Sciatica is not accutually a diagnosis, it is a symptom. The symptom is pain, paraesthesia (pins and needles), and/or numbness down the back of the thigh and/or leg. The key to treating sciatica is to find out the cause (i.e. nail down a proper diagnosis). Your GP has ordered a CT scan of your low back to ascertain whether you have a herniated intervertebral disc or some other form of space occupying lesion that could be compressing or irritating the nerves in your back that supply the lower limb. MRI studies are better than CT scan for this because they have better image resolution (more detailed images) and also has the added benefit of not exposing you to any inonising radiation (CT scan have a relatively small radiation dose). In Australia, MRI are not covered by medicare and cost between $200-300, while CT scan are covered by medicare, hence why GPs tend to send patients for CT over MRI.
If the images fail to show any space occupying lesions then the source of the sciatica must be somwhere else. A common scenario is sciatic nerve entrapment, which can occur anywhere along the route of the sciatic nerve. Basically what occurs is that soft tissue adhesions or scar tissue form between muscles/tendons/fascia and the nerve. The adhesions bind the nerve down and won't allow the nerve to slide freely past other soft tissue structures. This places tension on the nerve, and because nerves can only stretch to approximately 15% of their resting length, symptoms begin to appear. The posterior thigh pain (sciatica) that people get is their telling them something is wrong. Medications often only treats the symptom (pain) without addressing the actual cause; so even if the pain is alleviated by the drug eventually the affects of the drug wear off and the symptoms return.
The most common sites of sciatic nerve entrapment are at the piriformis and superior gemellus muscle (I find this on many of my patients, particularly one's that sit for prolonged periods of time), between the hamstrings, and at the tibial nerve at the tendinous arch of the soleus (top of the calf). If this is the form of nerve entrapment you have then you need to see a practitioner who is able to break up the adhesions along your sciatic nerve. I specialise in a technique called active release techniques (ART) which is extremely effective at releasing these forms of adhesions. However, there are other forms of soft tissue treatment that are effective at treating this as well.
If you would like more information you can contact me through one of my websites www.backtofunction.com.au or www.treatthecause.com.au
I hope that helps.
Dr Adam Gavine
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