This episode is entitled “Is my sciatica due to a disc?” and the topics covered are:

• Safety first
• Symptoms of a disc
  
• MRIs often don’t help
• Signs of a disc
  

It could be a disc prolapsed, disc herniation, slip disc. How do you know that your sciatica is related to that? I’m not there to examine you, so you’re gonna have to do it yourself. We’ve got nerve compression sciatica and non nerve compression sciatica. If it’s related to a disc problem, compressing the nerve, it would be nerve compression sciatica, which tends to be worse than non nerve compression sciatica. If your pain is severe, it’s more likely that it’s a nerve compression sciatica and it could be due to a disc.

Safety first

It’s important to exclude other possible causes of nerve compression sciatica. It isn’t just discs pushing on the nerves that can cause nerve compression sciatica, there are other possibilities. In order to exclude those, go to backpainandsciatica.com and take the free assessment, which will ask you a bunch of red flag questions. If you answer yes to more than one, get a clinical assessment from someone such as an active X-back clinician. It’s very important, from a safety perspective, to be confident that you don’t have an essencial medical disorder causing your sciatica.

Symptoms of a disc

If your pain is worse below the knee than it is above the knee, that’s a reasonable indicator that your pain is due to nerve compression. If you have pins and needles below the knee, it’s less likely that you have nerve compression sciatica.

Disc related pain is often worst first thing in the morning. The disc is a weight-bearing structure and when you’re lying down absorbs fluid, so it gets bigger. If there’s a bulge in the disc, it will be bigger first thing in the morning. The longer you stay lying down, the worst the pain will be. It tends to be worst either while you’re still lying, or when you first get up.

If you have a piece of disc that’s detached, (a fully prolapsed disc) that often isn’t worse for lying down or first thing in the morning, but if it’s a herniated bulging disc, it’s often worse first thing in the morning. Is it worse for bending forwards, or backwards?

Other symptoms are weaknesses such as finding it difficult to lift your foot up or losing power in your lower leg. When you’re standing up, keep the foot on the floor, but try and lift your toes up, especially the big toe. If you can do that on one, but not easily on the other, you probably have nerve compression sciatica.

MRI’s often don’t help

Even if you have an MRI that shows you have a disc prolapse herniation, that doesn’t mean that is the cause of your pain. There are a lot people with disc prolapse as herniations that have no pain. If you’ve had an MRI and you have severe pain, or the MRI assured that you have a disc prolapse, and you have severe pain pins and needles and so on, make sure you have a clinician who’s experienced in sciatica determine whether the two are connected or not.

Signs of a disc

The things we would look for in clinic. None of these are diagnostics on their own, we’re simply building a picture. Just because you have one of these doesn’t mean it’s a disc problem causing your sciatica.  We’ll look at reflexes, muscle power and sensation. Ankle direction, knee jerks, tap remotes.

If you have an ankle jerk on the right side, your pain is on the left, and you have new ankle jock on the left, that’s an indicator that you have a nerve root problem, and it could be caused by a disc prolapse. We light touch one leg and compare it with the other. If you’ve lost sensation, or you have diminished or heightened sensation on one side compared with the other, that’s likely a nerve compression sciatica. We do a straight leg raising test, lift one leg up at a time. If the pain increases down the back of your leg, that’s a positive straight leg test, and it could indicate that you have nerve irritation or compression.