Is Sciatica to Blame for Your Pain?

Sciatica can be easily misdiagnosed so it’s important to see a chiropractor to help determine the cause and source of the pain and find treatments and therapies to relieve the pain.

Could you please start us off by explaining what the term sciatica means?

Dr. Luke Stringer: Absolutely. Sciatica is a really common term that gets thrown around. However, true sciatica is actually a lot less common than you’d think. We’re going to go over what sciatica is.

First of all, what is the sciatic nerve? You have five nerves in your low back. They clump together, form your what we call lumbar plexus, a big clump of nerves, and then those nerves form the sciatic nerve. The sciatic nerve is the thickest nerve in your body, as thick as your thumb. When the sciatic nerve gets impinged and or adhered to, essentially the classic symptom is you will get pain. It could be a sharp pain, a burning pain that radiates along what we call the sciatic dermatome, which is down the back of the butt, down the back of the leg, and then down all the way down into the back of the leg and back of the foot.

Essentially, that’s what sciatica is. Sciatic is the actual nerve, and then “a” just essentially stating that nerve is inflamed. And again, sciatic nerve, if it is true sciatica, it is going to create pain out the pelvis, down through the middle of your butt, down the back of your hamstrings, and then all the way down to your feet and your toes. It’s typically not fun. It’s intense and it’s really difficult to treat.

If someone suffers from low back pain, could that be caused by sciatica?

Dr. Luke Stringer: Great question. Yes and no. Is low back pain commonly associated with sciatica? Yes. Is low back pain that refers down into the extremity commonly misdiagnosed as sciatica? Absolutely. Typically for us, someone is going to have some form of low back pain that accompanies the sciatica, but we have plenty of cases that come in where it’s not really any low back pain, it’s just that referral pain down into the glute and the back of the leg. For us, if you’re going to get sciatic pain, you have some form of low back and or pelvic dysfunction. So, you may not have low back pain per se, but the low back is absolutely driving or contributing to the sciatica. It’s a loaded question there, Liz. Hopefully I answered that one for you.

What type of leg pain is caused by sciatica?

Dr. Luke Stringer: If it’s absolute sciatica, again, it’s going to be pain that refers out of the lower back, down the middle of your glutes, and then down right through the center of the back of the leg, and it’s going to carry all the way down the back of the leg, into the heel, and under the foot. It’s going to create pain down into the foot. Essentially, it radiates along the path of the nerve, which is the dermatome, and if you think you’ve got sciatica and it’s anything but that symptom, so it crosses into your leg or it crosses your knee or it stops at your ankle, that’s not sciatica. That’s nerve root impingement in the lower back. True sciatic pain is going to follow that sciatic nerve root dermatome, which is what we just discussed.

What other painful symptoms can be caused by sciatica?

Dr. Luke Stringer: Something that’s really commonly associated with sciatica is that piriformis syndrome. So, what is the piriformis? It’s a little muscle that is on the side of a hip, and it helps control, and internally and externally rotate the hip, allowing your leg to move in and out. What happens typically for us, or the theory is, let’s imagine we’ve got a weak pelvic floor, so no core. We like to move, and we’ve got poor glute function because we sit at a desk all day. And we go play racketball, and then we’re moving laterally a ton. Because the core isn’t engaging, the glute muscle is engaging and you’re moving in that side-to-side motion, what happens is the little muscle, the piriformis (but there’s also six other muscles in that area that can create sciatica) gets really tight and switched on. Obviously, when muscles are getting tight, those nerves pass through a channel per se, above and in between and below.

Once muscles are being overused due to compensation issues like we just discussed, those muscles are going to break down. When they break down, they get full of something called adhesion. Adhesion is like glue in a muscle. Now, when you are bending or you are lifting your leg, that nerve should be able to floss through those structures smoothly without adhering to anything. But now, imagine because we’ve got poor function in the core or the low back or the glutes, then they all work together and those muscles get tight. When they get tight, they create adhesion, then adhesion acts like glue in a muscle and it sticks to that side now. So now, imagine you wake up in the morning, you bend over to put your socks on, that motion should be able to floss through those butt structures, but all of a sudden, it’s sticking to that structure or several other structures that it transverses through. That’s going to create tension on the sciatic nerve. That’s going to create sciatica down the dermatome that we just discussed.

How is sciatica diagnosed and can it be treated and healed?

Dr. Luke Stringer: Great question. Sciatica can absolutely be diagnosed. Again, you need to know what you’re looking for. Perform a detailed history consult, spinal examination, orthopedic examination, neurological examination. If we’re working with referral pain, we should be taking an x-ray. Some patients like to get an MRI, but what you’re going to typically see is one or two things. For example, on a physical exam, just really poor, weak core muscles or overcompensating muscles in the low back and the glutes, which can create that adhesion that we just discussed.

But also, it can be coming from the degeneration within the spine. For example, we have five bones in our lower back. Between the bones are the discs. Discs are like shock absorbers, they absorb force. If you’ve got poor alignment from sitting all day, those discs degenerate, we lose disc space. That creates less room for the nerve to work with, so what we call the L5S1 nerve root, which is the last disc in your spine. If we’ve got impingement on that nerve from a disc bulge or what we call occlusion in the nerve canal, i.e., that gets really small and it compresses the nerve, then you’re going to get that sciatic pain. That pain that refers down your butt all the way into your feet.

We had a lady in this morning that is suffering with sciatic pain, and she checked every box from the functional to the radiology report. We managed to diagnose it and yes, we can absolutely treat it. What do we need to do? We need to get that joint in your lower back and your pelvis moving via adjustments. We need to work on the alignment in the spine. If you’ve got, for example, a reduced lordotic curve in the low back, it’s going to increase disc pressure. This should be absorbed pressure at the back, not at the front. Lack of curve pushed this fluid back. That creates impingement under the nerve. We’ve got the lady working on lumbar lordosis in traction. She’s going to be working on breaking down all the muscles that compensate in the glutes and low back through pressure point therapy, stretching, mobility work, and then obviously lots of physical therapy to address the muscle imbalances that occur in the core, in the glutes, in the hamstrings. When you repetitively do those things over a period of time, you can absolutely correct sciatica. Now, every case is different. How degenerative is the spine? Was there a huge trauma that blew the disc out? Is this 10 years chronic? It is a really difficult condition to treat however, we get really good results here at the office.

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