What is sciatica?
Sciatic pain or sciatica can be described as dull, achy, sharp, toothache-like, pins and needles or similar to electric shock-like shooting leg pain. Other sciatica symptoms may include burning, numbness and tingling sensations. Sciatica is also called radiating or referred pain, neuropathy, or neuralgia. A misconception is that sciatica is a disorder—however, sciatica is really a symptom of a disorder. When your doctor diagnoses you with sciatica, you’ve really only been told in Latin that you you have pain in your leg – this is not a diagnosis.
What causes sciatica?
Sciatica is generally caused by nerve root compression, specifically the nerve roots making up the sciatic nerve. Spinal disorders known to cause sciatic nerve pain include lumbar spine subluxations (misaligned vertebrae), herniated or bulging discs (slipped discs), pregnancy and childbirth, spinal tumours and non-spinal disorders such as diabetes, constipation, or sitting on one’s back pocket wallet. There are many factors that lead to subluxations and this is mainly what we deal with.
How do you determine the cause of sciatica?
It’s fair to say that some trial and error may be involved. Patients present with many variations and different symptoms. There are many tests and some carry more weight than others. Compiling a thorough health history is essential and this leads the physical examination that follows when orthopaedic and neurological tests help narrow down the likely cause. A chiropractor is well educated in performing a detailed physical exam to check the motion and function of the spine, pelvis, joint motion and nerve function from these areas.
What imaging tests help find the cause for sciatica?
Plain film x-rays of the lower back are usually the starting point but even many patients already know they only show the bony structures and not the spinal cord, spinal nerves and discs.
It takes a CT scan or MRI to reveal the soft tissues and all important parts of the nervous system that may be impinged, compressed or displaced by a bony growth or a disc lesion which might be described as a bulge, protrusion, herniation or sequestration. It’s not so much the test performed but the interpretation that is so important.
Doctors sometimes focus on what ever changes are noted on the report without correlating them to the history, timelines and examination signs. For example something might be seen that’s on the other side of the body to the pain. It may not be relevant.
Chiropractic care for sciatica.
There are many approaches and ideas around bed rest, exercise, medications, manual therapy, nutrition, rehabilitation and chiropractic’s place in the care of sciatica. In some cases chiropractic helps relieve pressure on the sciatic nerve. Sometimes ice and heat are used to assist relieving acute pain.
Anti-inflammatory medications like non-steroidal anti-inflammatory drugs (NSAIDS) or oral steroids may be used to help relieve inflammation. In many cases structures like the sacro-iliac joints or piriformis muscles can be determined to be the location of the nerve irritation and treated with success. Too much medication can be dangerous and sometimes chiropractic care may be the only option to slowly restore movement and function.
“What is most important is that we’re trained to work with musculoskeletal concerns, so we can help identify what’s the root cause of your symptoms”, says Dr Michael Black, Chiropractor in Armadale and Doncaster in Melbourne. “Whether we can treat it or you need referral elsewhere, there are steps to record, examine and diagnose that must be taken without shortcuts.”
Limitations in treating sciatica.
The truth about any episode of nerve inflammation is that it may settle down, with or without conservative treatment meaning exercise, chiropractic and rest. There is often no need to rush into more intrusive methods.
However sometimes the examination signs may show weakness or numbness, loss of muscle stretch reflexes or even incontinence of bowel or bladder where a surgical option might look like the optimal approach. Each case is different and must be examined on its merits.
Imaging often gives a realistic picture although so much detail can confuse the picture and highlight other areas that are not even contributing to the presenting symptoms. When it’s necessary microdiscectomy is far less invasive than it used to be and can be a godsend.