Sciatica is one of the most common complaints treated in a Chiropractic office. Symptoms can come seemingly out of nowhere or following trauma. Common questions from patients include asking what causes it, how long does it last, and what can be done to alleviate it. Today, we will discuss those answers and also give some self-care tips that can help relieve sciatica. Treatment can change depending on patient response, so please exercise caution and consult a Chiropractor or Physical therapist. This blog does not constitute medical advice.
What is it?
Sciatica is defined as leg pain due to compression, irritation or trauma to the sciatic nerve. The sciatic nerve is a nerve that goes down the back of the leg, starting in the pelvis and is fed from nerves in the lower back. Pain is typically on the back of the leg and can be described as burning, numb, tingling and shooting. Many times, patients also have lower back pain or pelvic pain on the same side. The pain can be only in the back and buttock, or run partly down the leg, or all the way down the leg to the toes. In the most severe cases some people can have muscle weakness in their legs or loss of bowel or bladder continence. This loss of continence is referred to as ‘cauda equina syndrome’ and is a medical emergency. Anyone experiencing this should not wait to make an appointment but go to their local emergency room. Cauda equina syndrome is not at all common, but always worth mentioning.
Additionally, sciatica is often used as a catch all term to describe leg pain in general. Sciatica does not describe all leg pain, just pain that is a result of irritation to the sciatic nerves. One easy way to tell is based on the location of pain. If the pain is on the front of the leg, it is not from the sciatic nerve.
You have two sciatic nerves, one on each side of your body that run through your hip down your buttock and down the back of your leg. The sciatic nerve is the largest nerve in the body and can start in the buttock and go all the way down to the foot and toes. In the US, sciatica is a quite common condition with up to 40% of people experiencing some form of it during their lifetime. It has equal incidence in men and women, but typically happens in the 40+ population.
Many common causes of sciatica can include muscle spasms in the muscles of the lower back and pelvis, disc bulges, postural changes (such as those from pregnancy), as well as several types of arthritic changes to the vertebrae in the spine itself. Tighter muscles can directly and indirectly put more pressure on the sciatic nerve increasing irritation. A very common cause of sciatica is disc bulges and herniations. These describe a change in disc shape in the spine, often bulging out (think a bulge on a tire) and getting closer to the path of the nerve. When this happens there are often positions of comfort and positions that cause increased pain in the leg.
A thorough exam including orthopedic tests, neurological tests, functional tests, and ranges of motion is enough to diagnose sciatica. Sometimes lumbar spine xrays are needed based on findings. Occasionally, MRI or CT of the lumbar spine are also needed to ascertain lack of progress or to look for causes of weakness.
Other risk factors include age, obesity, pregnancy, occupation, and diabetes. It is unusual for someone to have sciatica in their teens through early 30s if not due to trauma. Both pregnancy and obesity change posture and mechanics of the lower back accentuating the curve in the lower back and tipping the pelvis forward. Additionally, occupations that involve a lot of sitting can also have that postural effect on the hips and pelvis. Jobs that involve heavy lifting can also have an increased incidence.
Best Practices for Improvement
At IHS, we practiced evidence-based care. That means we utilize a combination of best research practices, doctor experience, and marry that with patient preference to determine a treatment plan.
Commonly for sciatica that includes joint manipulation or adjustment, soft tissue work (both in office and at home), functional exercises, and dry needling with tens (electric stimulation) to help relax the muscles and encourage activation of inhibited muscles. The adjustments restore proper motion to joints around the area, often affecting muscle tension as well. Soft tissue work is performed by hand or with an instrument depending on location and helps work out trigger points and knots in the tissue and help it to relax and begin to behave more normally. At home soft tissue work is also taught so that improvement can continue at home. Dry needling with tens is using acupuncture filaments to relax very tight tissue and trigger points. It is especially helpful for sciatica due to the depth of the tight tissues. A tens unit can be connected to the filaments and microcurrent run through to help normalize tissue function and produce even more relaxation. Functional exercises work to correct whatever pattern caused the posture/tension that is responsible for the irritation. In the case of disc involvement, exercises and at home workout as well as adjustments are tailored to minimize disc irritation and encourage the disc to return to normal shape and function. Often ergonomics are also reviewed to make sure that frequently performed movements or tasks are not prolonging irritation in any way.
Sciatica is commonly resolved by 4-6 weeks. However, sometimes it lasts longer. It is considered chronic if you have had pain for 3 or more months. Remember that both acute and chronic can respond to treatment. But it is always best to start earlier. There is often increased muscle tension with more chronic cases.
Other common treatments not performed in our office include oral anti-inflammatories, corticosteroid injections, and spinal surgery. Current research shows that one year after treatment, the groups of patients who were treated with manipulation and exercise were no different from those who had surgery. This means starting with conservative care is the best option, with referrals to orthopedic surgeons as needed.
Self Care Tips
There are several commonly tightened muscles that can cause sciatica. One of the best known is the piriformis. The piriformis externally rotates the hip, and the sciatic nerve runs right next to it. In some people, the nerve even pierces through the muscle! This means that when that muscle gets too tight, it can easily cause irritation to the nerve. The piriformis stretch is a great way to loosen that up and can provide some relief. Below is a great video on the piriformis stretch:
Another way to get increased relaxation in the gluteal/piriformis area is with a lacrosse ball or massage ball. Stretching is great for tight tissues but will not affect trigger points much. Trigger points respond best to more significant pressure and dry needling. The lacrosse ball is a great way to work on this at home. The below video shows how to use a lacrosse ball against the wall to release that tension.
Exercises that increase activation of the muscles of the pelvis such as the gluteal bridge and clam are also sometimes helpful to relax muscles in that area. There are other exercises and stretches that are more tailored depending on the reason for the sciatica and are best given by a professional that has evaluated you.
Sciatica is something many Americans will experience in their lifetime, but has a very good prognosis, and can most often be treated conservatively with good results. Research shows a combination of strengthening exercises and joint manipulation are the best conservative treatment with acupuncture also commonly used. If you or anybody you know is suffering from pain that begins in the pelvis and that travels down the leg. Please send them this blog and look into conservative care. If you are in the Indianapolis area, we would love to help.
Content provided by Dr. Elizabeth Bouse
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