What is Sciatica?
Sciatica or Sciatic pain refers to irritation or compression to sciatic nerve specifically. Sciatic nerve is the largest nerve in human body that originates from low back and runs the course of the entire leg. Sciatica is one of the most debilitating types of pain with a lifetime incidence of ~30%. “Sciatica is NOT a diagnosis but rather a symptom of sciatic nerve complaint.
Symptoms of “Sciatica” can include one or more following:
- Pain: Pain can be stabbing, burning and/or shooting in nature. Originating from lower back and traveling down the buttock, back of the leg towards the big toe or bottom of the foot.
- Muscle Weakness: inability to raise your big toe towards the sky or walk on your toes.
- Sensory Changes: Numbness, tingling and/or burning sensation may be describe, that one foot or leg feels different than the other.
Quick Facts About Sciatica and Sciatic Nerve
- Sciatic nerve is the largest nerve in human body.
- Sciatic nerve is formed by 5 spinal roots segments L4-S3.
- Most common type of sciatic pain is disc herniation.
Who is at risk for sciatica?
- Age – people in mid 20’s-30’s are more likely to develop sciatica.
- Gender – Males are more likely to develop sciatica. male > female (3:2)
- Occupation – heavy lifting, repetitive twisting, chronic over load to the lumbar spine.
- Sedentary lifestyle – prolonged sitting, lack of exercise, poor core strength, poor pasture, muscle imbalances.
Causes or Triggers for Sciatica
Cause: Disc herniation
Signs and Symptoms:
Low back pain and leg pain below the knee. Onset of the pain usually after heavy lifting and/or twisting. Pain level increase with coughing or sneezing. Most common segment is L4-L5 followed by L5-S1. Herniated disc may compress and irritate the nerve root. Which, subsequently will result in low back pain and leg pain that extends beyond the knee. Furthermore, true lumbar disc herniation will be accompanied by lower limb:
- Muscle weakness
- Sensory changes
- Decrease in deep tendon reflexes
- Burning pain
- Pain relieved by extending (arching) lower back
Only ~2% of the people with disc herniation will require a surgical intervention.
Cause: Piriformis Syndrome
Piriformis is a small muscle in the buttock area. How is it relevant to the sciatica? Sciatic nerve most commonly runs underneath the piriformis muscle. When the muscle gets too tight due to over use or prolonged seated position, the muscle may compress the nerve. Patient will complain of buttock pain that runs back of the thigh. Onset of the pain primarily not traumatic.
- Prolonged seated position
Fat wallet – “George Costanza wallet”(do not sit your wallet in your back packet)
Cause: Lumbar Stenosis
Lumbar stenosis refers to narrowing of lumbar spinal canal. Narrowing may be caused by bony out growth on the lumbar spine as well as thickening of ligaments. Due to such variability presentation of lumbar stenosis may vary.
Signs and symptoms:
- 60 + years of age
- Lower limb pain
- Pain is decreased with sitting or leaning forward
- Pain relieved with rest
There are 5 different causes for the slippage of the vertebral body.
- Dysplastic – meaning person was born with it. Extremally important to understand spondylolisthsis does not mean person will experience low back pain.
- Isthmic – Most common type. It is a fracture through the pars interarticularis.
- Degenerative – Due to age related normal degenerative changes
- Traumatic – Fracture through neural arch (medical emergency)
- Pathological – Secondary to underlying conditions
How can a doctor diagnose sciatica
Sciatica may vary from person to person due to different causes or triggers mechanisms of sciatica. Firstly, doctor needs to go through patient’s medical history to identify possible underlying medical conditions. Secondly, doctor will perform the physical examination on the patient to identify the cause of the sciatica. Physical examination includes series of specific tests that will lead the doctor to identify what structure causes the sciatic nerve irritation or compression.
Lastly, doctor should provide detailed and comprehensive report of finding to the patient. However, if doctor finds that further diagnostic imaging is required, he/she will refer the patient to X-ray, CT scan or an MRI.
Chiropractic treatment for sciatica
Depending on the cause of the sciatica, patient will have different options for sciatica treatment. Disc herniation respond greatly to a chiropractic treatment. When sciatica is addressed earlier it is easier to remove the symptoms for the medical professional. Take away points from chiropractic treatment for sciatica is that do not wait few months before you see a doctor. See a chiropractor when the pain begins and he/she will be able to treat the sciatica or refer the patient to an appropriate treatment.
Prevention of sciatica
- Exercise and stretching
- Loose excess weight
- Stay active, DO NOT stay in bed if your sciatica is acting up again
- Quit smoking
- Eliminate modifiable risk factors
Exercises for sciatica
There is a ton of material on sciatica and what you should do, what type of stretches and even some web material may call “bullet prove stretches for sciatica”. The truth is, depending on the cause or the trigger of the sciatica will determine the stretches and the exercises patient will be prescribed. Wrong exercises it WILL AGGRAVATE the symptoms. Therefore, contact local chiropractor or medical professional when you experience sciatic nerve pain.
How long does sciatica lasts
Sciatica is a debilitating pain that may last from several weeks to couple of years, depending on the primary cause of the sciatica. It has been well documented that conservative care can alleviate the leg pain caused by sciatica.
- Conservative treatment: The aim of conservative treatment is to provide pain relief for the patient either by reducing pressure on the nerve or creating mobility in the effected segment. Also, eliminating the presence of the any additional co-occurring pains and aches.
- Medication: Over the counter medication such as aspirin, ibuprofen, Tylenol are the nonsteroidal anti-inflammatory medication. These types of medication will help the patient with immediate symptoms and may reduce the pain level. However, it does not treat the cause or the root of the sciatica, they just mask the pain.
- Steroidal Injection: Steroidal injection may be prescribed in severe causes of sciatica. Cortical steroid injection is a very powerful anti-inflammatory medication that is delivered to the affected area via injection. It may reduce the pain in the leg but it is temporary relief and in some cases pain may return.
- Surgery: Surgical intervention should only be considered when conservative treatment has failed or patient progressed to more sever condition. Studies have shown satisfaction rate after one year are equal with surgical intervention and conservative treatment.