SCIATICA – IT’S A PAIN IN THE BUTT
Sciatica is pain that travels down the distribution of the sciatic nerve. The sciatic nerve is comprised of sacral nerve roots, however, nerves from the lower lumbar region also make up the sciatic nerve. When pressure or damage occurs to the sciatic nerve, the symptoms of sciatica occur.
- Lower back pain, if at all, is not as severe as leg pain
- Constant pain in only one side of the buttock or leg, but rarely both the right and left sides
- Pain that originates in the low back or buttock and continues along the path of the sciatic nerve – down the back of the thigh and into the lower leg and foot
- Pain that feels better when patients lie down or are walking but worsens when standing or sitting
- Sciatic pain that is typically described as sharp or searing rather than dull
- Some experience a “pins and needles” sensation, numbness or weakness or a prickling sensation down the leg
- Weakness or numbness when moving the leg or foot
- Severe or shooting pain in one leg that may make it difficult to stand up or walk
- Depending on where the sciatic nerve is affected the pain and other sciatica symptoms may also include foot pain or pain in the toes
Common Causes of Sciatica:
Herniated Lumbar Discs:
HLD are the most commonly known cause of sciatica however only 5% of the time does it cause low back pain and sciatica.
25% of adults under the age of 60 have herniated discs and 50% of us have bulging discs however most of these are asymptomatic.
The most common symptoms of HLD are a sudden onset of back pain followed by leg pain that persists.
Risk factors for disc herniations:
Genetics: Having a parent with disc herniation
Lifestyle: Cigarette smoking, obesity, jobs involving repetitive lifting or twisting
Piriformis syndrome is a more common cause of sciatica but manifests as leg pain only and not back pain. The pain follows the distribution of the sciatic nerve down the back of the left and can cause numbness, weakness and tingling. The piriformis muscle shortens as we sit and begins to irritate the sciatic nerve causing leg pain.
More rare than disc herniations, spinal stenosis is classified as either spinal canal or lateral recess stenosis. Either the spinal cord is direactly affected or the nerve root is directly affected. Stenosis is uncommon in people under the age of 60 years old however the condition is typically due to spinal degredation.
** Sitting decays our spine like sugar decays our teeth**
Sciatica is diagnosed by taking a medical history and a physical examination
The treatment for sciatica may vary depending on what healthcare professional you see. Chiropractors will provide manual soft tissue techniques and adjust the joints that are involved.
- Soft tissue techniques are used to decrease muscular tension and nerve irritation. These may include: Active Release Technique, Graston, Ultrasound, Laser
- Chiropractic adjusting is used to increase the motion with a joint. A chiropractic adjustment is safe and effective for the majority of patients with disc herniations and this should be considered a first option for conservative care.
- Bed rest: evidence suggests that bed rest may actually worsen the condition and that activity may improve the outcome
- Back belts: A belt may be effective at managing pain initially but should never be used for an extended period of time because our core stabilization muscles begin to get weaker with belt use.
- Activity modification: Avoid sitting any more than 20 minutes at one time. A lumbar roll or back support may also be helpful.
- Medications: Acetaminophen vs nonsteriod anti-inflammatory
Acetaminophen (ie Tylenol) should be tried first as it is safer than NSAIDS. 325-650 mg every 4 hours to a max of 4000 mg/day
NSAID’s (ie Ibuprofen/Motrin/Advil) 200-400 mg/6 hrs to max of 1200mg/day
Yoga Poses for Sciatica: