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Sciatica

LBP radiating into the buttock and leg is one of the most common symptoms that I see daily in the clinic. There are numerous causes of this symptom but many people refer to it as “sciatica” so I thought I would explain what sciatica is and how Chiropractic may be able to help it.

The term sciatica describes the symptoms of leg pain and possibly tingling, numbness or weakness that originates in the lower back and travels through the buttock and down the large sciatic nerve in the back of the leg.

Sciatica is often characterized by one or more of the following symptoms:

  • Constant pain in only one side of the buttock or leg (rarely can occur in both legs)
  • Pain that is worse when sitting
  • Burning or tingling down the leg (vs. a dull ache)
  • Weakness, numbness or difficulty moving the leg or foot
  • A constant pain on one side of the rear
  • A sharp pain that may make it difficult to stand up or to walk

Sciatica symptoms occur when the large sciatic nerve is irritated. The sciatic nerve is the largest single nerve in the body and is composed of individual nerve roots that start by branching out from the spine in the lower back and combine to form the “sciatic nerve”.

  • The sciatic nerve starts in the lower back at lumbar segment 3 (L3).
  • At each level of the lower spine a nerve root exits from the inside of the spine and then comes together to make up the large sciatic nerve.
  • The sciatic nerve runs from the lower back, down the back of each leg
  • Portions of the sciatic nerve then branch out in each leg to innervate certain parts of the leg – e.g. the buttock, thigh, calf, foot, toes.

There are three main causes of sciatica:

  • Because the sciatic nerve originates in the low back, one cause is impingement or pressure on one of the nerves forming (or contributing to) the sciatic nerve.  Such nerve impingement can be from a malpositioned bone in your lower back or from a bulging disc.
  •  A second location where the sciatic nerve can be irritated is in the pelvis at the sacroiliac joint.  If you have ever fallen on your hip or pelvis; if you have ever broken a leg bone or had a major foot, ankle, knee or hip joint injury or surgery; if you have a muscle imbalance from performing a particular sport or activity – you may have a rotated pelvis which stresses a sacroiliac joint, and from there the sciatic nerve that runs right in front of it.
  • The third location where pressure can be put on the sciatic nerve is in the buttocks.  There are many muscles located there and the sciatic nerve passes underneath these muscles- at least they are supposed to.  In some unlucky people the sciatic nerve passes through a muscle called the piriformis muscle.  So, if it contracts, it can actually pinch or ‘scissor’ the sciatic nerve.  Simple actions such as pressing on the gas pedal while driving, can cause this muscle to contract thereby pressing on the sciatic nerve.

Treatment for Sciatica

There are a number of treatments that can help with sciatic pain:

  • Often when you are in pain, the first option is to get prescription medication or some over-the-counter (OTC) pain meds or anti-inflammatory formulas which may provide some temporary relief but physical therapy will resolve the root cause
  • Chiropractic may help if the root cause is a structural one, such as a misaligned vertebra or pelvis, or a muscle spasm.
  • Physiotherapy could help relieve sciatica by manual therapy and stretching so the spine is in spinal extension taking pressure of the sciatic nerve.
  • Acupuncture and dry needling can also help with the pain management of sciatica.