In the last month I've seen quite a few cases of sciatica
and the equivalent problem in the neck and arm, namely brachial plexus
irritation. Both of these problems
stem from an irritation or damage of the inter-vertebral discs. In old money this is a "slipped disc". Truth is, the discs don't slip out of
position, but they do bulge, become inflamed, tear and even burst.
The discs themselves are constructed of rings of fibrous
cartilage running in opposite directions with a soft gel like centre called the
nucleus palposa. Think jam filled
donut. Ironically the centre gel
is one of the most active nerve irritants known. If the disc bursts or even leaks the resulting nerve pain is
excruciating. Patients will
describe the pain that shoots down the leg to the foot as if they were
connected to the mains. The pain often
rates above child birth, but below that caused by kidney stones. This and the fact the discs are mostly
water is a very good reason to keep fully hydrated.
If you ever
wonder why you are taller in the morning, it's partly because gravity squashes
the water out of the discs during the day. Often most noticeable to drivers as they need to adjust the
rear view mirror in the morning as they are taller than the evening
By around the age of 35 the soft core thickens to become
all cartilage. Beyond this age it's a small tear or bulge and swelling that
pushes onto the sciatic nerve resulting in the pain. The cause to avoid is lifting a weight away from the body
with a rotation to one side. Add in a sudden unexpected load, "they dropped
their end", and the shearing force can tear the disc. Lifting a baby carrier
into the back of a car is another good example.
Usually it is one of the two discs between the lowest
lumbar vertebrae that cause the problem (L4/L5 or L5/S1). Key diagnostic indicators are; the leg
pain is worse than the back pain, there is little relief lying down or at
night, bending forwards shoots the pain down the leg, the foot can become numb
or weak and the idea of coughing or sneezing is terrifying!
A course Chiropractic care will usually resolve the
problem. In a recent study the course averaged at 13.2 treatments, personally I
find it's about 8 treatments.
Those that don't resolve, about 4%, may require surgery. The traditional method is a discectomy
possibly with fusion of the vertebrae.
Disc replacements are increasingly available, but at £15,000 and with no
certainty of result, often the last choice.
Chiropractor at South Street Chiropractic