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Sciatica (Sciatic Neuralgia):
How is it helped with chiropractic care?
When you think of sciatica, especially if you’ve ever experienced its debilitating pain, strong leg pain comes to mind. But, as with most conditions, there is a range of symptoms, and more than one cause of sciatica. The symptoms can range from mild localized pain in one or both buttock regions to excruciating pain all the way down the back of the leg to the foot. If the cause is structural a chiropractic adjustment can provide ready relief.
Let’s take a closer look at the varying forms of sciatica, its causes, and how chiropractic adjustments can help both with back pain relief and with correcting the root cause of the problem.
What is Sciatica?
Sciatica is an irritation of the sciatic nerve, the longest and largest nerve in the body; it measures three-quarters of an inch in diameter. It originates in the sacral plexus; a network of nerves in the low back (lumbosacral spine). The lumbosacral spine refers to the lowest 2 vertebrae of the lumbar spine (L4 and L5) and the sacrum combined. (the 'L' means lumbar, and the numbers indicate the level of the vertebra—where it is in your back). The sciatic nerve also travels through your pelvic region (sacrum).
In most people, the sciatic nerve runs under the piriformis muscle (in the buttock region) which moves your thigh side to side. From there, the sciatic nerve descends through the buttocks and the back of the thighs. Behind your knee, smaller nerves branch out from the sciatic nerve and travel down to your feet. The sciatic nerve and its nerve branches enable movement and feeling (motor and sensory functions) in the thigh, knee, calf, ankle, foot, and toes. If your sciatic nerve is compressed, it can cause pain along these pathways; that is how sciatic pain can "spread" or radiate to another part of your body.
Sciatica can be one of the most painful, and persistent conditions known to mankind. It often starts without warning, and gets worse over time. After a few bouts of sciatic pain, there is a good chance that your condition will become chronic – and sciatica will flare-up nearly every time you ‘move the wrong way’ or pull a muscle.
The Many Faces of ‘Ouch’
Pain is described as other symptoms associated with sciatica include burning, numbness and tingling sensations.
What are the symptoms of sciatica? Irritation of the sciatic nerve can result in any number of symptoms including PAIN (of course), but is also described as dull, achy, sharp, toothache-like, pins and needles, similar to electric shocks; also as numbness, weakness, burning, or a more subtle sensation that’s not really pain and not really numbness, but just feels ‘odd’ or different. Sciatica is also called radiating or referred pain, neuropathy, or neuralgia. These symptoms can also be called lumbar radiculopathy. A misconception is that sciatica is a disorder—however; sciatica is really a symptom of a disorder.
Low back pain is common with sciatica, but is not always present. Whatever symptoms you do experience, their location may be only in the buttocks or they may travel all the way down the leg to the foot. The symptoms may be on one leg or in both legs, and the intensity may be stronger on one side vs. the other. Interestingly, the symptoms may also be found only in isolated body parts – such as the foot or calf only.
What Causes Sciatica?
There are three main areas causing sciatica:
1. Nerve Impingement (Pressure)... Because the sciatic nerve originates in the low back, one cause is impingement or pressure on one of the nerves forming (or contributing to) the sciatic nerve. Such nerve impingement can be from a mal-positioned bone (vertebra) in your lower back or from a bulging or herniated disc (when the center gel of the disk begins seeping out) in the lower back that can place pressure on the surrounding area beginning a sciatica episode. Whether a disc bulges or herniates, disc material can press against an adjacent nerve root and compress delicate nerve tissue and cause sciatica.
The consequences of a herniated disc are worse. Not only does the herniated disc cause direct compression of the nerve root against the interior of the bony spinal canal, but the disc material itself also contains an acidic, chemical irritant (hyaluronic acid) that causes nerve inflammation. In both cases, nerve compression and irritation cause inflammation and pain, often leading to extremity numbness, tingling, and muscle weakness. Therefore, sciatic nerve compression may result in the loss of feeling (sensory loss), paralysis of a single limb or group of muscles (monoplegia), and insomnia.
Chiropractic care has been proven to be effective in combating sciatica, even if the pain comes from herniated disks.
Additionally, when one nerve is inflamed, which is evident if you are feeling the burning, stabbing, throbbing and radiating pain of sciatica – surrounding nerves can also become affected if left unattended.
2. Sacroiliac Joint... A second location where the sciatic nerve can be irritated is in the pelvis at the sacroiliac joint. If you have ever fallen on your hip or pelvis; if you have ever broken a leg bone or had a major foot, ankle, knee or hip joint injury or surgery; if you have a muscle imbalance from performing a particular sport or activity – you may have a rotated pelvis which stresses a sacroiliac joint, and from there the sciatic nerve that runs right in front of it.
3. Buttocks... The third location where pressure can be put on the sciatic nerve is in the buttocks. There are many muscles located there and the sciatic nerve passes underneath these muscles- at least they are supposed to. In some unlucky people, the sciatic nerve passes through a muscle called the piriformis muscle causing the so called “piriformis syndrome”. So, if it contracts into spasm, it can actually pinch or ‘scissor’ the sciatic nerve irritating it. Simple actions such as pressing on the gas pedal while driving can cause this muscle to contract, thereby pressing on the sciatic nerve.
Help is on the Way! How to Treat Sciatica Successfully...
When you are feeling the intense pain of sciatica, understandably all you want is for the pain to go away. At such moments there is a temptation to seek drugs – and the stronger the better. While prescription medication or some over-the-counter (OTC) pain meds or anti-inflammatory formulas may provide some temporary relief, we advocate treatment that gets to the source of the problem: a structural examination by a chiropractor that may include spinal x-rays, chiropractic adjustments, low-level laser therapy (LLLT) and physical therapy which also includes stretching and strengthening exercises. If the root cause is a structural one, such as a misaligned vertebra or pelvis, or a muscle spasm, the treatment should also be structural in nature so as to fully resolve the problem at its root.
Millions of people suffer needlessly with such pain. Often they are told, incorrectly, that the only option is drugs. Drugs all carry potentially dangerous side effects while failing to fully correct the underlying problem.
Three 'TOP' Reasons Chiropractic for Sciatica Works:
1. It is Natural - Chiropractic care deals with the entire spinal column, and is focused on restoring proper alignment. When your spinal column is aligned properly, ALL of your nerves (including the sciatic) are able to work properly. As an added bonus, your body is more prone to healing from inflammation and other illnesses when the spinal column is aligned. Because it is natural, you are not at risk of becoming addicted to pain killers or taking medications that can wreak havoc on other parts of your body.
2. The Results are Long Lasting - If you have sciatica, and have had the condition for a while, chances are you will require several adjustments. The reason for this is because it takes some time for your muscles to readjust to supporting the spinal column in the way they were designed to. In other words, it is your muscles that ‘hold’ your spinal alignment. However, once you achieve this alignment – the results are long-term. Most people find that they do not need to continuously go back to a chiropractor once they achieve spinal harmony.
3. Pain Relief is Often Immediate! - As mentioned in #2 above, you may require a series of several chiropractic spinal and pelvic adjustments. However, most people – especially those suffering from sciatica experience a degree of immediate pain relief after receiving just one adjustment.
Research demonstrates that chiropractic care is a safe alternative form of treatment to standard medical therapy, and studies have shown this line of treatment to be very effective in relieving sciatic symptoms and should be resorted to in the first place.
The chiropractor's assessment starts with a detailed consultation and examination which includes the patient's medical history, a review of current medications, a chiropractic, orthopaedic and neurologic examination. If warranted, x-rays, a CT scan and/or an MRI will be obtained thru a medical referral.
Dr. Pisarek will observe your posture, range of motion and physical condition, noting any movement that causes you pain. Dr. Pisarek will palpate (feel) your spine, note its curvature and alignment, and feel for muscle spasm. During the neurological exam, Dr. Pisarek will test your reflexes, muscle strength, and other nerve changes. To diagnose the cause of your sciatica, you may need to have some imaging tests. You may have an x-ray, a computed tomography (CT or CAT) scan and/or electrodiagnostic tests (nerve conduction velocity, electromyography). If it's possible you have a herniated disc or spinal stenosis that's causing your sciatica, Dr. Pisarek may order a magnetic resonance imaging (MRI) test. The CT, MRI and electrodiagnostic tests are requisitioned with a medical fax referral. A proper diagnosis also requires an analysis of the patient's pain. The patient is often provided a ‘Pain Diagram’ to illustrate pain distribution and sensation (e.g. tingling, numbness and burning). These examinations and tests help to detect possible contraindications to spinal adjustments and other chiropractic therapies.
The purpose of chiropractic treatment is to help the body's potential to heal itself. It is based on the scientific principle that restricted spinal movement leads to pain and reduced function and performance. Chiropractic care is non-invasive (non-surgical) and drug-free. In college and during their training, students of chiropractic learn many different adjustment techniques enabling them to treat several types of subluxations (spinal misalignments) and disorders. Techniques vary from a swift high velocity thrust to those that combine minimal force and gentle pressure. Mastery of each technique is an art that requires great skill and precision. Spinal manipulation is the treatment that differentiates chiropractic care from other medical disciplines.
To prepare a patient for adjustment, the chiropractor may instruct the patient to sit up or lie down. It is not uncommon for the chiropractor to use a totally different adjustment technique during the patient's subsequent visits. Treatment tables differ too. Some are stationary, flat padded tables and others are elaborate with electrically or manually operated head and foot rests.
For the treatment of sciatica, a chiropractor will be able to provide the spinal adjustments (manipulations) to best relieve the problem. Chiropractic care is based on improving spinal function and mobility. This process works synergistically in an effort to decrease the pain from the sciatic nerve irritation, and prevent future incidents.
The type of chiropractic therapy provided depends on the cause of the patient's sciatica. A sciatica treatment plan may include several different treatments such as spinal adjustments (sometimes called spinal manipulation), ice/cold therapies, low-level laser therapy (LLLT), ultrasound, and TENS.
Physical therapy includes both passive and active treatments. Passive treatments help to relax you and your body. They also prepare your body for therapeutic exercise, which is the active part of physical therapy. Your physical therapy program is individualized, taking into consideration your health and history. It may include aerobic conditioning, strengthening exercises, and movements to increase flexibility and range of motion. If needed, you will learn how to correct your posture and incorporate ergonomic principles into your daily activities. This will be done to work on preventing future episodes of sciatica.
Those with lower back pain have historically been prescribed bed rest in order to offer relief for aching bones and joints. Research in recent years has suggested that bed rest alone will not offer relief for those suffering from nerve pain such as sciatica.
Staying active may be more beneficial for those who suffer from back pain. Not to say that you should be running marathons! Activity means being up and mobile for periods of time that is not enough to cause further pain and aggravation to your back. Some chiropractors may prescribe specific stretches and strengthening exercises, or some may simply suggest walking.
The goal of using prescribed or over-the-counter (OTC) medications to address sciatic nerve pain is to provide some pain relief. However, medications are not addressing the root cause of your sciatic pain; they aren't healing or curing the spinal condition that is leading to sciatica. While you're experiencing relief from your sciatica, you may be better able to do physical therapy or exercises that may help address the sciatic nerve compression.
Dr. Pisarek can manage the acute symptoms associated with your sciatica, and provide preventative spinal adjustments, stretches and strengthening exercises along with lifestyle modification changes to decrease the chance of a future sciatic occurrence.
Chiropractors correct the vertebral subluxation complex (VSC), which causes poor spinal alignment and nerve pressure. Doing this, chiropractors relieve stress on the spinal nerves, joints and discs. Just as you get your car's alignment checked and corrected, so you should periodically get your spine's alignment checked out and corrected. Is chiropractic spinal care a treatment for sciatica? No, it is a procedure for the analysis and correction of spinal nerve stress. And yet, if you do have sciatica, a chiropractic spinal adjustment is very badly needed. Every sciatica sufferer needs a healthy spine.
Sciatica - Chiropractic Results
For over a hundred years, doctors of chiropractic world-wide have given spinal adjustments to millions of patients, many of them sciatica sufferers. During that period, chiropractors have observed the benefits that chiropractic subluxation correction has on many of those suffering from sciatica and leg pain; many sciatica sufferers have reported dramatic relief of their condition after chiropractic care. Many sciatica and leg pain sufferers have found that chiropractic was superior to traction and pain injections, often saving them from the prospect of having to live with pain, or perhaps face spinal surgery.
Sciatica - Don't Wait to Treat
Chiropractic care appears to have the most effect on sciatica when problems first occur. However, even in those who have suffered for longer periods and have been through the "medical runaround" (from specialist to specialist), chiropractic may provide excellent results. Too many people who suffer from lumbo-sciatalgia (lower back and sciatica pain), disc disease or protrusion think the only sources of help are drugs, physiotherapy and painkillers. Think again! Chiropractic care is the drug-free, natural alternative. In many cases of severe health conditions, it is still not too late to enjoy the benefits of chiropractic care, but please...don't wait.
Sciatica - Conclusion
To millions of sciatica sufferers, chiropractic's unique approach to wellness has been a blessing. If the spine becomes misaligned or distorted, it could damage (impinge) the nerves it is designed to protect. The impinged nerves can upset the delicate workings of the body and set the stage for disease, pain and body malfunction. Throughout your life, you have your teeth, blood pressure and eyes checked-how about your spine?
Chiropractic's Limitations in Treating Sciatica
Sciatica can be caused by other disorders beyond the scope of chiropractic practice. If patients do not respond favourably to non-invasive chiropractic, physiotherapy, stretching and exercise treatment options including lifestyle modification, Dr. Pisarek will discuss this with you and recommend a referral for either alternative treatment methods (needle acupuncture, acupressure, biofeedback, yoga) or medical intervention elsewhere by another health specialist. In some cases, Dr. Pisarek may continue to treat the patient and co-manage the patient's care with the other specialist(s).
Will I ever need drug therapy or surgery for my sciatica?
Most patients with sciatica respond well to non-surgical treatments such as chiropractic care combined with other modalities as explained above, so spine surgery is seldom needed to treat it. Often, the medical approach to sciatica is symptom treatment with painkillers, muscle relaxers and orthopedic devices such as traction bracing and physical therapy. Sciatica is particularly frustrating to treat with prescribed drugs because, in many cases, even strong painkillers bring little or no relief. However, relief may be obtained by injecting painkillers directly into the nerve roots! As with all painkillers, there is always a risk of drug dependency. Orthopedic surgery may be resorted to if the pain persists.
The severity of your pain determines the prescription, which could be:
• Epidural Steroid Injections: Steroids, which reduce inflammation, can help ease your sciatic pain. With an epidural steroid injection, you get a corticosteroid medicine injected near the spinal nerve roots. These injections can reduce pain for months and sometimes longer. However, epidural steroid injections aren't effective for all patients.
• Over-the-counter NSAIDs (non-steroidal anti-inflammatory drugs): These will help reduce swelling while relieving your pain. If an over-the-counter NSAID is an option for you, you and your doctor have plenty to choose from. You can use ibuprofen (Advil) or naproxen (Aleve).
• Prescription Medications: If you have chronic sciatica, you may need a muscle relaxant to help ease muscle spasms. As surprising as it may seem, anti-depressants can be effective drugs for treating pain because they may help block pain messages on their way to the brain. They can also help increase your body's production of endorphins, a natural pain killer.
As with any treatment, you must follow your physicians' advice precisely. Never mix over-the-counter and prescribed drugs without consulting your doctor. You should also let your doctor know about all other medications you're taking (and even which vitamins and supplements you take); there could be interactions you want to avoid.
Spinal surgery may be contemplated if:
What kinds of common spinal surgeries are used for sciatica?
Recovery from Surgery to Relieve Sciatic Nerve Pain
After your surgery, you aren't going to be instantly better. You will most likely be out of bed within 24 hours, and you'll be on pain medications for 2 to 4 weeks. After the surgery, you'll receive instructions on how to carefully sit, rise, and stand. It's important to give your body time to heal, so your doctor will probably recommend that you restrict your activities: in general, don't do anything that moves your spine too much. You should avoid contact sports, twisting, or heavy lifting while you recover.
Will Spine Surgery Relieve Sciatica?
The best answer here is: that is the goal of spine surgery. The surgeon will work to provide you with pain relief and better mobility (although the specific goals can vary based on your symptoms and needs). By removing whatever is pressing on your sciatic nerve (a herniated disc, for example, or a bone spur), the end goal is to decompress that nerve, which should relieve your sciatic pain.
As mentioned above, spine surgery is rarely the first treatment tried for sciatica. Natural non-invasive methods such as what is offered at Advanced Healthcare should be exhausted first!
If you suffer from sciatic pain, get the back and leg pain relief you deserve. At Advanced Healthcare, chiropractic treatment from Dr. Pisarek for sciatica and low back pain is one of his specialties. Just give us a call @ (416) 633-3000 for an appointment to start you on your recovery from sciatica!
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I have been a patient of Dr. Pisarek for a few years now. Every morning I have to say "thank you Dr. P.!". Your care and your treatment renew my energy... no more pains in my lower back, knee and foot. With your help I lost 20 pounds and I am keeping it off. I am really grateful to you and your wife Hilda for taking care of me. My retirement got a new meaning, thanks to you.