Sciatica & Disc Herniations in Crossfit
Spinal Anatomy and biomechanics
The lumbar spine consists of a 5 vertebral bones and 5 intervertebral discs in between the bones. These intervertebral discs provide shock absorption between the vertebrae.
When the disc either bulges or leaks, it can lead to compression and irritation to the nerves in close proximity. A majority of the disc bulges and herniations occur at the lower part of the lumbar spine (L4, L5, and S1). These nerve roots form the sciatic nerve which runs along the backside of the leg. This is why disc herniations can cause sciatica.
The symptoms of sciatica and disc herniations include pain or numbness down the backside of the leg with or without low back pain. Sometimes this is caused be a specific injury like heavy squats or deadlifts, but can also begin with no specific injury. The symptoms in sciatica and disc herniations are generally made worse with bending forward.
Imaging for Disc Herniations
While imaging is typically not necessary initially, an MRI or a CT can be used to identify a disc bulge or disc herniation.
It is important to note that not all disc bulges or herniations will result in low back pain or sciatica. A systematic review of 3110 individuals found that there is a high prevalence of abnormal disc images in healthy individuals without low back pain. The changes seen on imaging are more closely related to age than they are to low back pain.
The point being that just because imaging shows a disc bulge or herniation, doesn't mean surgery or chronic low back pain are in your future. Disc herniations and sciatica can be treated conservatively.
Treatment of Sciatica and Disc Herniations
Sciatica and pain related to disc herniations can often be treated conservatively. A combination of spinal joint manipulation, soft tissue therapy, and exercise can be effective in reducing pain and numbness associated with sciatica. Spinal joint manipulation, also called an adjustment, is useful in creating movement and reducing inflammation in the joint near the sciatic nerve. Soft tissue therapy is also frequently performed in the glute and piriformis region to help reduce muscle spasm and therefore compression on the sciatic nerve.
An effective exercise approach is the McKenzie Method which involves extending the low back to reduce pressure on the sciatic nerve. Repeated extension in the low back is believed to move the disc herniation away from the nerve, thus reducing pain and numbness.
Nerve flossing is another approach which can be used for sciatica and disc herniations to reduce the compression on the sciatic nerve. Nerve flossing involves moving joints in different directions to mobilize the nerve. An example would be flexing and extending the ankle to decrease tension on the sciatic nerve.
Generally, 6-8 weeks of conservative treatment are recommended before seeking surgical treatments. Surgical treatment usually involves a laminectomy (removing part of the vertebra) or a microdiscectomy (removing part of the disc).