What is Sciatica?
Sciatica describes leg pain, numbness, tingling, weakness, or any combination of those symptoms, that begins in the low back or pelvis, and radiates down – through the glutes, into the hamstrings, and in some cases into the calf and foot. It's caused by pressure on the sciatic nerve, which begins in your lower back and pelvis, specifically nerve roots L4 through S3. Pressure on the sciatic nerve as it traverses the structures of the low back and pelvis causes that pain, tingling, weakness, or numbness that is characteristic of sciatica.
The sciatic nerve is the largest nerve in the human body, and can be up to 2 cm in diameter, and its branches reach from the lower spine to the heel. Pressure on the nerve or its branches can produce symptoms of sciatica. Most commonly, this pressure occurs in the low back as a result of some lumbar disc pathology like a herniation or disc bulge.
There are other conditions it can be caused by, one of those being spondylolisthesis, which describes a misalignment of the vertebrae, potentially encroaching on the space which the nerves occupy. Additionally, inflammation or spasm of the surrounding musculature can produce symptoms. Thorough examination and diagnostic imaging can determine the root cause the symptoms.
Some data suggests that up to 40% of people experience sciatica at some point in their lives, and generally people in their 30s and 40s are most likely to experience it, with no predominance for one sex over the other. Occupational conditions like heavy physical labor or driving trucks can predispose people as well, and people who have experienced symptoms in the past are more likely to experience reoccurrence in the future.
Evaluation, Treatment, and Management by Chiropractors
Evaluation should begin with a health history and physical and orthopedic examination designed to provoke symptoms. Generally, this is all that is required to arrive at the proper diagnosis. However, in a condition that is not responding to conservative care we may refer out for diagnostic imaging. MRI is the best way to come to a definitive diagnosis and determine the root cause of the symptoms.
In the office, we begin with spinal manipulation to the level that the patient can tolerate. Often times, patients are in a great deal of pain when they first present to the office, so treatment begins gently and slowly, and ramps up as they improve and their tolerance for adjustments increase. Additionally, we may spend some time performing assisted stretching with the patient to help relax the surrounding musculature.
Patients who come to Tarry Chiropractic are often given a list of home exercise and stretching recommendations. These are designed to supplement the care we provide in-office, and not as a replacement for in-office treatments. The exercises prescribed are typically simple movements focused on stabilizing the core musculature that surrounds the spine. Stretches prescribed are simple and meant to be safely performed without doctor supervision, but can help provide some relief between treatments.
In the case that a patient is not improving, we can always discuss and consider the option of referral to another provider for other interventions. These can include oral or injected steroids, pain medication, muscle relaxants, or evaluation for surgery. Generally a trial of conservative care lasts 4-6 weeks before seeking more invasive treatment options.
Common Misconceptions
The most common misconception I hear is people referring to any low back or leg pain as sciatica. While the root cause may be similar, sciatica refers only to pain on the back of the low back, hip, glute, thigh, leg, and heel. Any pain in the front of the leg would not be considered sciatica, as the nerves that innervate that portion of the leg are different.
Another common misconception is that it's "just a muscle". While the muscles are often involved, it is rarely a result of only the muscle causing pressure on the nerve. Often times, sciatica arises as a result of some poor biomechanical pattern. This can be poor range of motion in the hips, knees, or ankles even, but can also be a result of poor core stabilization or anterior pelvic tilt. The bottom line is the cause can be multi-faceted and complex, and a skilled clinician should evaluate as many of these avenues as possible to fully understand the cause(s).
Let Us Help You!
Chiropractors are well suited to treat and manage sciatica, and we'd love to help you further understand what you're feeling and help you feel better. Give us a call any time at (913) 400-2014, or schedule an appointment so we can get you on the road to a pain free life!