Manage Sciatica
WHAT IS SCIATICA?
Sciatica is a symptom of a medical condition characterized by immense pain that is localized in regions supplied by the sciatic nerve especially the lumbosacral nerve roots, L4-S2. The sciatic nerve is the largest nerve in the body supplying muscles of the lower limb and the sensation of the skin of the foot. It is relatively common affecting approximately 4 out of 10 people in the United States. The condition is often associated with lower back pain. In fact, studies have shown that an estimated 5-10% of people suffering from lower back pain have sciatica. However, contrary to the popular belief, sciatica isn’t limited to the back. The pain often run down from the back to the back of the legs. Those who’ve experienced sciatica can tell you that aside from the pain, there’s probably a lot more you do not know about this condition. In this article, we will explore more about this condition and its management through chiropractic practices.
WHAT CAUSES SCIATICA?
While there are several causes of sciatica, 90% of cases are due to spinal disc herniation. The bony spine is made up of vertebral bones which form a canal through which the spinal cord runs its course. Between vertebral bones are cartilaginous disks which act as cushions allowing the spinal column to be flexible. Certain conditions may cause the disk to be dislocated out of place resulting into the compression of spinal nerve roots, in this case, the sciatic nerve roots. Other causes include:
Spinal stenosis:
a condition that involves the narrowing of the vertebral canal resulting in spinal cord compression. Spinal stenosis can be caused by bone spurs, local inflammatory processes, and spondylolisthesis. These conditions all cause the reduction in available space within the vertebral canal resulting in compression.
Piriformis syndrome:
Is a rare condition caused by shortening or spasms of the piriformis muscle resulting in the compression of the sciatic nerve that runs through it. It is commonly known as the “wallet sciatica” inferring to the compression of gluteal muscles by a wallet in the rare hip pocket.
Pregnancy:
Pregnancy results in the compression of the sciatic nerve due to the weight of the fetus on the sciatic nerve especially during sitting and in case one is having leg spasms.
RISK FACTORS FOR SCIATICA
Not all who suffer from these conditions will present with sciatica. There are several risk factors that increase one’s predisposition to sciatica. They include:
- Age: The risk increases with increasing age peaking at 45-64 years
- Lifestyle practices such as smoking
- Strenuous activities such as the lifting of heavy objects
- Occupational risks such as driving
- Mental stresses
HOW IS SCIATICA DIAGNOSED?
The diagnosis of sciatica is mainly clinical and is done through history and physical examination. The patients often describe an immense pain originating from the lower back and radiating to the back of the legs. The pain often follows a dermatomal pattern.
The most common form of physical examination performed is a neurological test known as the Lasègue’s sign. The test is usually positive when there is pain in the regions supplied by the sciatic nerve during passive flexion of the straight leg between 30 and 70 degrees. The Lasègue’s sign is, however, not specific for sciatica. Studies have shown that approximately 70% of patients that test positive using the Lasègue’s sign do not really have sciatica.
Other tests that can be performed are mainly the imaging tests such as the magnetic resonance imaging (MRI) and the computed tomography (CT Scan) which can help in the visualization of a herniated disk.
HOW IS SCIATICA MANAGED?
When you have a constant pain emanating from your back, it is understandable that you would do anything for the pain to stop. Well, the good news is that there are several modes of treatment for sciatica. These can be both conservative and surgical. Conservative management involves the use of medications such as analgesics and opioids that will help reduce inflammation and lower the pain as well. Aside from medication, one can also perform certain exercises such as light stretching that will help loosen up the muscles and reduce pain.
Should conservative methods fail to take effect, then surgical options such as lumbar laminectomy which involves widening of the spinal canal in the lower back to help with the reduction of the pressure exerted on the nerves and discectomy which involves the removal of the herniated disk preventing its compression effects.
However, before you resort to surgery, it is recommended that you consider alternative practices such as visiting a chiropractor. Chiropractic practices operate on the principle that with sufficient flexibility, the body is able to heal itself. The pain we experience is due to rigidity and reduced function and performance. Chiropractic procedures are non-invasive and entirely drug-free.
There are several types of chiropractic procedures that can be done to relieve sciatica pain. The choice will depend on the cause of the patient’s sciatica. They include:
Cold compression therapy
Transcutaneous electrical nerve stimulation (TENS):
This is achieved using a TENS box which is a muscle stimulating machine. The machine has variable intensities that help reduce pain by controlling muscle spasms.
Spinal manipulation:
Spinal manipulation involves the realignment of spinal bones resulting in reduced restricted movement of the vertebral bones. It also reduces nerve irritability which is often the cause of the pain and inflammation associated with sciatica.
While not common to many, chiropractic practices have proven to be most effective in the management of sciatica. A study published in 2010 in the journal Spine found that approximately 60% of people who had sciatica and underwent chiropractic practices had significant relief which was at a similar level as those who underwent surgical procedures. Should you suspect that you are experiencing some sciatica pain, please visit a chiropractic doctor who’ll help you get rid of the pain quickly.
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SOURCES: Chiropractic for Sciatica. (n.d.). Retrieved from https://www.spineuniverse.com/conditions/sciatica/chiropractic-treatment-sciatica Low Back Pain and Sciatica: Overview, Pathophysiology, Characteristics of Pain-Sensitive Structures. (2018, January 2). Retrieved from https://emedicine.medscape.com/article/1144130-overview?pa=P6PCZHGBjgJOD1KO%2FAssnhF8fpMjuk56gW2rCPsiXgW0Jn%2BIp%2Fsfm4jzU9xH9mOJ56MI7dGTgNawPfsOtJla9Q%3D%3D Sciatica: Causes, treatment, exercises, and symptoms. (n.d.). Retrieved from https://www.medicalnewstoday.com/articles/7619.php Treatment, F. (2011). Great Sciatica and Lower Back Pain Treatment Relieves Sciatica & Back Pain Straightaway. SciVee. doi:10.4016/26531.01