Up to 85% of adults will experience low back pain in their lifetime and if you are one of them, read on to learn more about low back pain and how we approach low back pain treatment at the Unpain Clinic.
How can I tell if it’s back pain or sciatica?
Back pain and “sciatica” are both common, but they are not the same thing. Back pain is generally any pain which occurs in the middle or lower parts of the back, while sciatica is a general term referring to pain which radiates down the leg, typically with a low back origin although the low back may not be painful with sciatica.
Back pain is one of the most common musculoskeletal problems affecting roughly 85% of adults at some point in their life. Back pain can range in severity from mildly annoying to completely debilitating and can affect your ability to work, exercise or even complete your activities of daily living. The causes of back pain can be simple and straightforward or complex with multiple etiological factors. There are a number of pain sensitive structures in the spine including the muscles, tendons, ligaments, joints, joint capsules, spinal discs, and the bones of the spine themselves which can become injured or diseased leading to pain and dysfunction in the back.
Some of the more common causes of back pain include muscle strains or ligamentous sprains, herniated/injured discs, arthritis and spondylolisthesis, and even non-specific mechanical back pain. Non-specific mechanical back pain occurs when one or several pain sensitive structures become irritated for a variety of reasons (see image and read on below).
Sciatica is a general term referring to pain which radiates down the leg (front or back), typically with a low back origin although the low back may not be painful with sciatica. Sciatica can cause pain, numbness, or tingling down the leg (usually on one side) and is often, but not always, caused by a herniated disk in the lower back compressing and irritating a nerve root. The nerve branches most often compressed are those from the L4-S1/2 levels which are all part of the sciatic nerve, however, other nerves higher up can be compressed causing referral to the front or sides of the leg as well. Most healthcare professionals no longer use the term sciatica and instead call it radicular pain.
Causes of Back Pain and Sciatica
Back pain and sciatica are common complaints that can have a variety of causes. There are a number of pain sensitive structures in the spine including the muscles, tendons, ligaments, joints, joint capsules, spinal discs, and the bones of the spine themselves which can become injured or diseased leading to pain and dysfunction in the back.
Bulging Discs/Herniated discs
Bulging or herniated discs can be a common cause of back pain. The discs are specialized connective tissue elements found between the bones of the spine.
Contrary to popular belief they are not shock absorbers for the spine, but rather they connect the spinal segments and allow for movement between the vertebrae.
The spinal discs can become injured over time with excessive strain or immediately with spinal trauma. When the outer fibrous part of the disc is injured, the jelly-like inner core called the nucleus pulposus can push outwards to create a bulge if some of the annular fibres are still intact, or a frank herniation if the annular fibres are torn.
Sometimes this bulge or nucleus material will compress the spinal cord itself or one of the nerve roots that provide motor and sensory innervation to the lower limbs causing pain, numbness, and/or tingling in the back and legs. In most cases the pain from disc herniations or bulges will resolve with time and treatment, but rare cases may require surgical repair.
Muscle strains are some of the most common injuries in the lower back and can occur when a muscle is overstretched or if it is overloaded with too much weight or tension.
Muscle strains in the back can be acute (from a sudden injury during sports or lifting) or can come on over time from chronic wear and tear to the spine.
Athletes, people who have jobs involving heavy lifting and repetitive movements and sedentary people over-exert themselves are more prone to straining their back.
Symptoms of a muscle strain can include pain, swelling, and weakness. Strains will generally resolve with conservative management.
Sciatic Nerve Impingement
The sciatic nerve is the largest nerve in the human body. It is made up from the L4-S2/3 nerve roots which are a part of the sacral plexus.
This nerve runs from the level of the sacrum and down the back of the leg before it splits into 2 parts at approximately the level of the knee.
The branches of the sciatic nerve are responsible for innervating the muscles of the legs and feet. It is possible for the sciatic nerve to become entrapped or impinged at several locations as it passes through the pelvis and posterior thigh.
Symptoms can include pain, numbness/tingling or weakness in the muscles of the leg.
Arthritis and Stenosis
Osteoarthritis is a condition that is present to some degree in most people over the age of 40 years old. It is caused by wear and tear and old injuries and can range from very minimal to quite severe. Interestingly, the degree of arthritis seen on an x-ray does not necessarily correlate well with the amount of pain that a patient will suffer.
What this means is that someone who shows moderate to severe OA on a radiograph, may have no back pain at all, while someone with minimal to mild arthritis may have severe pain.
When arthritis is the cause of back pain patients will generally have pain, swelling or stiffness in their joints which can be worse in the mornings or with exposure to the cold.
With arthritis it is possible for patients to develop stenosis. This is a condition in which the spinal canal itself or the spinal foramina (holes through which the spinal nerves exit the spinal canal) become narrowed and can sometimes cause impingement of the spinal cord or nerve root(s).
Symptoms of spinal stenosis can include tingling or numbness in the back, severe pain or back stiffness, spasms or charlie horses in the legs, problems with walking or standing long periods (it may feel better to lean forward) and issues with balance.
Treatment for spinal stenosis generally involves symptom management, but in some severe cases the nerves may require surgical decompression.
How do back pain and sciatica develop?
Back pain and sciatica can develop as a result of a number of factors including injury, systemic disease or progressive wear and tear to the back.
Some factors like age, genetics, anatomical variants, poor posture, bad ergonomics, weight gain and deconditioning can predispose people to developing back pain more readily.
Usually there is not a singular cause of back pain and sciatica but rather a cluster of things that contributed to developing the problem.
Symptoms of Back Pain and Sciatica
Symptoms of back pain can include dull aching pain, muscle spasms and tightness, swelling, stiffness, weakness in the back muscles, pain with moving or walking, or pain with sitting for prolonged periods.
Symptoms of sciatica include pain, weakness, numbness or tingling in the leg which may be worse when trying to move the leg, pain that is worse with sitting and pain that may change positions in the leg depending on the patient’s body position. Sciatica may be present with or without back pain.
If you experience either back pain or sciatica with a complete loss of sensation or strength in one or both legs, a sudden loss of bowel or bladder control or loss of sensation in the perianal/genital area (can’t feel it when you wipe) or inner thigh area, seek emergency medical attention immediately.
These symptoms are related to a condition called Cauda Equina Syndrome which occurs when the nerve roots of the lower spine become compressed. This condition can require surgical decompression and can lead to permanent disability if not managed appropriately.
Diagnosis of Back Pain and Sciatica
Diagnoses of back pain and sciatica are generally made based on the history and presenting symptoms of the patient. A healthcare provider will perform a history and physical exam and may order tests such as x-rays, MRI or an ultrasound.
One thing to keep in mind however is that these imaging modalities are not usually necessary to make a diagnosis and in many cases back pain will resolve before some types of imaging are even available to a patient.
Imaging and advanced testing are usually reserved for trauma, non-traumatic cases that are very severe, when the pain could be related to non-musculoskeletal factors or when patients are not responding to conservative care.
Treatment of Back Pain and Sciatica
A good treatment plan for back pain and sciatica can include many elements and a variety of healthcare professionals. Which elements you might need will depend on the severity and cause of your pain, as well as your ability to function and perform your activities of daily living. Possible treatments for low back pain can include:
- Ice, analgesic use, rest, stretching and simple exercises
- Advice and education on lifestyle and activity modification
- Prescription medication use
- Chiropractic or physiotherapy – can include manual therapy (mobilizations, manipulations, soft tissue therapy), rehab exercise prescription, modalities (shockwave, TENS, Laser, ultrasound, IFC), taping or bracing, dry needling
- Massage therapy
- Psychological counselling and education on meditation and mental pain relief strategies
- Assistive devices – braces, canes, walkers, wheelchairs
- Surgery – used only in the most severe cases where patients do not respond to conservative care or require spinal decompression to relieve pain and symptoms.
Goals of Physical Therapy and Exercise in Treating Sciatica
The goals of any kind of treatment for back pain and sciatica are to help you reduce pain, improve function, and regain and improve your strength and mobility. Another important part of care for back pain is to help you identify areas of lifestyle improvement and educate you on building better habits and ergonomics to protect your back in the future.
Back Pain and Sciatica Relief in Edmonton
If you are suffering from back pain or sciatica, relief is available. Our team of experienced professionals at the Unpain Clinic can help you get back to living your best life sooner.
We offer a variety of treatments, including chiropractic care, massage therapy, physiotherapy, and shockwave therapy to help you recover.
We also offer lifestyle advice and education, exercise prescription and ergonomic advice to help you stay healthy and pain free.
Book a free no-obligation tele-health consult with us today to find out how we can help you get relief from your back pain or sciatica.
Can sciatica pain be cured by physiotherapy?
Possibly. Physiotherapy and chiropractic can be great options for treating sciatica. The response of any patient to therapy depends on the cause of the sciatica as well as several other factors related to general health and lifestyle.
In many cases a treatment plan that includes a good mix of education and advice, rehab exercises and stretches, manual therapy (soft tissue therapy, mobilizations, manipulations) and the use of modalities ( such as TENS, Shockwave, laser, IFC, etc) is sufficient to help patients with sciatica. In some cases with a complex cause such as a herniated disc or spinal stenosis, or if patients do not respond to a course of conservative care, surgery may be indicated.
Which treatment is best for sciatica?
There are a number of treatments that can help relieve the pain of sciatica, so it can be hard to know what to try first. A good place to start is with a visit to a chiropractor, physiotherapist or medical doctor. They will help you develop a treatment plan that takes into account the cause of your pain, the severity of your symptoms and lifestyle factors that could be contributing to your discomfort and dysfunction.
What exercises can I do for sciatica and back pain?
There are many exercises that can be done to help relieve sciatica and back pain. Safe exercises for most types of back pain include easy walking and gentle stretches or yoga. That said, a group of exercises may help one type of back pain while aggravating another. The best exercise plans target the cause of the pain and your healthcare provider can help you develop a rehab plan to strengthen and stretch the right areas and get you back to optimal functioning.
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