The bones (vertebrae) that form the spine in your back are cushioned by small, spongy discs. When these discs are healthy, they act as shock absorbers for the spine and keep the spine flexible. But when a disc is damaged, it may bulge or break open. This is called a herniated disc. A herniated disc is by far the most common cause of sciatica.
There are many different terms to describe lumbar disc pathology. The terms include: annular tears, bulging disc, disc protrusion, slipped disc, herniated disc, ruptured or extruded discs, sequestered disc, disc degeneration (or degenerative disc disease), pinched nerve, sciatica etc.
You can have a herniated disc in any part of your spine. But most herniated discs affect the lower back (lumbar spine). Some happen in the neck (cervical spine) and, more rarely, in the upper back (thoracic spine).
Sciatica is a term that refers to irritation of the sciatic nerve, which comes out of your lumbar and sacral spine. When people irritate a nerve in the back — for example, from a disc herniation — they can irritate the sciatic nerve. It is the longest nerve in the body, running from the lower back through the back of the thigh, and innervates all the muscles below the knee, all the way down to the foot. The sciatic nerve also has branches into the hip, buttock and hamstring regions.
Besides having poor genetics, one of the largest risk factors in developing sciatica is your chosen line of work. Research has shown that “sedentary work” and “heavy manual labour” are the two types of employment commonly associated with this condition.
Lumbar disc herniations are one of the most common causes of low back pain and occur 15 times more than cervical disc herniations. The peak occurrence is between the ages of 25-40. Males are affected more than women by a ratio of 3:2. About 90% of all lumbar disc herniations occur between the fourth and fifth lumbar vertebrae and fifth lumbar vertebrae and sacrum.
Symptoms of Sciatica
For most people with a herniated disc, low back pain is the initial symptom. This pain may last for a few days, then improve. It is often followed by the eventual onset of leg pain, numbness, or weakness. This leg pain typically extends below the knee, and often into the foot and ankle. It is described as moving from the back or buttock down the leg into the foot.
Symptoms may be one or all of the following:
- Back pain
- Leg and/or foot pain (sciatica).
- Numbness, burning or a tingling sensation in the leg and/or foot.
- Weakness in the leg and /or foot.
- Coughing, Sneezing and Laughing may increase the pain.
- The patient may not be able to sit prolonged.
- Loss of bladder or bowel control (extremely rare). This may indicate a more serious problem called cauda equina syndrome. This condition is caused by the spinal nerve roots being compressed. It requires immediate medical attention.
Not all patients will experience pain as a disc degenerates. It remains a great challenge for the doctor to determine whether a disc that is wearing out is the source of a patient’s pain.
Treatments for Sciatica
At Spinal and Sport Care our philosophy is to prevent as many patients as possible undergoing spinal surgery.
Through a thorough evaluation, we aim to identify the potential cause of your sciatica. Our practitioners are all trained to accurately assess, diagnose and treat all forms of disc herniation and sciatica.
Lower leg pain originating from or relating to low back dysfunction can be successfully treated & even prevented by Spinal and Sports Care.
In the majority of cases, a herniated lumbar disc will slowly improve over a period of several days to weeks. Typically, most patients are free of symptoms by 3 to 4 months. However, some patients do experience episodes of pain during their recovery.
Unless there are neurological deficits — muscle weakness, difficulty walking — or cauda equina syndrome, conservative care is the first course of treatment. Because it is not clear that nonsurgical care is any better than letting the condition resolve on its own, the focus is on providing pain relief.
Common Treatment measures include:
- Protective Optimal Loading. Usually several days where movement is initiated but protected to avoid further injury. Take rest breaks throughout the day, but avoid sitting for long periods of time. Make all your movements slow and controlled. Change your daily activities so that you avoid movements that can cause further pain, especially bending forward and lifting.
- Anti-inflammatory medications. Medicines like ibuprofen or NSAIDs may relieve pain. Ice is much better than heat initially.
- Chiropractic & Physical Therapy. Specific treatment such as massage, Maitland’s mobilisations and manipulations in conjunction with specific exercises such as McKenzie Exercises can reduce inflammation and muscle spasm as well as strengthen your lower back and abdominal muscles. In addition to other conservative treatments, there are also several modalities that can be included in treatment for lumbar herniated discs. These include:
- Mechanical traction
- Low-Power Laser
- Surgical Treatment Only a small percentage of patients with lumbar disc herniations require surgery. Spine surgery is typically recommended only after a period of nonsurgical treatment has not relieved painful symptoms.
- Microdiscectomy. The most common surgical procedure for a herniated disc in the lower back is a lumbar microdiscectomy. Microdiscetomy involves removing the herniated part of the disc and any fragments that are putting pressure on the spinal nerve.
- Rehabilitation. Most patients do not require formal physical therapy after surgery. After your surgeon evaluates you and confirms that your incision is healed, you may begin a rehabilitation exercise program. A simple walking program 30 minutes each day, along with flexibility exercises for the back and legs, can be done as a home program.
Regardless of the kind of treatment prescribed, there is a 5% chance of the disc herniating again.
The risk of nonsurgical treatment is that your symptoms may take a long time to resolve. If after about 6 months, you elect to have surgery, the final outcome may not be as good as if you had elected surgery earlier.
One of the most surprising discoveries from research regarding treatment options for disc herniation-induced radiculopathy is that disc surgery (microdiscectomy) and conservative non-surgical treatment have the same outcome with respect to over-all long-term improvement.
So keeping that in mind, the only true indications for surgery in the short to medium term are;
- The patient simply can’t stand the pain or take the leg discomfort any longer
- The patient has a progressive worsening of neurological symptoms or the development of a cauda equina syndrome.
The only advantage of microdiscectomy is that usually gets the injured person out of pain and back to work faster than conservative care alone.