Sciatica

Sciatica is a relatively common condition and a term typically used to describe pain, tingling, numbness or weakness down one leg as far as into the toes. For many, the effect of sciatica symptoms is an everyday battle which immensely impacts the quality of life. Muscle, joint and nerve pain, like the symptoms of sciatica, is one of the most common reasons people visit their primary care physicians, miss time from work, and file for disability.

What it is

The term “sciatica” refers to pain radiating down the path of the sciatic nerve. The sciatic nerve is a collection of nerve roots exiting both sides of the low back, combining to form the sciatic nerve at hips and buttocks, then travel down each leg.  Importantly, just because you have pain in your butt or your legs, does not mean you have sciatica.  Make sure to get your problem accurately diagnosed.  Pain can be referred down the leg or buttocks from facet joint inflammation or dysfunction, muscle tension or trigger points, sacroiliitis, nerve tension, chemical irritation, and more.  Each is treated differently so a proper diagnosis is critical.

Acute sciatica is an episode lasting no longer than six weeks, which is more common than chronic sciatica pain lasting longer than three months.

Sciatica occurs when one or multiple nerve roots comprising the sciatic nerve are irritated, pinched, or even compressed. Irritation, pinching, or compression of the nerve roots is commonly thought to be because of a disc bulge or herniation, a boney growth of a spine bone (spinal vertebra bone spur), or more rarely, a tumor or damage from a disease process like diabetes.

Sciatica is most commonly a mechanical problem, meaning an issue occurring as the result of how we use or don’t use our body. If your sciatica pain changes — for better or worse — with varying movement, postures, or positions accompanied by, you likely are suffering from a mechanical low back problem causing sciatica symptoms.

Because the nerve supply to your legs stems from the nerve roots of the spinal cord within the spine, poor spinal mechanics and joint function can alter the signals from your brain to the muscles. And vice versa. Poor muscle function can cause faulty joint motion.  Sound like a circle? It’s because it is.

Think of Sciatica as a “kink in the garden hose,” where our nerves are the hose and the water is the information the brain sends to our leg muscles. When the hose is kinked, the full flow of water turns to dribble out the spout. The lack of flow causes an alarm to set off which is sciatica pain and symptoms. Typically, the source of the “kink” is at the level of the spine!

What’s causing the “kink”? It mentioned above, it’s thought to be from disc bulges and bone spurs. However, we’re finding sciatica symptoms can occur with the absence of structural changes, and you can have an identified disc bulge or a bone spur that’s not associated with your sciatica!

Often time the sciatic nerve gets pinched or irritated further down the chain from the spinal canal, as it pierces a muscle caused the piriformis.  This is piriformis syndrome.  This muscle is in the gluteal region, and through periods of prolonged sitting, can become tight around the nerve, thus “kinking the water hose.”  This distinction is important because muscular causes or spinal causes of sciatica are treated differently, making the diagnosis imperative to successful treatment.

In rare cases, sciatica can indicate a serious medical problem requiring immediate attention.

Although most cases of sciatica will resolve on their own without treatment, if you experience constant weakness and numbness of the affected leg, bladder dysfunction, fever, direct trauma, or unexplained weight loss accompanied by sciatica pain, seek immediate medical attention.

What it isn’t

Sciatica not an admission to the operating room for surgery. Only a very small percentage of problems with sciatica symptoms require surgery. Sciatica pain doesn’t have to be debilitating and just because you have sciatic pain does not mean you’re broken, needing to be “fixed”.

The pain we feel is simply a request from our brain to change. Pain is often not associated with damage, rather a very apparent alert we need to change our physical behavior or else physical impairment will proceed.

Sciatica also is not any pain you have down the leg.  People love self-diagnosing themselves with sciatica because they have pain that travels down the leg.  True sciatica must be diagnosed by a trained health care provider.

Just because you have pain doesn’t mean you need an MRI; just because your MRI shows “degeneration,” “disc bulges,” “bone spurs,” or “arthritis,” doesn’t mean it’s the cause of your pain.

Sciatica is often unassociated with structural changes commonly found from imaging, e.g. X-ray, CT scan, MRI. Also, there’s a high prevalence of interpretive errors between radiologists. So, not only does a picture of your spine mean you’ll find lots of stuff, the professionals interpreting them cannot always agree upon what they find!

MRI tells the truth and nothing but the truth, but not the whole truth!

Common Causes

Sciatica is most commonly caused by poor body mechanics and postural habits such as repetitive bending and prolonged sitting.  People sit for HOURS a day on the sciatic nerve and the surrounding muscles, so it is easy to see how inflammation could happen.  

Sciatica can occur suddenly from something as simple as bending over to pick up a pencil or can gradually occur for no apparent reason.

Bending and sitting aren’t inherently bad; however, we bend forward over 4,000 times per day inducing repetitive stress — it’s the straw that broke the camel’s back.

Think about the average desk worker’s day: sit for breakfast, sit in the car to work, sit at the desk, sit for lunch, back to sitting at the desk, sit in the car back home, sit in front of the T.V. — you get the point.

An injury as the result of the accumulative postural stress of daily sitting, which is a risk factor for sciatica, is like a cut on the back of your knuckle. If bending split open that knuckle, it’s important to straighten out that finger so the wound can close, scab-up, and heal. Just as the knuckle will be sensitive and irritated, the nerves in and around the spinal bones and discs can be irritated as well, causing sciatica symptoms.

Humans are meant to move and move often — not sit in chairs and stare at electronic screens for hours on end. From infancy through the first year of life, we learn to how to move, setting us up for the rest of our lives.

Risk factors increasing the incidences of sciatica are age, obesity, occupation, postural habits, and diabetes.

Common Treatments

The most common treatments for sciatica are rest, medication, physical therapy, chiropractic, rehab exercises, cupping, acupuncture, massage, and other various conservative therapies.

While most acute bouts of sciatica will resolve on their own within a few weeks, the risk of recurrence is very high, because even though the injury has healed, the cause of the problem has not been addressed. The greatest risk of injury is the previous injury.

Few individuals need surgery for Sciatica. Have a disc bulge? Even if it’s relevant, lumbar disc herniations have been shown to resolve on their own without surgery.  Remember, a large amount of asymptomatic people are living with disc herniations right now.  So no, a herniation is not a reason to be prevented from doing what you love to do

If you have intense and unrelenting radiating pain down the leg with progressive muscle weakness, bladder or bowel symptoms, or specific structural problems not responding to conservative therapy, surgery may be warranted.

What I Can do About it

With all mechanical pain, there’s a ‘what’ and a ‘why’ — what the problem is and why it’s occurring in the first place. To achieve resolution, it’s critical to not only identify and correct the problem but address the behaviors which lead to the problem in the first place.

The truth is 80% of muscle, joint, or nerve pain problems can be resolved rapidly — within days to weeks — with the correct movement strategy.  Nexus Spine & Sport is here to speed up the recovery process and make the process a more pain free experience. 

Based on the outcomes data we collect, we average 7-9 visits total to resolve 80% of problems, whereas mainstream physical therapy and chiropractic suggest 20+ visits over months and you’re not guaranteed an outcome.

Nexus Spine & Sport identifies and helps you correct sciatica by utilizing evidence-based diagnostic protocols, including tools such as FAKTR, FMS, or Mckenzie Method (MDT) for example.  MDT is a proven system of examination, treatment, and classification of spinal, joint, and other musculoskeletal pain, backed by years of research, evidence, and practice. These systems have been shown to be low cost, fast, and effective even for chronic pain.

Classifying musculoskeletal pain has been shown to drastically improves outcomes because it identifies what tool is best to correct the problem.  Only after a thorough history and necessary orthopedic and neurological are performed can an accurate diagnosis be attained.  It is then that the specific treatment plan can be created.  Treatment can vary from massage, to cupping, to adjustments, to laser, to rest and more.  If a mechanical force caused the problem, then it is logical that a mechanical force may be part of the solution (i.e. adjustment, MDT end range loading, etc.)

The goal is for you to be able to understand and control your pain yourself, not needing your doctor/chiropractor on a repetitive basis. If your problem is something we are unable to treat, we will know this within the first few visits, and then we recommend the next best course of action to find you a solution.

If you have intense and unrelenting radiating pain down the leg with progressive muscle weakness, acute onset bladder or bowel symptoms after trauma, or loss of sensation in both feet after trauma, seek medical attention immediately.