Sciatica is a condition which is characterized by pain originating in the lower back or buttocks with symptoms traveling down one or both legs.  It is known as sciatica because it resembles a condition that could be caused by an irritation of the sciatic nerve.

The sciatic nerve is a large collection of nerve fibers that originate in the lower back, traveling down the back of the thigh and calf, and extending all the way down to the foot.  This nerve is comprised of five separate nerve ‘roots’ that exit the spine at the 4^th and 5^th lumbar segments, plus the first three sacral segments of the pelvis.  This nerve provides brain-body communication to and from the muscles, connective tissues, blood vessels and skin for most of the lower body.

Chiropractors often sees patients presenting with sciatica.  Symptoms related to this condition will vary from person to person.  The pain may be described as dull, achy, and diffuse, or sharp, localized and specific.  There can be an electric-shock sensation that shoots down the leg, or more burning, tingling, or numbness that is associated with the leg symptoms.  The intensity of the symptoms varies from mild to severe.

There are a number of potential sources of sciatica-like symptoms.  The first is direct irritation of the sciatic nerve.  This could be caused by lumbar disc-herniations, degenerative joint disease, spinal misalignment, or muscle spasms.  Other conditions that resemble sciatic nerve irritation may include muscle ‘trigger points’, referral pain from lumbar or pelvic joints, diabetes, constipation or tumors.

If your back pain/sciatica is making you tilt to one side to find relief, and it hurts more when you cough, sneeze, or strain when making a bowel movement, chances are you may have a disc bulge in your lower back causing sciatic nerve irritation.  If the symptoms in your leg do not travel past your knee, chances are more likely that the sciatic nerve irritation is not the main cause.

To differentiate the ‘true’ sciatic nerve irritation from other causes of sciatica, your chiropractor should conduct a thorough medical history and physical examination, including neurological tests of your lower legs.  In addition to direct nerve-testing, another common test that usually elucidates a sciatic nerve irritation is the Straight Leg Raise test.  When your leg is raised off the table, and your symptoms are reproduced or made worse by this position, there is a good chance that the sciatic nerve is being irritated.  To confirm or rule out the more serious causes, you may be referred to a specialist for further studies, including x-rays, CT or MRI scans, before treatment may begin.

If it is determined that your case of sciatica involves the joints and/or discs of your lower back or pelvis, an initial course of chiropractic treatments is justified.  By applying quick, controlled pressure to the vertebrae in specific directions, chiropractic adjustments can alleviate excessive pressure on the joints, discs or nerves caused by misalignment and/or restriction.  Although a single adjustment can often result in significant and immediate relief, most often several adjustments will be required to ‘fix’ the problem.  Research has consistently shown that people with low back pain can significantly benefit from chiropractic care.^1-4

Given the fact that many people with sciatica are in a lot of pain, it may be difficult to treat the problem with chiropractic adjustments alone.  Your chiropractor may recommend massage or physiotherapy to compliment chiropractic care.  Massage therapists are skilled at providing relief from tight, sore lower backs.⁵  Physiotherapists are also practitioners who are trained in reducing the symptoms associated with lower back conditions.⁶  Informing your family physician of your health condition is always a good idea, as analgesic and/or anti-inflammatory medication may be required in some cases. 

In addition to getting professional help for this condition, there are a number of things you can do at home to help yourself.  Ice/cold therapy, plus nutritional supplementation are techniques recommended to help reduce painful inflammation.  Applying a cold pack for 10-15 minutes to the area of pain can sometimes provide immediate relief.  Foods that have anti-inflammatory properties include citrus fruits, and anything that contain omega-3 fatty acids (fish oils), bromelain (pineapples) or papain (papaya).

Specific movements known as McKenzie exercises have also been shown to help with cases of sciatica that involve disc bulges or herniation, sometimes with very favorable results.⁷  Ask your chiropractor if these exercises would be appropriate for you to do.

Recovering from sciatica can be a very painful, and often prolonged, process.  However, if dealt with right away, many cases can be resolved rather quickly with a combination of chiropractic adjustments, a decompression program, and muscle-therapy.

References:

1.        Muller R, Giles LG. Long-term follow-up of a randomized clinical trial assessing the efficacy of medication, acupuncture, and spinal manipulation for chronic mechanical spinal pain syndromes. J Manipulative Physiol Ther. 2005; 28(1): 3-11.

2.        Triano JJ, McGregor M, Hondras MA, Brennan PC. Manipulative therapy versus education programs in chronic low back pain. Spine. 1995; 20(8): 948-55.

3.        Niemisto L, et al. A randomized trial of combined manipulation, stabilizing exercises, and physician consultation compared to physician consultation alone for chronic low back pain. Spine. 2003; 28(19): 2185-91.

4.        Aure OF, Nilsen JH, Vasseljen O. Manual therapy and exercise therapy in patients with chronic low back pain: a randomized, controlled trial with 1-year follow-up. Spine 2003; 28(6): 525-31.

5.        Tsao J. Effectiveness of Massage Therapy for Chronic, Non-malignant Pain: A Review. Evid Based Complement Altern Med  2007; 4(2): 165-179.

6.        Critchley D, et al.  Effectiveness and Cost-Effectiveness of Three Types of Physiotherapy Used to Reduce Chronic Low Back Pain Disability: A Pragmatic Randomized Trial With Economic Evaluation.  Spine 2007; 32(14): 1474-1481.

7.        Berthelot JM, Delecrin J, Maugars Y, Passuti N. Contribution of centralization phenomenon to the diagnosis, prognosis, and treatment of discogenic low back pain. Joint Bone Spine 2007; 74: 319-323.