Leg Pain Sciatica

Leg pain sciatica can stop you; in fact, it can ruin your life if you don't sit up and take notice. You can be sure the huge sequestrated disc seen above at the L5-S1 level did not arrive out of the blue. This person has been receiving warning signs, probably for months or even years; and ignored them.

This page was last updated by Dr Barrie Lewis on 17th April, 2019.

Anecdotes from the coalface are interesting but have no scientific value. 

Yesterday I was consulted by a man who developed low back pain about eighteen months ago, after gardening. A few weeks later, it started tingling in his leg, and then his lower limb became numb.

Three months ago he had a back operation. The next day he couldn't lift his toes off the ground; he still walks with a typical foot drop gait.

And the patient still has pain running all the way down to the foot.

Ironically in Dutch the colloquial term for an operation is "I have been helped." Ik ben geholpen.

After he was "helped" by the surgeon the man could no longer lift his foot. One of the sciatic nerve roots was damaged by the miner, working with his chisels and drills.

Can chiropractic help him? Time will tell.

I confess this man is but one of many, and I can't remember who he is or what transpired. Suffice it to say, try everything else before going under the knife.

Leg Pain Sciatica

Leg pain sciatica is always a challenge, never the same, but usually with a successful outcome with chiropractic provided you comply with instructions. Lower back exercises are mandatory every morning before arising and you may be for period not allowed to sit and must consequently take some bed rest.

Slipped disc... an analogy 

Leg pain sciatica usually, like the common cold, starts insidiously. Ignored, a cold may go through this process: Cold > Influenza > Bronchitis > Pleurisy > Pneumonia > Death

The process can usually be stopped at any stage with the appropriate treatment. Neglected, the disease process marches remorselessly on.

In the lumbar spine

In the lumbar spine, every case is different, yet the same:

Low Back Pain, LBP >>>

> LBP + tingling in the leg

> LBP + leg pain + sensory changes

> LBP + neurological signs, like a foot drop

> The true hernia: no or very little back pain + severe leg pain, and possibly in very rare, extreme cases loss of bladder control.

Research shows that 5% proceed to intractable pain within six months. Please don't assume you will be in the ninety-five percent.

Tracking the progression of leg-pain is done using the slump test for sciatica. You can use it at home.

• Lower back and leg pain
• Slipped disc diary
  

Type "slipped disc diary" into this search engine to garner more information.

Constipation

Bearing down on the toilet becomes very painful when you have a slipped-disc; it requires the use of the so-called valsalva manoever. Inactivity and pain medication have a serious effect on the motility of the colon; constipation.

It's vitally important. All that extra fibre is what makes a bowel movement much easier; having to bear down hard will certainly aggravate any leg pain sciatica. It makes sense anyway as constipation is a significant cause of colorectal tumours; along with food plans very high in fat, meat and alcohol. A lack of the many phytochemicals in very coloured fruits and vegetables also contributes.

Constipation and carthartics are risk factors of colorectal tumours, published in the journal Pharmacology.

Prevention

Neglected both the common cold and low back pain, if ignored, may become medical emergencies. An ounce of prevention is worth a pound of cure!

Almost invariably this situation occurs only by neglect. That may be on the patient's part, his doctor's fault, and yes, even your chiropractor's poor management of your condition.

Sometimes, it was just that misfortune intervened; a shower of sneezes, a slip on a lettuce leaf but usually, it's neglect

The result is leg pain sciatica; we see it all the time at the coalface.

• ATHEROSCLEROSIS SYMPTOMS and low back pain; clogged arteries cause LBP.

Slipped disc rules

These slipped disc rules may just save your bacon if you have severe lower back pain, particularly if it radiates into your leg. Never underestimate how a herniated disk, neglected, can ruin your life. Really, I mean it. Take it seriously, go for treatment, get into a lower back and leg pain exercises program and sit less.

Eat plenty of roughage if you have leg pain sciatica, or if it affects the femoral-nerve which is equally serious; then the knee begins to give.

Fish oil has enormous proven benefits for all joints, not to mention the heart, mind, and the neurodegenerative conditions like Parkinson's disease. The benefits are for everyone; the omega-3 removes fatty plague from the arteries. Freshly ground flaxseed is the vegetarian alternative; genuine free range eggs, if you can find them, have three times the amount.

From the coalface, here's another anecdote.

Mrs S consulted me 10 days ago. Ten years ago she had a prolapsed disc and successful surgery, though the pain in her back never went completely away. Regularly she had problems. Her saving grace is supreme fitness; she rides 40 km to work, and back, every day; that's no mean feat. Then three-weeks ago the pain became the most severe since her operation, and she decided to consult me.

Fortunately she was at grade I. Only low back pain and responded extremely well to what we call the chiropractic adjustment; after only two treatments she had 70-percent less pain. Every doctor loves to treat fit patients.

Then on Friday Mrs S. fell down five dangerous Dutch stairs. The proverbial-stuff happens to put it bluntly and now the future is very precarious. It pays to be careful when you have a sore back; leg pain sciatica looms.

Here is an update. Mrs S is fine. For once the Dutch stairs had no great deleterious effect. She went, with arm twisting, through the full rehab programme, and has no pain. It's not always like that. I have learned the hard way, and you can benefit from my experience; never take your low-back pain for granted. It can turn around and bite you.

Chiropractic

What does chiropractic have to offer when you are suffering from leg pain sciatica?

Mr Jansen consulted me yesterday; his history was fairly typical. Three weeks ago a bit of pain started in his low back. A one-man band contractor he was in an invidious position; no work means no pay. So he continued as usual. "Ik kan me voorstellen," as we say in Dutch. "I can imagine." I would have probably done the same.

And yet lower back pain usually means we have to stop for a period.

There he was, standing before me, twisted like a gnarled tree in what I call the typical "Pisa sign". His frame looked for all the world like a leaning tower in what we call an antalgic posture. They come in two sorts and fortunately he was indeed leaning away from the painful side, and not towards.

An antalgia is an extremely serious sign. Always in my opinion, you should go to bed until you can stand up straight, but research proves that it is not enough. You must exercise, get up every hour and take a walk, use ice, and my advice, yes, I'm prejudiced, consult a good chiropractor. Ask your friends and neighbours, your doctor, and they will tell where to find one. So often a neglected painful antalgia leads inexorably to leg-pain sciatica.

A bilateral sciatica down both legs is much less common but it can happen and is always serious especially if it affects your bladder control.

If you are interested in sciatica home treatment always remember to exercise your back every day.

You can and perhaps should always consider home treatment for lower back pain, but if it goes down your leg then it's time to find a good chiropractor.

There are two kinds of antalgias: you may lean towards the painful side, or away. They are quite different.

Those who lean "towards" the painful side, if they are smart and listen to their chiropractor, will get better much quicker, but the chance of relapse is greater if they will not accept that, like the "away from" type, the disc will take at least 6 weeks to heal.

If the woman in the picture had pain on the left, and she is leaning towards the right side, then she has the "away from" kind. They take longer to come straight, but have a better chance of complete healing.

Antalgia should always be treated seriously. It is often the prelude to a nasty leg pain sciatica that wends its way down the weary limb. Follow your doctor's instructions, but my advice is to stay at home at least until you can stand up straight. Don't sit, alternate between lying (with a cushion under your knees) and walking. Move onto your side as your back dictates, with the pillow then between your knees.

During the day, get up at least every hour and walk around. Research shows that too much bed rest is not helpful.

If you've come to this website because you're a bookworm, then you may enjoy this short story from Frog in my Throat . This story is all about an antalgia, in an amusing setting.

Tip

Bernard Preston's rule is, if you are in the Pisa sign, then you shouldn't be at work. Don't sit, do not bend, and try very hard not to sneeze. A quick nose-blow will usually stop it.

Depending which disc has been effected the leg pain sciatica may go down the back of the leg to the side of your foot, or down the side of your limb and over the big toe, or onto the top of your thigh.

Classically, there are four important grades. I add a fifth.

1. Back pain only.
2. Back pain spreading down into the leg.
3. Back and leg pain with first increased sensation and later if neglected, ominously, numbness.
4. Back and leg pain with crippling weakness.
5. In the true hernia, there is less back pain, but the leg is on fire. The bladder may be affected.

I could add a sixth.

6. Death. Balderdash you say, that is pur sensationalism. I have a close relative who died after her seventh lower back and upper leg pain operation, aged 42. It happens. (She never consulted me!)

The essence of good health care is to prevent this progression. Take leg pain sciatica seriously when your are at stage-one.

• You can test yourself by pricking your limb with a pin and comparing it with the other leg. Are they the same?
  
• Can you walk on your heels and lift your big toe?
• Are you able to stand on your toes on the effected-foot, and bounce up and down?
• Can you take your full weight on one-knee without the leg buckling?

My rule: You can wait a few days with a sore back, perhaps it'll get better of its own accord, but if you have leg pain sciatica spreading down the limb then it is best to get to your chiropractor fast. Read more about the scientific rationale for Chiropractic Therapy.

Help for sciatica pain is an every-day event at the chiropractic coalface. Slipped disc symptoms abound.

There's really nothing unusual about it. For example just read about this degenerative disc disease casefile.

Complications of surgery; whilst an intervention can be wonderfully successful it can be a disaster too. I suppose our critics would say the same of chiropractic. 

Forward bending

Forward bending to collect doggy-poo, for example, is not advisable if you have lower back pain, or a long history of leg pain sciatica.

Many a lower back condition would heal of itself if we simply refrained from forward bending for a period, sat less and steadfastly did a simple set of lower back exercises before arising every morning.

Far better is to go down on one knee, but that of course is difficult on the stones.

Lumbar facet arthropathy

The lumbar facet joints are another cause of leg pain sciatica. Chronic, neglected lumbar facet subluxations lead to premature degeneration, wear and tear, of the hyaline cartilage, known as lumbar facet arthropathy.

They become large and rough preventing you from standing up straight and often causing leg pain sciatica if you bend backwards, or to the side.

Pain down to the lower leg, and sometimes the upper leg if it affects the femoral nerve; don't let it happen. Exercises every day before getting out of bed, and an occasional but regular visit to your chiropractor is our solution. Occasional, not every week. Too much manipulation is also not healthy, though the distraction treatments and activator are less traumatic.

Inversion traction is an option to be considered, if you have no blood pressure or vertigo issues.

• Lumbar facet arthropathy
• hyaline cartilage

Leg pain on top of the thigh

But perhaps your pain isn't at the side or back of the leg. It's in the groin or front of the leg. That's the distribution of the femoral nerve; this pattern tends to happen in patients rather older - due to facet degeneration, rather than a slipped disk.

• Femoral nerve casefile

Leg length inequality

Or in normal jargon, could you have a short leg? Leg length inequality research confirms that it causes not only hip and knee arthritis, but also lower lumbar back pain. It probably ultimately is also one of the causes of lumbar stenosis. Leg length inequality and low back pain are now confirmed to be strongly associated.

Not responding to Chiropractic? Has your Chiropractor considered a short leg?

• LEG LENGTH INEQUALITY and Low Back Pain.

Slump test for sciatica

The Slump test can be done at home if you have LEG PAIN SCIATICA.

Sitting in an upright kitchen chair, straighten each leg, one at a time, parallel to the ground. Does it hurt? In the back? In your leg? Then it's best to get to your Chiropractor.

When the Slump test for sciatica is strongly positive, particularly if it hurts in the leg, you must take it seriously; even more if you are one of those suffering from failed back surgery.

• Lower back and leg pain, a difficult case file.
• Femoral nerve damage

When you break the health rules it invariably catches up with you; despite that, a positive frame of mind is vital in difficult cases. There are hard odds to be faced.

These decisions, in this case to simultaneously lose a lot of weight and give up smoking, made the difference; faced with major surgery, I did not give him a chance. Can doctors be overly pessimistic? If you destroy hope, then all is lost; but if these desperately important issues aren't considered squarely, the future is indeed bleak.

If the pain radiates down the back of the leg to the side of the foot or great toe area it's likely to be associated with sciatica.

However, as in this femoral nerve damage case file, very severe pain may radiate to the front of the thigh and down the inner lower limb. Then the quadriceps muscles may become weak.

As a very broad generalisation, which is certainly not always true, femoral nerve damage tends to occur in the older person; read, perhaps over sixty.

Sciatica continues to affect young and old.

Right now a famous cricketer is complaining of a pulled hamstring and lower back pain; or is it a leg pain sciatica? The Slump test makes the diagnosis.

Femoro Acetabular Impingement Syndrome (FAIS)

Whilst leg pain may appear to be leg pain sciatica, the reality is that there are many causes of leg pain. One of them is FEMORO ACETABULAR IMPINGEMENT SYNDROME. It comes in two forms. Pincer and Cam. Groin and side of the hip pain are the common features.

• FEMORO ACETABULAR IMPINGEMENT SYNDROME Pincer ...

Hip arthritis is the inevitable result of untreated FAIS. Greatly reduced range of motion in the young person? Can you pull your knee to your chest without discomfort?

Think FAIS; consider Chiropractic.

Sacroiliac joint inflammation

New medical research confirms what chiropractors have long known. The sacroiliac joint is a major cause of lower back pain. It can also cause leg pain in pregnancy and leg pain sciatica.

• Sacroiliac joint inflammation

Hot cold therapy

Hot and cold therapy is a vital part of the pain control and anti inflammatory management of lower back and leg pain. This especially true for LEG PAIN DURING PREGNANCY when of course medication is verboten.

Arthritis in lower back

Falls on the buttocks, other injuries that were not well managed, a short leg causing a scoliosis and a heap of other causes such a poor diet, cause arthritis in lower back; leg pain sciatica lurks.

Another important cause is immobilisation arthritis which starts when joints in the lower back are fixated, reducing the normal swish of synovial fluid through the joints (it brings fresh nutrients and oxygen to the cartilage, and removes waste products)

• ARTHRITIS IN LOWER BACK.
  

What is so surprising is how well even elderly patients with arthritis in the lower back usually respond well to gentle Chiropractic treatment. Not always alas; every case of leg pain sciatica, or a femoral nerve neuropathy is a challenge.

Leg pain in the absence of LBP

There are few more challenging conditions for the chiropractor than the patient with severe leg pain, but no low back pain. For many years I would not accept such a case, but after poor resolution after surgery, I discovered to my surprise that careful management of these cases is often, though not always, successful.

Serious adverse events

Doctors in general are not famous for heralding their mistakes, and chiropractors are no exception to the rule. A recent review of the literature, reported in JMPT, June, 2013 attempts to look further into the situation.

A review of all the literature, revealed a meagre 77 patient cases who had serious adverse affects after manipulation, only 80% of which were actually treated by chiropractors.

The research confirmed what we already know: all forms of treatment can and do have adverse effects; after manipulation these are mostly short lived, but 77 cases have been revealed in the literature that were disastrous.

This is obviously very low, considering that the average chiropractor would be treating this number of lower back pain patients in an average month or two; it's is the most common reason why folk consult chiropractors.

The only really interesting facts thrown up by the review are:

• There was a very similar risk of a serious adverse event after manual and exercise therapy. RR 1.04.
• The risk compared to a serious adverse event after drug therapy was very much lower. RR 0.05. Medication is by far the greatest cause of iatrogenic disease; doctor-caused illness.

Add to that the many thousands of cases of failed back surgery, and you realise that chiropractic manipulation in a leg pain sciatica is arelatively safe procedure.

Inflammation and sciatica

Medicine sees leg pain sciatica as an inflammation; in part chiropractors would not disagree with that. Pinched nerves becomes angry and inflamed.

So there is a place for anti inflammatory drugs in the treatment of sciatica. It's just they have such severe side effects in many cases.

Rather we should all on a daily basis be enjoying foods that are rich in anti inflammatory compounds.

Useful links

Restoring worn cartilage

There's masses of research showing worn cartilage can be restored. Think movement, think diet and, if pertinent, think weight loss.

• Gelatine powder for arthritis for the restoration of worn cartilage. Easy to make in your own kitchen.

• Anti inflammatory omega 3.

• Lower back and leg pain exercises