Sciatica takes its name from the sciatic nerve, which has is derived from the nerves coming out of your low back or lumbar spine. It is formed by 5 separate nerves that exit your spine and form one nerve that runs down through the back of your thigh, into the leg and foot. Sciatica strikes when the sciatic nerve is irritated or aggravated, which can cause local pain as well as referred pain down the entire leg. As the sciatic nerve makes its way down the thigh, lower leg and into the foot, smaller nerves branch off, supplying messages to joints, muscles, ligaments and other soft tissue structures. People with sciatica may experience a myriad of different signs and symptoms. Some may feel a local pain in the buttock or low back. Others may experience a sharp pain in the low back and numbness and tingling down through the buttock, back of the thigh and into the lower leg and foot. If the cause is a bulging disk or a disk herniation, the location of the pain will be in a specific pattern down your leg. This is called “radiating” pain. Factors that commonly aggravate sciatic pain include sitting, straining on the toilet, coughing or sneezing. Generally it is the twisting and bending-forward movements that are the worst. For that reason, activities like golf, tennis, hockey and running commonly exacerbate symptoms of sciatica.
Diagnosing the condition is not particularly difficult, but determining its true cause can be tricky. The main reason is that there are five structures that can irritate or aggravate the sciatic nerve. The structures that can cause sciatica are 1) a disk herniation (neurogenic sciatica); 2) a tight muscle (myogenic sciatica); 3) an irritated joint (scleretogenous sciatica); 4) a narrowing of the space where the nerve roots exit the spine (neurogenic claudication, also known as intervertebral foraminal encroachment); and 5) a space-occupying lesion (any kind of growth, such as a tumor) impinging on the sciatic nerve. Fortunately, healthcare practitioners such as chiropractors have an expertise in differentiating between these different causes.
Depending on the cause of your sciatica, your chiropractor will develop a care plan that is best for you. This will probably begin with a thorough assessment of the injury and its history, as well as a discussion of previous occurrences. Your chiropractor may also perform a comprehensive physical and neurological examination to assess your condition. In some cases, chiropractors also take x-rays or obtain an MRI to help determine the source of the problem. In such case, your chiropractor would review the test results with you, explain how he or she plans to manage your condition and set an immediate course of care. (In cases where the cause of the back pain is more serious, such as in the case of a tumor, your chiropractor will make an appropriate referral.)
Chiropractic care varies according to the cause of your sciatica. If muscles are involved, you may benefit from modalities such as interferential current, ultrasound or laser therapy, which help decrease inflammation and promote healing. In approximately 5% of cases involving disk herniation or other severe causes, surgery may be necessary. In such cases, your chiropractor would make an appropriate referral.
In most cases, your chiropractor will perform adjustments, otherwise known as spinal manipulative therapy to help correct subluxations or spinal joint dysfunctions that may be contributing to your condition. Adjustments help restore normal motion to joints and realign the spinal column. This helps to reduce pain and inflammation and allows surrounding structures, such as nerves and muscles, to heal and function properly.
The bottom line? If you have a pain in your rear-end, or pain going down your leg, your chiropractor can determine its cause and implement an appropriate plan of care. Early care will generally result in a better prognosis and, with any luck, have you feeling better soon.