Simple Lower Back and Leg Pain
(April 2004)
by Mr. Marc Jones DO (UK), BSc(Hons)Ost, Osteopath (UK)
The picture to the right is taken from Gray's Anatomy of the Human Body and shows the sciatic nerve as the thick yellow line travelling from the right buttock to the foot.
A 53-year-old RCMP traffic officer in good health, with an unremarkable previous medical history and currently active with cycling, walking and jogging, was referred to me by his physician.
His complaint was of right-sided lower back pain with a referral of pain to the back of the thigh and occasionally to the ankle or heel. This is a classic example of a 'sciatic' distribution of pain (patients often call it 'sciatica'). This developed 2 years previously, after performing an abdominal 'crunch' exercise which caused local right-sided back pain and a pain down the back of the leg. Since this time, the symptoms had never fully disappeared and would be more uncomfortable after inactivity, early in the morning or when driving his patrol car. It was more comfortable if kept mobile or if anti-inflammatory medication was taken.
There were no general health or systemic problems described.
A thorough osteopathic examination revealed restricted spinal joint movement at the L5 area and noticeable soft-tissue tightness present in the right-sided lower back and pelvic areas with no neurological involvement. A working diagnosis of functional restriction to the ilio-lumbar area causing sciatic irritation was recorded and treatment commenced immediately.
After a total of four osteopathic treatment sessions, supplemented with self-help exercises, the patient described the recovery as "almost perfect". The patient was advised to continue with flexibility and strength exercises and to return periodically to maintain functional mobility.
Discussion
The original injury was likely to have involved an injury to the periphery of a spinal disc that irritated part of the sciatic nerve. Although the acute pain of the injury eventually reduced, the function of the area was compromised leading to chronic pain and altered neuro-muscular function. The typical age range for disc injuries is 30-50 years of age and, as a traffic officer with the RCMP, the spine can become stiffer when in a driving position. These two factors are very common with lower back and "sciatica" type pain.
The osteopathic manipulation of the spinal joints was able to restore joint function almost instantaneously, but the chronic tightness of the soft-tissues would continue and give no longer-term relief unless also treated. (Contrast this with the contra-indication of manipulating a freshly injured herniating disc, which can cause a prolapse of the disc and compression of part of the sciatic nerve with long term severe leg pain.)
With the spinal joints and soft-tissues restored to their normal movements and congestion around the area of the spinal nerves reduced, the referral pain through the leg consequently disappeared.
If you suffer from similar symptoms, osteopathy may be able to help you.
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Copyright © Marc Jones - Osteopath (UK), Osteopathy Vancouver 2003 onwards
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