I Have Sciatica...What Does that Mean?

Contrary to popular belief Sciatica is not a diagnosis but rather a symptom which can be caused by a number of conditions.  Sciatica can be a very debilitating symptom and understanding the root cause allows for appropriate treatment.

What is Sciatica?

The sciatic nerve is the largest and thickest nerve in the body that begins in the lower back and descends through the buttock and down the leg.  Sciatica is defined as pain radiating to the leg, normally below the knee and into the foot and toes. It tends to follow along the dermatomal distribution of nerve roots L5 and S1 (back of leg and side of foot). It is associated with numbness and/or pins and needles. Lower limb muscle weakness, lack of sensation in areas along the leg and reflex changes can also occur. This pain may last more than two weeks and is worsened with coughing, sneezing, deep breathing and bending forward.  It is important to note that not all leg pain is indicative of sciatica, which is why proper diagnosis is essential.

The main cause of sciatica is a lumbar (lower back) disc herniation, followed by lumbar canal or foraminal stenosis (osteoarthritis). In rare occasions tumors or cysts can cause sciatica. The main cause of symptoms is due to inflammatory changes resulting from irritation or compression of the affected nerve root by its surrounding tissues. Unfortunately, those patients with true sciatica along with low back pain will have more persistent severe pain that causes a prolonged state of disability and absence from work compared to patients with low back pain alone.

There is a condition called piriformis syndrome that can mimic sciatica type symptoms. The piriformis is a muscle that overlies the sciatic nerve and when it becomes tight or spasms it can irritate the nerve. Symptoms include buttock pain and leg pain that doesn’t refer past the knee (in contrast to sciatica, which radiates down the entire leg). This pain is exacerbated with sitting and sitting cross legged. Unlike true sciatic pain, piriformis syndrome is typically not associated with low back pain.

How do you treat Sciatica?

Treatment of sciatica first and foremost requires accurate diagnosis, which can be performed by a chiropractor. Manual therapy techniques geared toward treating the lower back musculature and joints are important. Such techniques include: chiropractic mobilizations/ manipulations, active release technique, Graston technique, and acupuncture. Rehabilitation is a must and although you may feel that bed rest is the answer you can actual cause more damage. Visiting a chiropractor as soon as possible will help decrease the severity of the symptoms and they can prescribe appropriate rehabilitative exercises and spine sparring techniques. Bottom line, early diagnosis and keeping your back strong and moving properly is important when treating low back pain associated sciatica, so don’t lie there, get help.

Dr. Jaclyn Kissel BSc, DC, CSCS, FRCCSS(C)

References

1. Fritz J, Delitto A, Vignovic M et al. Interrater reliability of judgments of the centralizations phenomenon and status change during movement testing in patients with low back pain. Archives of Physical Medicine and Rehabilitation. 2000; 81:57-61
2. Konstantinou K and Dunn K. Sciatica: Review of epidemiological studies and prevalence estimates. Spine. 2008; 33(22):2464-2472
3. Jawis R, Assourn H, and Kharnis C. Anatomical, clinical and electrical observations in piriformis syndrome. Journal of orthpaedic surgery and research. 2011; 5(3): 1-7

Comments

[mackenzie]

I suffer from sciatica and my doctor tells me I should try to stretch everyday. I think I am going to start doing yoga. Lets hope it helps!