Sciatica is a condition commonly seen by chiropractors and although mechanical back pain is way more common, there is always a steady flow of patients with sciatica making their way into chiropractic offices.
The Sciatic Nerve
Sciatica essentially refers to compression of the sciatic nerve, the largest and longest nerve in the human body. The sciatic nerve originates in the lower back from a number of nerve roots exiting off the spinal cord which then join together to form the sciatic nerve. The nerve then travels down the leg and is responsible for supplying sensation and function to all the structures of the leg.
Compression of the nerve can come from different sources, but the most common is a disc protrusion, commonly referred to as a ‘slipped disc’. In reality the disc doesn’t ‘slip’, but it can bulge, protrude or herniate. I usually describe it to patients as similar to tooth paste being squeezed out of the tube. There can be just a small amount ‘peeking’ out of the tube (bulge), or, with more pressure on the tube, a larger amount comes out (protrusion) and with even more pressure some of the tooth paste can actually ‘break off’ and separate from the rest of the tooth paste in the tube (herniation).
Sciatica and Back Pain
The nerve bulge, protrusion or herniation usually occurs as a result of a strain or injury that causes a tear in the fibers that support and hold the disc in place. Because these fibers do have pain receptors there can be some lower back pain in the initial stages, however usually the back pain does not persist for very long before the leg pain takes over as the primary problem.
Who should manage and treat sciatica?
In my 27 years of practice I have found that chiropractic management and treatment of sciatica is can be very effective and should definitely be the first ‘port of call’ for patients with sciatica.
Results with a disc bulge or protrusion are usually excellent, but results may be variable with a disc herniation.
Aside from the pain in the leg, patients can present with or without neurological signs and this would depend on the degree of nerve compression. The greater the pressure, the more the chance of ‘hard’ neurological signs such as decreased or absent reflexes, marked tingling, pins and needles or numbness and even muscle weakness.
These are more serious signs and should not be allowed to persist for an excessive amount of time with out referral for an MRI scan
If patients are experiencing unrelenting severe pain as well as ‘hard’ neurological signs I am of the opinion that a neurosurgical consult is warranted.
Management and Treatment
The first thing to note is that there is no ‘quick fix’ with true disc problems, as can be the case with mechanical back pain.
The bed rest is coupled with using ice packs intermittently to help reduce inflammation and chiropractic treatment 3 times a week in those first 14 days. I always recommend natural muscle relaxant supplementation and, occasionally, if the pain is very severe I may recommend anti inflammatory medication as well.
Sitting is to be avoided at all costs.
Even if the symptoms improve after 7 days I still caution patients about being too optimistic as I have seen too many instances of where retuning to normal function too soon causes a more severe relapse.
There are times however, where surgical intervention is necessary and this is usually to relieve the excruciating leg pain. Rest and conservative treatment, however, should always be given a chance. There are risks with any surgical procedure and a documented failure rate of around 20% for surgical procedures for sciatica. The research also clearly shows that at 12 months the results of conservative vs surgical management are exactly the same.
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