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In the final instalment of our back pain focus, GP Alice Fitzgibbon looks at conditions associated with nerve issues, in association with ToughBuilt
This month we cover the final part on the mini-series of back pain. Let’s have a look at back pain associated with nerve issues – like slipped discs and sciatica.
Your spine runs all the way down your back from the base of your skull to your bottom. It is made up of vertebrae (the spinal bones), intervertebral discs (cushions that sit between the bones to help absorb shock), ligaments and muscles. The vertebrae have a ring like shape – this creates a hollow centre, called the spinal canal, where the spinal cord lies.
The spinal cord is a collection of nerves all carrying signals from the brain to different parts of the body. This is how our brain controls what we do. All the way down from the neck, nerve roots leave the spine at every vertebra. Each nerve root has a different job and provides feeling and movement to different areas of the body. If something interrupts the signals in the nerves then function will be lost.
Having a slipped disc or a disc prolapse is a worry for many people who present with back pain. As people get older, the intervertebral discs shrink and are more likely to move out of position. Excessive exercising, lifting heavy objects incorrectly, operating heavy or vibrating machinery and being overweight can all increase the risk of disc movement. If a disc moves out of place it can cause back pain, and if it presses on a nerve root or the spinal cord itself, it can also cause symptoms such as weakness, numbness and tingling.
Here is an example. A man comes to the GP – he tried to lift a heavy slab at work, resulting in back pain, pins and needles in his right leg and tripping over his right foot. So, what has happened? The lifting mechanism has caused slipped disc on the right side of his lumbar spine (lower back). It is pressing on a specific nerve root which supplies the messages to tell the ankle joint it needs to bend upwards to lift the foot. As the messages do not get through, the foot is weak and floppy. There is pain from the nerve compression.
Each nerve root from the neck to the bottom has a different job and the symptoms of slipped discs are different depending on where in the spine is affected (eg. if it is the neck, the hands or arms will be affected). Physiotherapists are experts in finding out what is going on where after back injuries or with back pain. Slipped discs that affect nerve roots can often be managed with rest, exercises and pain killers and settle down with time.
In some cases, if initial treatment does not work, further investigation may be needed by means of an MRI scan (X-rays are not helpful). In very few cases, surgery may be required to release pressure on the nerves. Any pain in the neck or back with symptoms affecting the arms or legs should always be seen by a doctor or physiotherapist so if you have symptoms, do not delay assessment.
So, what is sciatica? The sciatic nerve is a nerve that runs from the lower back to the feet. It is made up of several nerve roots together. The symptoms of sciatica can be variable. It can be pain in the buttock, down the back of the leg or in the foot and toes. It might feel like a stabbing pain, aching pain, burning pain, numbness, pins and needles or a general weakness.
Pain in the back might also be felt, but it is generally not as bad as the leg pain. The causes of sciatica are compression or irritation of the nerve. This might be due to a slipped disc, spinal stenosis (narrowing of the spinal canal – a long term condition), general back injuries causing muscle spasm or inflammation that presses on the nerve or when a vertebrae slips forwards out of place in the spine (a condition called spondylolisthesis).
Sciatica can be a very painful condition. Most cases settle with time- although this will take weeks (approximately 4-6 weeks but may be longer). Painkillers, exercises, keeping active and sleeping with a pillow between your knees may all help manage the symptoms. If there are progressive or ongoing symptoms then further investigation and intervention might be needed, such as with a slipped disc.
If you have had an episode of sciatica then you might be more prone to another one. Keeping active, using good techniques for heavy lifting, having good posture when standing or using a desk and losing weight can all help to prevent further flares. If you have symptoms of sciatica then it is definitely worth seeing a health professional for assessment, exercises and painkillers if required.
For further information on NHS Physiotherapy, visit Back pain – NHS (www.nhs.uk).
