Sciatica is a commonly used term to refer to that sharp shooting pain down the back of your leg. It is, however, a symptom of an underlying cause, not a diagnosis itself. In this post we will explore some of the different possible causes of this uncomfortable symptom..

Many causes for sciatica are nothing to be concerned about and can be treated and generally ease with time, despite being uncomfortable and often painful. However, in some cases the cause for sciatica can be more sinister and require attention immediately.

If you’re experiencing sciatica in both legs, have a weakness or numbness in both legs that is progressing, have numbness in the saddle area (genitals), bowel and bladder changes, seek medical attention immediately.

A common cause of sciatic nerve compression is when discs between the spinal vertebra herniate. In many cases this won’t interfere with the nerve roots exiting the spinal canal, and they may result in just lower back pain or be asymptomatic. However, If a herniated disc pushes onto a nearby nerve root, you will likely experience some nerve pain that will follow the path of this nerve. If this is in the low back, the pain commonly refers down the back of the leg via the sciatic nerve (S1). 

Disc herniations are most common in the bottom few spinal levels, so can also affect other nerve roots which will  cause leg pain in different locations. This allows us to diagnose which levels might be affected, alongside neurological testing of reflexes, sensation & muscle strength.

The central canal of the spine can become narrowed and put pressure on the spinal cord, often seen in older age groups where the spine is more prone to degenerative changes. Often lumbar spinal stenosis is asymptomatic, but it can result in irritation of the sciatic nerve and cause leg pain too! 

In these cases leg pain is often worse with back extension,  prolonged standing and walking. Often progressing in its' intensity until you rest or bend forward. It is also called neurogenic claudication.

Symptoms are typically in both legs accompanied by lower back pain, with numbness and tingling present in the majority of patients. 

The piriformis muscle runs from the bottom of your spine (sacrum) to your hip crossing the path of the sciatic nerve. In some people the sciatic nerve runs through this muscle, and in these cases, the sciatic nerve may be more prone to irritation.

If the piriformis muscle becomes overused, irritated or inflamed, it can compress the nearby nerve resulting in sciatic nerve irritation and the leg pain you may be experiencing. Typically patients experience:

• Chronic pain in the buttock and hip area
• Pain when getting out of bed
• Inability to sit for a prolonged time
• Pain in the buttocks that is worsened by hip movements

The good news is chiropractic care may be able to help. Sciatic pain and its causes are conditions that chiropractors are trained to treat and see regularly in clinic.

During a chiropractic consultation we will take a detailed case history, conduct a thorough physical and neurological exam to localise the cause of your pain. We will then work together to create a personalised treatment and rehabilitation plan. If needed we can also organise a referral for imaging or another appropriate care provider if chiropractic isn’t suitable for you at this time.

The classic chiropractic spinal manipulation is not always an appropriate treatment for our patients, especially those with acute disc prolapses. Below are some different techniques that our chiropractors might use to help you with your sciatica symptoms.

Flexion-distraction is a form of traction that gently mobilises and stretches your spine, gaping your vertebrae and opening up the spaces where the nerves are getting compressed.

As well as stenosis and disc herniations, flexion-distraction can be used to treat many other causes of lower back pain. It can reduce pain and stiffness associated with osteoarthritis and can be helpful if you have sacroiliac syndrome, ankylosing spondylitis,  sprains, and strains. It's also very effective in treating muscle spasms or low back pain unrelated to a specific condition. The technique is gentle enough to use after spinal surgery and can be a safe therapy option for those who have osteoporosis.

Acupuncture stimulates the nerves in skin and muscle, producing a variety of effects. It increases the body's release of natural painkillers, endorphins and serotonin, in the pain pathways of both the spinal cord and the brain. This modifies the way that pain is felt. 

Modern research shows that acupuncture can affect most of the body's systems including; the nervous system and muscle tone.

This can be a useful tool to help patients struggling with neurological pain, and to relax muscle spasms.

Information obtained from the British Medical Acupuncture Society, cited 02/06/14

http://www.medical-acupuncture.co.uk/Default.aspx?tabid=79

It’s thought that remembering steps and making split-second adjustments to your movements stimulates the brain’s ability to make new connections between cells. Music itself is believed to have a therapeutic effect, and the social interaction involved in dancing helps boost mental health.

Regular dancing is linked to a 76% reduction in the likelihood of developing dementia, according to US researchers, who studied the link between leisure activities and dementia risk.^[1]

Dancing is also beneficial for dementia patients. A New Zealand study found that older adults with dementia appeared to have experienced an improved quality of life after exposure to music and dance. ^[2]

It doesn’t matter which step you do, so choose a dance type you enjoy, whether that’s waltz, salsa or something else. There are other proven mental health benefits of dance, including a reduced risk of depression and anxiety. Dancing also can affect your mood by raising levels of our natural feel-good hormones, dopamine and serotonin.

Cycling can hold back the effects of ageing and rejuvenate the immune system, a study has found.^[1]

Scientists at the University of Birmingham found cyclists aged 54-79 produced more immune cells (T-cells), the production of which usually starts to shrink from your 20s. They also preserved muscle mass and strength with age while maintaining stable levels of body fat and cholesterol.

You can integrate it into your lifestyle, simply as part of your movement pattern. Regular moderate exercise is more beneficial than one big weekly workout, so it makes physical and economic sense to incorporate your bike ride into your everyday exercise.

A study has shown that moderately intense aerobic exercise, such as walking, reduces the time it takes you to nod off and increases the duration of sleep.^[1]

It could in part be due to the release of anxiety-busting brain chemicals such as serotonin, and the rise and subsequent fall in body temperature that helps promote sleep. Walking outside in natural daylight also helps to set your circadian biological clock – your natural sleep-wake cycle, which controls the release of the sleepy hormone melatonin. And it’s not just great for a good night’s sleep. Walking helps to protect against cardiovascular diseases, cancer, bone-thinning osteoporosis, and dementia. It’s also good for our mental health to get outside and see gardens or green spaces, and walking can be sociable too.

 ^[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5093382/

Regular weight-bearing activity, such as racquet sports, can help maintain bone density. Bone is a living tissue, which grows stronger with the force of our muscles pulling against it. Exercise can help delay the rate of age-related bone density loss. Osteoporosis is a condition where bone density and quality are reduced, and it affects more than two million women in the UK. After the menopause, when the protective effect of oestrogen on the bone is removed, there is often an accelerated rate of bone loss^[1]. So playing tennis in later life is a great way to keep bones healthy. Another great reason to play tennis is that it can add 10 years to your life! It’s thought the social side of the game as well as the physical activity boosts longevity.^[2]

^[1] https://theros.org.uk/information-and-support/bone-health/exercise-for-bones/

^[2] https://pubmed.ncbi.nlm.nih.gov/30193744/

2:  For Improving Memory – Dancing

A study from 2017 found that all exercise can help reverse the signs of ageing in the brain, but dancing more than any other sport.[1] The study, which focused on adults in their late 60s who took part in a weekly dance class, found that all participants showed an increase in the hippocampus region of the brain, which can be affected by diseases such as Alzheimer’s and dementia, as well as more general age-related decline.
https://www.newswise.com/articles/new-study-jogging-keeps-you-young

3. For Back Pain – Active Therapies

Many GP appointments are connected to muscle and nerve problems- and these are often based in the back. If you suffer with back pain, you will know that it can affect your movement and sleep and leave you feeling quite low. Luckily, help is at hand in the form of gentle stretching.  Also, research shows that active therapies, such as chiropractic treatment, are a great option for managing back pain and to create optimal alignment, balance and symmetry. 

4. For Depression and Anxiety - Walking

Science agrees - walking outdoors has been linked to a reduction in stress and a boost in mood, particularly for those who have just been through a negative life event such as a serious illness or the loss of a loved one. Brisk walks have also been shown to help women deal with anxiety and stress that's sometimes associated with menopause. Movement helps your brain to release endorphins, the feel-good hormones that can reduce the perception of [pain as well as depression and anxiety. 

5. For Bone and Muscle Health – Weight Training

Experts are increasingly suggesting a bit of strength training goes a long way when it comes to better bone and muscle health. As we get older, we start to lose muscle mass, which can leave us prone to falls, as well as making it easier to gain weight. So think of strength training as insurance for your later life. While this could mean leading to lift lightweights, it can also mean strength exercises using your own body weight – such as sit-ups or squats. It’s really never too late to start. A study of 90-year-olds found that 12 weeks of strength training improved their muscle tone, ability to balance, general power and walking speed.

Don’t forget 150 minutes (just over 21 mins daily) is the minimum moderate exercise the NHS recommends for adults to stay healthy! And the best part is, it’s freely available to most of us, small things make a big difference. Movement is the new medicine!

The British Chiropractic Association (BCA) are encouraging parents to straighten out their approach to back care as consumer research shows that 79%* of the UK population has suffered from back / neck pain  at some point in their lives – 61%* of those being parents.

The research also shows that over half (55%*) of parents’ back or neck pain has prevented them from lifting or carrying their child. 40%* of women said their back or neck pain had prevented them from carrying their child’s car seat or carry basket and 40%* of men said that back or neck pain had prevented them from playing with their child.

Choosing a cot:

• Find a cot which has sides that drop down to several levels, and a base that moves up and down. The less you have to lift and lean over to put your child into the cot, the better. A 'next to me' crib can ensure safe co-sleeping.
• A 5kg weight at your chest equates to five times that amount at arms length! So when placing your child in the cot, keep them as close as possible to you. Remember, you will be doing this thousands of times! 
• Fix the cot to the floor or wall as toddlers can rock the cot causing it to tip, and either injure your child or you as you run to stop it falling.

Feeding:

• Whether breast or bottle feeding, find a comfortable posture. Your arms should not be bearing the baby’s weight, so use pillows to support your arms and shoulders.
• It is not uncommon for mums and dads to get neck strain from checking that the baby is feeding properly. Keep looking up to give the neck a rest, or if it is really painful try using a mirror positioned so you can see. 
• When looking down tuck your chin in to engage the core muscles of your neck.
• Alternating feeding sides is a good idea when bottle feeding, as it evenly spreads any strain.  
• Feeding a child in a high chair can place strain on your back. Sit as close as possible in front of your child and adjust the height of the chair so that you are not leaning too high or too low. 

• Try different positions to best see which suits you and baby, and remember that will change as baby grows so keep experimenting.
• If baby is struggling to latch initially when breast feeding your flow might be too fast so try reclining slightly or reassess babies latch is correct.
• Try different formulas to see which suits baby best
• If baby struggles with wind and colic and there is a family history of IBS, dairy or gluten intolerance, speak to your midwife or health visitor about specialised formula milk. If breast feeding consider excluding these from your diet to see if symptoms improve.
• Ask your midwife or health visitor for advice as there might be local free groups you can join to help with positioning. In Cardiff contact the NHS Seren team who have weekly drop in clinics for weighing and positioning tips. 

The British Chiropractic Association (BCA) is urging parents to think about their children’s posture as part of the preparation for the new school term. Whilst stationary and school books are important, it’s how your child carries them that can have the most impact on their health. 

According to research from the BCA:

• over a third (33%) of parents say that their child has suffered from back or neck pain in the past and, whilst back pain can be caused by a number of different factors, overloaded school bags are a common trigger.
• Nearly a third (31%) of children carry a one-strapped bag which can cause a number of problems due to the weight being loaded to just one shoulder.
•  16% of parents admitting to never checking their child’s school bag

The BCA is calling for more parents to keep an eye on what their children carry around with them on a daily basis.

Tim Hutchful, BCA chiropractor, comments: 

“Making sure your child doesn’t suffer from back or neck pain this autumn term can be as simple as checking they aren’t carrying around heavy items with them unnecessarily and that they carry their school bag correctly." 

“I see an increasing number of young people complaining of back or neck pain and often it’s due to the weighty bags they carry. As youngsters have more belongings than ever before, like mobile phones and tablets, there’s a tendency for them to overfill their bags but, by doing these two basic things, you could be helping them avoid painful back problems”.

TOP TIPS:

•    Keep it light – make sure your child is not carrying any unnecessary excess weight - check that all the items in their bags are essential for the day’s activity.

•    Check it out – make sure you know what your child is taking to school with them every day as they may be carrying heavy items with them unnecessarily. 

•    Choose the right bag - a rucksack is the best option as long as it is carried over both shoulders and the straps are adjusted so that the bag is held close to the back and weight is evenly distributed. If your child has a one-strapped bag, make sure they carry it across the body and alternate which shoulder they carry it on.

•    Footwear is key - Make sure your child has good footwear; soft-soled shoes that are supportive and have a good grip will make it easier for the child to carry a school bag.

For more specific advice please consult your chiropractor or physical therapist.

With an increase in the number of people working from home we have seen a surge in problems related to our patients home setup.

Many people find themselves using a computer for a large part of the day, and during these difficult times it's happening even more so.

Incorrect workplace design and layout can contribute to work related injuries (such as repetitive strain injuries), whilst correct chair height, adequate equipment spacing, and good desk posture can help you stay comfortable.

• Consider investing in a variable height desk to allow you to easily vary your posture without having to interrupt your work or meetings.
• Variable height desks allow for bespoke adjustments to suit your height, so can eliminate the need for footstools and ensure optimal positioning for you.
• Make sure you have plenty of space to work with so that you are not cramped (see document holder below).

• Ideally, use a swivel chair with wheels or glides to allow easy chair movement.
• Adjust the height of your chair so that your feet rest comfortably on the floor or, if this makes your chair too low in relation to the desk, use a footrest. 
• Your position when sitting, your knees should be about level with your hips, and the seat of your chair should not press into the back of your knees. Your spine should be against the back of the chair and your shoulders relaxed back and down.
• If your chair can’t be adjusted so that your back is straight, place a cushion between the curve of your lower back and the back of the chair.

• Position the monitor should be roughly an arm’s length away. The top of the screen should be at eye level or just below so that you look down at a slight angle to your work.
• If you wear bifocals, position the monitor lower than normal to compensate for needing to look through the bottom of your lenses. Raise your chair until you can view the monitor without tilting your head back. This may mean that you have to raise the keyboard and use a footrest. Alternatively when working at the computer, use a pair of single-vision lenses with a focal length designed for computer work.

• Arm position should be such that you are able to have your forearms close to horizontal and your wrists straight when using the keyboard, and your elbows close to your body. 
• Align with the monitor and directly in front of you, so that you don’t have to twist or rotate to use it.

• Consider using an ergonomic mouse to better align you shoulder and reduce strain on your arm and neck.
• Position your elbow close to your body to help with arm and shoulder alignment and reduce strain.
• The mouse should fit the size of your hand so that it is comfortable to work with. 
• Your wrist should be in a neutral position (minimal bend in any direction at the wrist) when you use the mouse, and your fingers should be able to rest on the push buttons between actions. 
• If possible position the mouse on the desk so that the weight of your arm is supported by the desk. 

Laptops were designed for short term or mobile use; however, this portability means that people often use them at an unsuitable work height and this may result in discomfort over a long period. There are several ways to address these problems such as

Spring is here and with it, for many comes the desire to don a pair of trainers and hit the road for a run.

Here’s how not to make it a troublesome one for your joints and muscles… 

Spring brings warmer weather and longer days, which is a great incentive to keep on running for longer than usual and push your body that little bit more. Of course reaching your goal is good, but pushing your body too hard might result in unwanted injuries.

 
You should always listen to your body’ natural resistance and follow these tips for a safe and effective wind down after your run:
 
Don’t Stop Moving
Keep gently mobile right after your run. Try regular walking for 5-10 minutes; it might be the last thing you feel like after running a few miles but remaining static should be avoided at all costs to avoid injuries.
 
Ice
Applying ice to specific injuries such as problems with joints is highly recommended. This is most effective when the ice is applied immediately after a run but still works when applied a few days following.
 
Heat
Taking a hot bath after a long run is ideal for strained muscles. It also helps with overall rejuvenation and relaxation, which is often needed after a strenuous or draining stretch.
 
Food For Thought
What we put in our bodies pre and post run is particularly important. Snack regularly, ideally on something that is high in carbohydrates, low in fat, which contains some protein; for example, a tuna sandwich is ideal. Ensuring you drink lots of fluids is also another very important factor for runners to remember. Water is of course an excellent choice when it comes to keeping well hydrated but there are plenty of other options out there, too, such as sports drinks and gels. Remember: after finishing your run, rehydrate as soon as possible, preferably within the first hour and always refrain from drinking alcohol until fully rehydrated.

Gardening

Gardening – Don’t overdo it with the spade or trowel!

As a nation, we love our gardens and spend a considerable amount of time and money on them. As we rush to get those jobs in the garden done, there is a risk that gardeners may injure themselves. What everyone wants is to be fit and healthy enough to actually enjoy sitting in their garden and enjoy the fruits of their labours come summer time, so here are some helpful tips from the British Chiropractic Association.

There have been constant challenges affecting our ability to get in to our usual routines with lockdowns and gym closures, BUT there are still so many ways to get active again. So, how can we build ourselves up to become active again? 

• Start walking - Getting active again doesn't always require you to sign up to a gym or or to run for miles on end. Start with 15-20 minutes per day or do a 1 mile routine around your village. For some needed motivation you can create a playlist to listen to, or an audio book, or even use the time on your walk to do your phone calls. 
• If you are working from home, stand while doing so, if you have those facilities, or have regular breaks. Once or twice a day use a break to do some form of exercise or use that time to go outside. Fresh air is great for the lungs! 
• Couch to 5K is great way to ease yourself in to running, and great for beginners. We have had many patients who have discovered a love for running using this programme which gently builds you up over a 9 week plan that be adapted to suit you. There are many Apps to help track your progress and guide you. The NHS have a great app, complete with podcasts and a trainer who tells you when to start and stop: https://www.nhs.uk/live-well/exercise/couch-to-5k-week-by-week/ 
• Live online exercise classes & video PT sessions have bought the gyms to our homes. Better than a DVD, that we may or may not do, these sessions are live and booked in which gives us a level of commitment to dedicate time to exercise. You also save time with travelling to and from the gym! Working closely with local personal trainer Richard Ford, we have seen our patients kept motivated and benefit from his continued online support, work out sessions, and nutritional plans through these tough times. For more details visit :https://integrafitness.co.uk/

Once restrictions are eased there will be even more for you to do!

How can we relax and alleviate some stress?

Watch a light hearted/funny movie or even some videos - let's face it, who doesn't like watching funny cat and dog videos.

Do something you enjoy, whether that's getting lost in a good book, drawing, painting, walking etc. It doesn't matter what it is, just find some time in your day to do it. It may spark some old habits you once enjoyed!

Switch off from your work life - once the time comes at the end of your working day, turn your laptop, emails or your phone off. Separate yourself from it to give you that time to focus on you.

All of these things contribute to your mental health and overall wellbeing to make you feel better, so if you are feeling low..

Talk to someone, as 'another problem shared is another one halved' as they say.

Reach out to others who you may feel needs some support and you can always do this virtually or over the phone - please do not be afraid to reach out! 

Although talking therapies, counsellors and hypnotherapists may not be providing face-to-face appointments, they are still supporting patients via video sessions.

Our Clinical Hypnotherapist/Psychotherapist Sue Pitman DHP, HPD, MNCH(Reg) is here to help, for more details please visit her page: https://www.thewhitchurchclinic.co.uk/twc-other-therapies/hypnotherapy/

What is Plantar Fasciitis?

Patellar tendinopathy (Sometimes known as jumpers knee) is a common soft tissue injury which can cause pain in the tendon below the knee cap (patella). The patellar tendon is important as it joins the thigh muscles (quadriceps) to the shin bone via the patella.

You may be more likely to have the condition if:

• Repeated stress on the patellar tendon
• Overweight individuals
• A sudden increase in body weight
• Tightness of leg muscles
• Weakness in thigh muscles
• Changing activity levels or progressing too quickly
• Inappropriate footwear
• Exercising on hard surfaces

How can Shockwave Therapy help? 

Shockwave Therapy uses a machine to deliver low energy sound waves through your skin to the injury point. It is recommended by the National Institute for Clinical Excellence (NICE) for Patella Tendinopathy and has been shown to accelerate healing and reduce pain for patients. 

How does it work?

• Increases blood flow to the surrounding tissues
• Triggers healing processes caused by Stem Cells
• Reduces the action of certain nerve fibres, thus lowering pain

Are there any risks?

• Following the treatment, you may experience redness, bruising, swelling and numbness to the area. These side effects should resolve within a week and before your next treatment.

• There is a small risk of tendon rupture or ligament rupture and damage to the soft tissue. The National Institute for Health and Care Excellence (NICE) have deemed this procedure to be safe. For this reason, every patient will be monitored before and after the treatments to discover how successful the outcome is.

• Studies have shown there is UP to 80% chance that it will be effective.

What is Plantar Fasciitis?

Plantar Fasciitis is caused by straining the part of your foot that connects your heel bone to your toes (Plantar Fascia).It is not always clear what causes Plantar Fasciitis.

You may be more likely to have the condition if:

• You are 40-60 years of age 
• exercise with tight calf or heel
• Overstretch the sole of your foot during exercise
• Are very overweight
• Recently started exercising on hard surfaces
• Recently started doing more walking/running
• Wear shoes with poor cushioning/support

How can Shockwave Therapy help? 

Shockwave Therapy uses a machine to deliver low energy sound waves through your skin to the injury point. It is recommended by the National Institute for Clinical Excellence (NICE) for Plantar Fasciitis and has been shown to accelerate healing and reduce pain for patients. 

How does it work?

• Increases blood flow to the surrounding tissues
• Triggers healing processes caused by Stem Cells
• Reduces the action of certain nerve fibres, thus lowering pain

Are there any risks?

• Following the treatment, you may experience redness, bruising, swelling and numbness to the area. These side effects should resolve within a week and before your next treatment.

• There is a small risk of tendon rupture or ligament rupture and damage to the soft tissue. The National Institute for Health and Care Excellence (NICE) have deemed this procedure to be safe. For this reason, every patient will be monitored before and after the treatments to discover how successful the outcome is.

• Studies have shown there is UP to 80% chance that it will be effective.