PAIN IN THE BUTT?
And down the leg into the foot? Pins and needles, tingling, or numbness?
Sciatic pain may be the cause, it typically occurs in the buttock, back or side of
the leg and calf and into the foot. Sciatica results from a structure impinging
on a lumbar nerve root, resulting in compression and/or inflammation to cause
neurological changes in the skin, reflexes and muscles served by the affected
nerve. This results in altered sensations, i.e. pain, tingling, numbness.
Reflexes can be diminished or absent and the muscles supplied by the specific
nerve root become weak. It is not a common syndrome, only that 3-5% of the
population suffer from sciatica, however, suffer they will! It can be extremely
painful and have a profound impact on function. Aggravating factors are
sneezing, coughing, sitting, driving and bending over. Putting on socks and
shoes can become a monumental task. Lying down or standing up usually ease
the symptoms.
It affects men and women equally, with men most susceptible in their forties
and women in their fifties. Up to a quarter have symptoms which last more
than six weeks and referral to physiotherapists for acute management is
routine. The onset of lumbosacral radiculopathy is often sudden with low back
pain; any back pain may disappear at the start of the leg pain.
Disc prolapse is typically the cause of proper sciatica, however the size of the
prolapse is not related to the amount of pain the person suffers. Disc prolapse
can result in the internal nuclear material being extruded past the outer disc
wall, physically compressing the nerve root which runs nearby. This substance
is also chemically irritating to the nerve structure, making the nerve and
nearby structures swell, partly blocking the local circulation and the nerve's
message transmission.
The lumbar discs are more likely to have prolapses due to the high levels of
force they have to endure. When we lift things away from the body, bend over
at the waist or perform standing activities the back has to cope with the
leverage involved. When stresses are loaded onto the discs the hydraulic
mechanism magnifies the forces on the outer walls by three to five times that
which the skeleton has to cope with. With time these stresses cause failure of
the outer disc material and allow prolapses to occur.
If the disc prolapse is higher up the pain may be in the front of the thigh and
travel no further down the leg than the knee. A patient may have an isolated
area of pain and still have a prolapse.
“Red flags” are potential warning signs that a person’s back pain could be
caused by a medical illness and they need referral to a medical advisor for
further investigation. The physiotherapist will ask about weight loss, difficulty
passing urine or stools, feeling unwell or having a fever, night pain, poor
appetite, a serious past medical history and note whether the patient is
younger or older than typical back pain onset age. The physiotherapist will also
record the areas of pain, the types of pain reported and the response of pain to
postures and activities.
A person with lumbar radiculopathy may exhibit abnormal posture, sometimes
bent forward and unable to bend backwards, with a one-sided trunk shift.
Physiotherapists check the ability to perform spinal movements, any pattern of
limitation or tendency for the pain to centralize on repeated movements.
Physios will test the reflexes, sensation and muscle power to perform the
neurological examination.
The McKenzie technique works on pain centralization, the tendency for pain to
move towards the back from the legs, suggesting a disc problem, and many
physios use this technique. Pain in the front of the thigh and over the knee can
be referred from the hip joint, so the physiotherapist will assess the lower limb
joints to check the diagnosis. A thorough examination allows the
physiotherapist to diagnose the cause of the pain and how to best treat the
syndrome, or determine that the individual needs to be referred to a medical
practitioner for a consultation and investigation.
Physiotherapists use a variety of therapies to treat sciatica, with McKenzie
technique being a mainstream technique for discogenic pains. Mobilization and
manipulation techniques, core stability work, active release techniques,
specific exercises, manual techniques, acupuncture and IMS, soft tissue work
and massage are all used in treatment. Patient education on rest and the best
position to relieve extreme sciatica pain and advice are instrumental in the
healing process. Most individuals recover fully without surgery, and a long term
exercise program is useful once the problem has settled. If you have a pain in
the butt you would like to get rid of, we can help!
Bragg Creek Physiotherapy
403 949 4008
www.braggcreekphysio.com