Lower Back Pain & Sciatica

Lower back pain is used to describe any pain associated with the lumbar region which is the part of the spine located between the pelvis and the thorax. It is a term commonly used to describe a problem in that area (symptom) and not to specifically appoint the cause of the pain. The causes of lower back pain involve a great number of pathologies with the most common being muscular strain of erector spinae, facet irritation, arthritis and disc bulging, with less common problems involving spondylolisthesis, metastasis and ankylosing spondylitis etc.

On the other hand, sciatica characterizes the pain along the length of the sciatic nerve, which starts from the lower spine and “runs” under or through particular muscles at the back of the pelvis and the thigh in order to separate behind the knee and to supply muscles of the lower leg and foot. Problems like disc pathology and spinal stenosis can often trigger the nerve at the beginning of its course, i.e. the spine, whereas peripheral irritation can be caused by conditions such as piriformis syndrome, trochanteric bursitis, diabetic neuropathy etc.

Therapeutic Approach

After the history taking and a thorough clinical evaluation, the clinician will apply skillful manual techniques initially on the lower back and later on adjacent regions of the body such as the pelvis, lower limbs and the thoracic spine*. The techniques vary from simple stretching, mobilization of joints, application of pressure on specific muscles, spinal manipulation to acupuncture. Also, the clinician will address other possible factors (e.g. stress, intolerance, poor circulation) with relaxation techniques, nutritional advice and hydrotherapy. Simple exercises are always suggested. No machinery or any other apparatus is used for treatment. The clinician’s main aim is to bring the body in such a balance so as to deal with the cause(s) of the pathology (if reversible), and at the same time to educate the patient e.g. ergonomic advice, life activities etc., in order to avoid any likely remission.

* Note: techniques on lower back are avoided in an acute episode of pain; they are only applied in adjacent regions. In the suspicion of bone fracture or metastasis the patient is immediately referred.

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