Today we begin a series focusing on Low Back Pain. Over the next few weeks we will be highlighting the different types of low back pain, what they are, how we define them, what causes them, and different treatment protocols. We hope you’ll follow along!
Article was edited for clarity on Sept 7th
What Is Sciatica?
Sciatica is a commonly used term for a type of low back pain that involves the nerves that exit your lumbar spine. The term “sciatica” is used because the nerve roots that exit the lumbar spine bundle together into what we call the “Sciatic Nerve.” This does not necessarily mean that the nerves are the primary problem as the irritation of these nerve roots can often be secondary to another issue. This terminology can challenging for many doctors because it is regularly used to describe a wide variety of different problems.
Symptoms of Sciatica Most often, sciatica will appear as pain in the low back or “hips,” accompanied by pain, numbness, tingling, or radiating symptoms into one leg…usually in the area of the glutes, thigh, or lateral upper leg, though it may extend into the calf and/or foot. It’s also common to see associated muscle tightness and/or spasm in the low back and hips as well. Sciatica presents differently from person to person and this is part of the challenge in identifying and diagnosing it.
Another type of radiating pain called “radiculopathy” may look extremely similar to sciatica, though in these cases, the pain/symptoms will follow the distribution of a single nerve root. This is something we’ll follow up with in another segment.
Causes of Sciatica When diagnosing sciatica, it’s important that we identify what the specific cause of your sciatica is because it allows us to appropriately target your treatment. These different causes can be triggered by a variety of lifestyle changes, physical trauma, etc. For some, sciatica may result from a drastic increase in activity levels, for others it could be a drastic decrease in activity. Other possibilities could be poor posture, bad mechanics, or lack of mobility/flexibility.
The main questions we look to answer during the diagnosis process are, 1) What is causing the irritation, and 2) Where the nerve is being irritated along its path. Some of the most common causes of sciatica are:
Lumbar disc bulge/herniation
Degenerative changes
Sacroiliitis (inflammation of sacroiliac joints)
Piriformis Syndrome (muscular spasm/contracture in the hip)
All these conditions create physical and/or chemical irritation for the nerve roots that compromise the sciatic nerve. For example, if your sciatica is being caused by piriformis syndrome, we might treat your lumbar spine all day without any significant improvement. Regardless of what the cause is, we can find an appropriate treatment and solution to your issues.
How To Treat Sciatica
After we’ve determined what is causing your sciatica, we need to develop a treatment plan. In our office, this often consists of the following types of treatments:
Chiropractic adjustments/manipulations for the lumbar spine and/or sacroiliac joints
Chiropractic care is crucial because it allows us to mobilize the joints that are involved while mediating local inflammation, improving biomechanics, and decreasing the stress on surrounding tissues.
Cryotherapy
Controls local inflammatory response
Low Level Laser Therapy
Laser therapy is extremely useful especially in cases where inflammation is a major factor.
Soft tissue/trigger point therapy
Helps alleviate muscle spasm and restriction. This is especially important in piriformis syndrome.
Home care: Icing, stretching, etc when appropriate
Other non-chiropractic treatments may include anti-inflammatories, steroids, muscle relaxers, or even surgical intervention in some extreme cases. Often we will co-manage our sciatica patients with their medical doctors and this leads to very positive results.
Prognosis Most individuals bounce back quickly from sciatica-type issues and typically without any long term lingering effects. For the patients that experience recurring bouts of sciatica, it’s important that we address the lifestyle related causes such as poor posture, bad movement patters, poor mobility, etc.
If you’re in the Raleigh or Triangle area of NC and suffer from low back pain, we’d love to help you. Our office has years of experience working with these types of conditions and we believe that when it comes to non-invasive care, we offer the best experience you can find! What’s Next? Up next in our low back series we’ll be focusing on Radiculopathy and Disc Bulges/Herniations.