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Understanding SCIATICA & LOW BACK PAIN:
Low back pain and/or leg pain that usually travels down the large sciatic nerve, from the lower back down the back of each leg, is generally referred to as sciatica and is fairly common. This pain can be caused when a nerve root in the lower spine that helps form the sciatic nerve is pinched or irritated. Bear in mind, that the sciatic nerve is the single largest nerve in the entire body. It is the diameter of your little finger, but most importantly, it starts out as many rootlets emerging from the spinal cord in the lower mid back and lumbar spine. All these separate rootlets join up in the lower hip region to form the larger main sciatic nerve. Sciatic is so common precisely because "sciatic pain" can start out at so many different levels throughout the low back.
New ARTICLE: McMorland, et.al., "Manipulation or Microdiskectomy for Sciatica? A Prospective Randomized Control Study," JMPT, Vol. 33, #8 Oct. 2010. Upshot: "Patients with symptomatic lumbar disc herniation, failing medical management should consider spinal manipulation followed by surgery if warranted."
Sciatica: is usually caused by pressure on elements of the sciatic nerve from a herniated disc (also referred to as a ruptured disc, pinched nerve, slipped disk, etc.) in the lumbar spine. The problem is often diagnosed as a "radiculopathy", meaning that a disc has protruded from its normal position in the vertebral column and is putting pressure on the radicular nerve (nerve root) in the lower back, which forms part of the sciatic nerve. Sciatica occurs most frequently in people of most age groups. It is not seen too much in pre-teens and teens but after the age of 20, sciatia becomes more common well into the late 60's. Often a particular event or injury does not cause sciatica, but rather it may develop as a result of general wear and tear on the structures of the lower spine. Many people who experience sciatica get better with time (usually a few weeks or months) and most sufferes find pain relief with non-surgical treatments such as CHIROPRACTIC CARE. Chiropractic care for this often involves muscle stripping, trigger point therapy as well as manipulation of the pathomechanical joint in question. General Low Back pain that does not involve pain down the leg is NOT sciatica. After imaging the low back either through X-Rays or perhaps MRI, chiropractors will approach LBP similarly to sciatica which again would include muscle work and manipulation of the spine.
Understanding sciatica pain: For some people, the pain from sciatica can be severe and debilitating. For others, the pain might be infrequent and irritating, but has the potential to get worse. Usually, sciatica only affects one side of the lower body, and the pain often radiates from the lower back all the way through the back of the thigh and down through the leg. Depending on which nerve root is originally affected, the pain may also radiate to the foot or toes.
Symptoms of sciatica pain can vary greatly but usually decreases after a few weeks or months with non-surgical treatment. One or more of the following sensations may occur as a result of sciatica:
Pain in the rear or leg that is worse when sitting
Burning or tingling down the leg
Weakness, numbness or difficulty moving the leg or foot
A constant pain on one side of the rear
A shooting pain that makes it difficult to stand up
Low back pain may be present along with the leg pain, but usually the low back
pain is less severe than the leg pain.
While sciatica can be very painful, it is rare that permanent nerve damage
(tissue damage) will result. Some times, sciatica pain syndromes result from
inflammation and will get better within two weeks to a few months. Also,
because the spinal cord is not present in the lower (lumbar) spine, a herniated
disc in this area of the anatomy does not present a danger of paralysis.
Symptoms that may constitute a medical emergency include progressive weakness
in the leg or bladder/bowel incontinence along with loss of feeling around the buttock. Patients with these symptoms may have Cauda Equina Syndrome (Latin: "tail of the horse") and should seek immediate medical attention.
A Few Words on Cauda Equina Syndrome: Is a rare, yet very serious condition that most DCs will encounter at some point in practice one practices long enough. It has been reported that CES occurs in only one of 2000 patients with LBP; in 1 - 16% of of those with lumbar disc herniations and in 2-3% of those that require surgery for lumbar disc herniation. A swift diagnosis (DX) is needed to prevent the terrible longer term consequences of CES such as bowel/bladder dysfunction, permanent neurological damage, and the medicolegal backlash that ensues for not having DX'd the problem quickly enough. There are 14 discrete pathologies reported in the literature of CES. Here are few of the more prominent and well known sequelae of CES:
1) Bladder trouble including retention.
2) Bowel: inability to void, lack of control during defication, sense of rectal fullness.
3) Anal Tone: voluntary control and reflex contracture are diminished.
4) Pain: Buttock and lower limb pain may be present.
5) Sensation: Lost around buttock, posterior thigh and perianal region.
See: Fraser S, Roberts L, Murphy E, "Cauda Equina Syndrome: A Literature Review of its Definition and Clinical Presentation," Archives of Phys Medicine and Rehab, 90: 1964-68, 2009.
In general, patients with complicating health issues should contact their PCP medical doctor or ER if sciatica occurs, including people who: have been diagnosed with cancer; take steroid medication; abuse drugs; have unexplained, significant weight loss; or have HIV.
Any condition that causes irritation or impingement on the sciatic nerve can cause the pain associated with sciatica. The most common cause is a lumbar herniated disc. Other common causes of sciatica include lumbar spinal stenosis, degenerative disc disease, or isthmic spondylolisthesis. See Taber D, "Chiropractors as First Line Providers in Lumbar Disc Herniations: Find Out Why Chiropractors Should Be Treating Herniated Discs," Am. Chiropractor, Vol. 31, #8, 8/2009. Also, Costello JA, "Treatment of an Acute Disc Herniation Resulting in Radiculopathy and Foot Drop Using High Power Laser Therapy," Am. Chiropractor, Vol. 31, #8, Aug., 2009.
Sciatica medical definition:
To clarify medical terminology, the term sciatica (often misspelled as ciatica
or siatica) is often used very broadly to describe any form of pain that
radiates into the leg. However, this is not technically correct. True sciatica
occurs when the sciatic nerve is pinched or irritated and the pain along the
sciatic nerve is caused by this nerve (radicular pain). When the pain is
referred to the leg from a joint problem (called referred pain), using the term
sciatica is not technically correct. This type of referred pain (e.g. from
arthritis or other joint problems) is quite common.
Sciatica nerve pain is caused by a combination of pressure and inflammation on
the nerve root, and treatment is centered on relieving both of these factors.
Typical sciatica treatments include:
1) Chiropractic Manipulation: Has proven to be highly effective in uncomplicated cases of sciatica and of course is non surgical and thus, very safe. In cases of advanced degeneration such as Spinal Stenosis (arthritic osteophytes and degeneration in the spinal canal where the spinal cord is), chiropractic has a more limited effect.
2) Wholistic Approach: Many doctors, including all Chiropractors will recommend dietary protocols for those patients who are overweight. Additionally, exercises including zero G water protocols such as lap swimming and/or water gymnastics are very effective. Stretching is often recommended as well.
3) Sciatica surgery: Such as microdiscectomy or lumbar laminectomy and discectomy, to remove the portion of the disc that is irritating the nerve root. This surgery is designed to help relieve both the pressure and inflammation and may be warranted if the sciatic nerve pain is severe and has not been relieved with appropriate conservative, manual or other medical treatments. Be advised that this kind of surgery is risky and not a guarantee of success. Most of these operations actually don't work.
4) Medication: In cases of highly advanced degeneration, often patients will opt for pain killing medication and/or corticosteroids. If the person's spine has advanced degenerative joint disease (DJD), then this may be a last option. Consultations with a number of doctors would be strongly advised first however along with advanced imaging such as CT scanning or MRIs to confirm or deny the presense of an advanced condition.
Dr. Haberstroh and the Staff at Boston Spine Clinicsmake every effort to insure the best care possible for cases like this. If it is discovered that a patient's problem is outside to scope of care here, we will gladly refer that patient to the proper specialist. Further imaging may be necessary and we frequently book patients for CT or MRI scans.