Back-related aches and pains seem to come in every size and sensation. But what if that stab you feel is in your butt? Maybe it’s sciatica.
That’s what everyone’s likely to say anyway.
But sciatica is a set of symptoms rather than a diagnosis. And, wow, if you have it, welcome to a wide range of pain possibilities.
The tricky inflammation can be felt in the back, buttock, leg or foot – and the pain can range from mild to debilitating.
It’s all caused by compression or irritation of one of the five roots of the sciatic nerve or of the sciatic nerve itself, which runs from your lower back through your buttocks and into your limbs.
Sciatica is one of those nasty little life interruptions that can be caused by anything from a postural glitch to a rare but life-threatening tumour.
What the experts say
“We only deal with severe, severe cases, using what’s called spinal decompression technology. We deal with disc herniations and degenerative disc disease, conditions that are primary causes of sciatica. Our treatments have an almost 90 per cent success rate in actually rebuilding the disc, or if you have a disc herniation, sucking that disc material back to remove the pressure. The longer you let things go, the more difficult it is to treat.”
RICHARD LIEM, director, Low Back Clinic, Toronto
“Commonly, sciatica is caused by a pinched, inflamed nerve, such as would be caused by a disc herniation. Degenerative arthritis is another cause. A tumour can push on the nerve or form within the nerve. A cyst can push against the nerve. It’s important to know what’s causing the pain. We give patients six to eight weeks of conservative exercises and sometimes analgesics for pain. If it doesn’t get better, we inject the area with cortisone. And if that doesn’t work, we operate to remove the pressure. Sciatica should not be treated lightly. It could a tumour, though rarely. It could be a sign of a massive disc herniation, which can cause paralysis. Decompression therapy on a degenerative disc is not going to do harm. But if your sciatica is cause by a tumour, it’s not going to help.’’
MARK ERWIN, assistant professor, orthopedic surgery, University of Toronto, Toronto Western Hospital
“Pain is real, but it has to be interpreted through the conscious organism, the brain. Each individual interprets it, responds to it, copes with it differently. Someone who has no social support may interpret those sensations differently from one who has a good diagnosis, understands what’s happening and has good supports and helpful physicians. If the pain is chronic, we help individuals cope effectively and feel they have some ability to self-manage. It’s important for people to understand that their backs don’t exist outside of their life experiences. To only focus on the disc or nerve root is forgetting the fact that the disc resides in a human being with a history.”
DENNIS TURK, professor of anesthesiology and pain research, University of Washington, Seattle
“Determine the cause of the sciatica. Internally, I suggest St. John’s wort, with vervain, scullcap and black cohosh. For severe nerve pain, Jamaica dogwood may be added to the formula. Externally, use a combination of St. John’s-wort-infused oil or tincture, cayenne tincture and essential oils of lavender and rosemary. This should be applied as often as possible. Many people with sciatica benefit from acupuncture. Gentle stretching, regular moderate exercise, hot and cold packs and massage can all assist the healing process.”
DANETTE STEELE, registered herbalist, Toronto
“Poor posture can lead to sciatica – sitting in a slouched position in a chair or a car. Anything that puts downward pressure on the spinal column can cause nerve problems. It can also be caused by exercising in the wrong way, repetitive movements that put pressure on the back. The solution is not a matter of sitting up straight; that will still put pressure on the spine. Sciatica usually starts with the pressure of the head and neck into the spine. If you look at a two-year-old child, you would say that their body is open. Getting the body to be open can only be done through education.”
ELAINE KOPMAN, Toronto School of the Alexander Technique