Introducing Michael and Amanda O’Doherty- the husband and wife team at the heart of Chiropractic Moves and Chiro Mamas. They run a family clinic in our lovely Rosalie Village, with a focus on treating conditions of the back and hips as well as working with mothers and babies to address the musculoskeletal issues of pregnancy, birth and breastfeeding.
They know that you have a lot going on and don’t have time to be slowed down by pain and injury. They also know you are willing to do the work to get results. They are here to help you get out of pain and resolve your musculoskeletal issues through specific Chiropractic adjustments, targeted muscle work and tailored exercises to create healthy movement and get you feeling more like yourself again.
Their clinic is special, not because it’s across the road from Witness The Fitness Paddington, but because there are just two of them and they each have their own clinical expertise, meaning they are able to offer diverse services to you and your family. In short, they don’t have regimented guidelines and processes handed from ‘the guys above’, you will get the best experience possible and suited to your situation.
Here is a short look at a very common issue; sciatica!
Sciatica
Sciatica is an injury usually characterised by low back pain that radiates (or refers) into one leg, or very rarely two legs. It is the most common kind of referring lower back pain, and is sometimes called lumbar radiculopathy or sciatic neuropathy.
The Sciatic Nerve
Is the longest nerve in the body, it has a number of functions and one those is ‘supplying’ sensation (relaying signals) to the skin of the side and back of the leg, and the foot. It also supplies signals from the brain back down to the hamstring muscles and some muscles of the calf.
Referred Pain
The referral pain in sciatica usually travels down the back and outer side of the leg to the foot, the areas supplied by the nerve, it is most classically a sudden lightning bolt of pain. And may occur many times throughout the day, especially with movement. But may be accompanied by deep or achy pain, pins and needles, a tingling or crawling sensation through the skin. It could feel like burning or it may lave the affected area feeling completely numb. It may also cause weakness of the hamstring and calf muscles down the same leg.
Low Back Pain
Sciatica is very frequently accompanied by low back pain, as the sciatic nerve originates in the lumbar spine and is formed from strands of a number of spinal nerves. It’s usually the last 2 lumbar segments, the L4 and L5 that are injured and cause the pain referral but the nerve can also become irritated further along its course, the piriformis muscle is a common culprit, giving rise to a form of sciatica called piriformis syndrome.
Diagnosis
There are a number of different structures and diseases that can cause sciatica, health professionals presented with apparent cases of sciatica will want to rule out things like infection, cancer, diabetes, arthritis and more.
Do I Need an Xray or a Scan?
X rays are rarely useful for diagnosing or managing sciatica and almost never used. Similarly CT scans are rarely useful for sciatica. MRI scans are good at demonstrating disc injuries and protrusions that can cause sciatica, but even they are rarely required.
We don’t use them much as the vast majority of cases can be diagnosed by a qualified person without an MRI. An MRI can however be a useful tool to plan a surgery or to rule out another condition.
Why is Sciatica a Problem?
Sciatica should always be checked out by a health professional, besides needing to be differentiated from the conditions mentioned above, some cases of sciatica may result in permanent nerve or spinal cord damage. This could lead to loss of bowel and bladder control, paralysis in muscles of one or both legs, and permanent loss of sensation in one or both legs.
Treatment for Sciatica
Most people with Sciatica will benefit from avoiding long periods of rest and keeping up normal daily activities as much as possible.
Medical Treatment
Some over the counter medications are useful, especially for short term pain management, and should be discussed with a GP.
Surgery can work quickly for some people who fail rehab or get worse under usual care. Surgery is generally reserved for cases where nothing else is working as it’s expensive, time consuming, and may require rehab post surgery.
Exercise
Exercise seems to be the most useful therapy for sciatica. This should be in the form of structured supervised exercises. Walking the dogs or upping your pedometer steps in the workplace probably doesn’t count. Exercise programmes will usually include some strength component, and some stability and balance work, aimed to increase range of motion, reduce pain, and speed up the return to normal activity.
Manual Therapies
Adjustments or mobilisations like those commonly delivered by chiropractors are seen as useful treatment for sciatica as they appear to reduce pain, increase range of motion and may help people get back to normal activities earlier. These therapies should be used in addition to exercise and rehab. And like most therapies, they could have side effects that you need to discuss with your chosen health professional.
Other therapies
Massage and acupuncture may have a role to play too but there is not much scientific consensus on where, when or how these therapies should be included. Traction is generally avoided.
Reading List
1. Rapid Review Report: Diagnosis, Investigation and Management of Low Back Pain
Prepared for the Australian Commission on Safety and Quality in Health Care June 2020
2. Low back pain and sciatica in over 16s: assessment and management.
NICE guideline [NG59] Published: 30 November 2016 Last updated: 11 December 2020
3. On the definitions and physiology of back pain, referred pain, and radicular pain.
Bogduk, Nikolai
Pain: December 2009 – Volume 147 – Issue 1 – p 17-19
doi: 10.1016/j.pain.2009.08.020
4. Non-steroidal anti-inflammatory drugs for sciatica.
Rasmussen-Barr E, Held U, Grooten WJA, Roelofs PDDM, Koes BW, van Tulder MW, Wertli MM.
Cochrane Database of Systematic Reviews 2016, Issue 10. Art. No.: CD012382.
5. Traction for low-back pain with or without sciatica.
Wegner I, Widyahening IS, van Tulder MW, Blomberg SEI, de Vet HCW, Brønfort G, Bouter LM, van der Heijden GJ.
Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD003010.
6. Rehabilitation after lumbar disc surgery.
Oosterhuis T, Costa LOP, Maher CG, de Vet HCW, van Tulder MW, Ostelo RWJG.
Cochrane Database of Systematic Reviews 2014, Issue 3. Art. No.: CD003007.
7. Non-steroidal anti-inflammatory drugs for acute low back pain.
van der Gaag WH, Roelofs PDDM, Enthoven WTM, van Tulder MW, Koes BW.
Cochrane Database of Systematic Reviews 2020, Issue 4. Art. No.: CD013581.
Dr Michael O’Doherty (Chiropractor)
21 Agars St
Paddington 4064
0404 717 488
info@chiropracticmoves.com.au