Pain or Chronic Low Back Pain depending on the conclusions of your Spine Team practitioner after your first visit.
Deep Referred Pain
Another type of back related leg pain where the pain uses the nerves to get around but in which the nerve itself is not trapped. These pains do not follow the pathway of a single nerve or nerve root but rather follow patterns within the muscles, joints and bones giving, as the name suggests, deep pain. This type of pain can be more constant and hard to control but is usually less sharp than a trapped nerve, it is also frequently associated with a postural or lifestyle weakness.
Your Spine Team practitioner will be able to help you understand this type of pain which usually requires you to change the way you use the area rather than have the problem fixed; this may be due to a postural weakness or an environmental or workplace habit or activity. It cannot be regarded as an injury as there is rarely any suggestion of injury, there is also a tendency for the body to learn this behaviour as part of the problem increasing the likelihood that it can develop into Chronic Pain.
Mechanical Back Pain with Deep Referred Pain can be treated at the Spine Team, this is a less common cause of leg pain than nerve irritation but can be treated in the same way as other types of Low Back Pain and your Spine Team practitioner will explain this after your first visit. This type of pain usually requires a change in lifestyle, either identifying and correcting the position, habit, posture or activity that puts you at risk or increasing the fitness of the body to cope with the load. A willingness to appreciate and overcome this will be required to make a recovery from this problem once it has become Chronic (lasting more than eight weeks).