Sciatic Treatment
Sciatica: Understanding, Diagnosing, and Treating
A large portion of my patients have mentioned sciatica at some point during their treatment time at my clinic. I can recall years ago, a patient came into my office crawling on his hands and knees, describing sciatic pain. He then proceeded to vomit into my trash can. It was not a good day for all parties involved! So let's discuss.
What is Sciatica?
Sciatica is pain affecting the lower back and hip, often accompanied by tingling or numbness. This pain may also radiate into the legs, typically one-sided. Understanding that sciatica is a symptom, not a condition, is crucial. Identifying this symptom's underlying cause is important to administer effective treatment.
The sciatic nerve is a collection of nerves formed in the lower back that travels into your hips, thighs, legs, and knees, splitting into smaller nerves from the knees into the ankles and feet.
There are two types of sciatica:
True Sciatica: Conditions that irritate the sciatic nerve directly.
Sciatica-like Conditions: These conditions feel like sciatica but are not. Symptoms are felt for other reasons related to the sciatic nerve.
Symptoms
The most common symptom of sciatica is pain. The severity and nature of the symptoms often depend on the underlying cause. For example, a patient who has suffered a car accident may present with numbness and tingling down the leg, indicating a possible disc injury that has irritated a nerve in the lumbar spine. The location of the symptoms can also help determine which disc in the lumbar spine is affected, a concept known as dermatomal distribution.
For example, if a patient states that pain radiates towards the hip(s) only, an examination would likely reveal L1-L2 segments as the source of the problem. However, if the pain radiates down towards the feet, then L4-L5 or L5-S1 segments would likely be affected.
Sciatica-like Symptoms or Conditions
Piriformis Syndrome occurs when the piriformis muscle is tightened or inflamed, irritating the sciatic nerve beneath it and producing an achy or sharp pain. To relax this muscle, sit in a chair, cross one leg over the other, and pull the crossed knee towards you. This stretch helps relax the hard-to-reach piriformis muscle. This condition is common in patients with sedentary jobs or pregnant women due to increased weight gain and arch in the lower back.
Causes
Sciatica is an irritation of the sciatic nerve. The cause could be:
Bone: A bone out of alignment can reduce the space where the nerve exits the spine, causing pain.
Ligament or Tendon: Injuries to ligaments or tendons produce unstable joints and nerve irritation. Identifying the specific ligament or tendon involved and using adjunctive therapies like ultrasound, electrical muscle stimulation, and massage can help.
Muscle: An injured muscle can produce pain, and surrounding muscles can irritate the sciatic nerve. In chronic cases, the muscles become tightened or create muscle knots that can squeeze and pinch nerves.
Disc: A disc flare-up can cause severe symptoms, including shock-like pain shooting down the leg, numbness, and tingling. Discs eventually wear out as we age, resulting in disc bulges or herniations. They cannot be regenerated, so preserving them as best as possible is important.
Treatment
There are various effective treatments for sciatica:
Chiropractic Care
Chiropractic adjustments help reduce nerve irritation by realigning the affected joint. Adjustments can also address disc issues that may be causing sciatic symptoms. Learn more about chiropractic care for sciatica and read supporting research here and here.
Physical Therapy
Physical therapy helps treat soft tissue injuries and strengthen compromised areas, addressing muscle, tendon, or ligament injuries that irritate nerves.
Massage
Massage is ideal for treating damaged muscles or tendons and can be used as a long-term solution to alleviate muscle knots caused by sciatic injuries.
Medication
For severe sciatica, where the patient cannot walk or stand up straight, seeking medical care is essential, especially if bowel or bladder control is lost. Such patients are not ideal chiropractic candidates as adjustments could cause more pain without significant benefit.
Rest
Rest is a crucial part of the treatment plan, if not the most. Patients with severe or recurring sciatica often don't take the necessary time to rest, hindering their recovery and increasing the risk of future injuries.
Prognosis
The prognosis for sciatica depends on its severity and cause. Mild to moderate symptoms usually resolve in a few days, while more severe cases require more attention and care. Consulting with a doctor for an accurate assessment is crucial for effective treatment and recovery. Be proactive with your health to reduce recovery time and improve your quality of life.
