Sciatica or sciatica and osteopathy

Sciatica (or sciatic neuralgia) is pain in the sciatic nerve. It may be due to compression, irritation, traction or injury to the sciatic nerve. 

The word "sciatica" is often used to define sciatica due to disc compression, but it often comes out of the mouths of pregnant women who suffer from sciatic nerve pain due to compression at the level of its exit from the pelvis, which is in fact sciatica in pregnancy.

• Sharp pain that starts in the back or buttock, moves down the back of the thigh and may extend to the foot
  • If the L5 root is affected, the pain is located at the back of the thigh, goes down on the external side of the knee and the leg to end on the top of the foot and the hallux (big toe)
  • If the S1 root is affected, the pain is located at the back of the thigh, then at the back of the knee, along the calves and the Achilles tendon, the heel and then extends to the sole and the outer edge of the foot up to the last toes.
• The pain is usually unilateral, meaning that it affects only one leg.
• Paresthesias with disturbances of sensitivity: burning sensation, tingling or electric shocks on the nerve path.
• Sometimes weakness with loss of strength of the affected leg.
• Increased pain at night when lying down (in cases of sciatica related to a herniated disc).
• The pain is increased when coughing, sneezing or when pushing.

These forms are rare but must imperatively require a medical opinion!

• Ponytail syndrome It combines
  • Sensitivity disorders of the leg
  • Sensitivity problems in the perineum with what is called anaesthesia in the stool (feeling of not being able to feel well when wiping the toilet)
  • Urinary and rectal sphincter disorders: difficulty urinating, inability to hold urine, etc.
• Paralyzing sciatica: impossibility to perform certain movements with the leg. Walking is very difficult or impossible.
• Hyperalgesic Sciatica 

The diagnosis of sciatica is often made on the clinical examination, but the cause can be confirmed by imaging.

• Interrogatory with evidence of sciatica-like pain
• Observation of the member
• Sensitivity testing
• Osteotendinous Reflexes Testing (ORT)
• Testing of the muscular strength

• Radiography 
• Scanner
• MRI

The causes of sciatica are all the phenomena that can cause compression or inflammation of the sciatic nerve.

• The disc herniation at the level of the disc between L4-L5 or L5-S1 can cause what is called a disco-radicular conflict, i.e. the disc (small cushion between the vertebrae) can overflow and compress one of the sciatic nerve roots. Be careful, not all herniated discs cause sciatica!

• The famous sciatica of the pregnant woman: compression of the sciatic nerve by the piriformis muscle. The pain is similar to sciatica but is much less serious because regular stretching of the piriformis muscle and an osteopathy session to correctly mobilize the pelvis is often enough to relieve the patient

Rarer causes:

• Osteoarthritis in the lumbar vertebrae
• An inflammatory pathology of the spine (ankylosing spondylitis, etc)
• A trauma on the lumbar spine
• A vertebral collapse due to trauma or osteoporosis
• A tumor or bone metastasis in the lumbar region
• An infection of the spine (e.g. Pott's disease or tuberculosis of the bone)

• Malformations (scoliosis, others)
• Trauma and micro-trauma
• Overweight
• Osteoarthritis
• Regular carrying of heavy loads, especially if a rotation component is added.
• Pregnancy

The treatment depends greatly on the cause of the sciatica: the patient can be treated with osteopathy, physical therapy, and in rare cases by surgery.

The most commonly used medications for sciatica are:

• Analgesics
• Short-term anti-inflammatory drugs
• Muscle relaxants

Electrotherapy relieves the patient's pain but does not treat it. The purpose of electrotherapy is to send an impulse to the brain so that the information receptors are saturated and the brain can no longer integrate the pain signals. The patient no longer feels the pain, or at least the pain is reduced.

Physiotherapy sessions not only provide relief through massage, but also strengthen the patient's back through specific exercises to prevent the pain from returning. Indeed, the muscles act as posts on the spine, the more muscular we are, the more the back is maintained, the less pain we have. It is therefore necessary to maintain a good physical condition and not to forget to continue your exercises at home after the physiotherapy sessions have stopped.

The osteopath's role will be to first test to determine if osteopathic treatment is possible. In case of doubt, he will redirect you to a specialist or your general practitioner for further examination.

The practitioner will adapt his techniques to each patient and each pathology. For example, he will not "crack" the vertebrae where there is a herniated disc or a vertebral compression but will work with flexible and adapted techniques.

After his clinical examination, your practitioner will treat your body with a set of techniques to allow an optimal functioning of your body.

Surgery is rare and is only necessary in less than 5% of sciatica cases.

Marie Messager
Osteopath in Versailles
78000 - Yvelines