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News - Steroid injections do not help sciatica

View the Mail OnLine article here

Well I guess this depends on whether the back pain is due to 'true' sciatica! As the article suggests sciatica is most commonly caused by the compression of the nerve by a 'slipped disc' but what is not usually considered is if the disc is not the primary reason for its malfunction anyway; in other words what about the 'Chicken and egg' scenario? It would be interesting to see what the inclusion/exclusion criteria for the participants considered for the study were.

Contrary to popular belief, the disc does not slip. The disc is rather like a jam doughnut and its integrity is reliant upon the mobility of the inner centre of material which should migrate easily within its outer covering. The centre migrates backwards and to the sides as pressure is applied from either the top or bottom of the spine. Each disc sits between two spinal bones and this arrangement is repeated throughout the length of the spine. The sandwich construction of the disc and the bones above and below are secured in place by corresponding adjacent parts of ligaments running the length of the spine and muscles found strategically at different levels of the spine and also running along the entire the length of the spine. Each 'sandwich' is secured at the back and slightly to the side by a joint on either side; the facet joints.

The sciatic nerve is a bundle of nerves coming from different levels of the lower back and depending upon which part of the bundle is compressed symptoms maybe felt in different parts of the leg, thus it is not a simple fact that all sciatica is the same! If there is a malfunction of the securing components of the 'sandwich' arrangement, it then maybe the case that the disc may not be able to migrate properly or return to its normal position after the pressure has been relieved. It is therefore possible that direct treatment of the disc may not yield dividends unless this natural movement is restored to this structural arrangement.

There is therefore the possibility that the findings of this study are distorted because the diversity of the type of patients suspected of suffering from sciatica. A skilled Physiotherapist is capable of determining what the primary cause of the problem may be. To do this the Physiotherapist creates an understanding of the symptoms as you describe them and seeks to correlate your descriptions to the findings of physical functional tests. This principle is based on the scientific assumption that there is always a cause to an effect. These tests may not correspond to the results of an MRI or X-Ray so do not be confused when this may be pointed out to you. This is not entirely surprising because these methods of examination are done when the patient is lying flat or standing whilst remaining completely still. Low back pain occurs when there is movement...remember the disc require pressure to migrate (or not) to produce compression of the nerve and only functional physical tests will provide that pressure!

© Dr A. A. Aluko, November 2012

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