Sciatica is a medical term which simply means the irritation of the sciatic nerve resulting in pain down the nerve distribution. Since the sciatic nerve originates in the lumbar spine and innervates the pelvic/buttocks, hamstrings, calves right down to the feet the pain usually begins to travel and can enter these structures.
There are many causes of sciatica. In rare cases it can result from infection, fracture, even cancer. These are screened for by the chiropractor and we do not treat these causes. In this article only the most common types will be discussed. It is important to note that non-traumatic sciatica is caused by long standing subluxation and joint inflammation in the lumbar spine. These subluxations result in deterioration of the vertebral structures namely the disc and facets. There are usually two main types of deterioration which results in the sciatic nerve type pain. They are typically referred to as vertebrogenic and discogenic.
Vertebrogenic sciatica simply means the inflammation from the local tissues of the vertebral joints (usually the facet joints) have "leaked" enough chemical mediators into the nearby nerve tissue to result in sciatica. However this is a very uncommon cause. More commonly it is the disc between the vertebra which either begins to degenerate via long standing fixation from subluxation or is acutely injured which leads to sciatica. If long standing inflammation of the spine is occurring from a lack of spinal hygiene (getting adjustments, proper exercise and diet), the inflammation will lead to degeneration and desiccation of the disc from vertebral fixation. This results in the more common discogenic type sciatica which will be discussed shortly. In extreme cases inflammation in the vertebra can lead to the facet joints degenerating to the point where bony stenosis of the canal can occur. Chiropractic can still be of help in this case as well but if too far progressed we will refer this type out to an orthopedist. To treat the facet joints, the chiropractor simply adjusts the vertebrae involved. This restores smooth range of motion and circulation to the joint tissues. The increased intra-capsular synovial circulation and range of motion allows the inflammation to pull away from the nerves.
Most discogenic sciatica is the result of a long standing degenerated disc. The patient can be pain free a day before sciatica begins but usually and admittedly will report having periods of low back pain and esp. stiffness in the mornings sometimes for months or years on and off. These patients never thought to see or more importantly was not properly directed to see a chiropractor or to be evaluated because the pain went away. As the inside of the disc starts to break down it will eventually become very pain sensitive and begin to dump lots of chemicals into the nearby nerves. The nerves will communicate this to the brain and the brain will go and start putting lots of pain and muscle tightness to both guard and protect this area of the spine. If continued to be left alone and if the vertebral discs are incapable of healing the pain will progress down the leg as the brain puts more and more pain to immobilize the body. The brain is actually sabotaging the way you move to protect the spine at this point by constantly checking certain motions. It does this to make the person pay attention and start to listen to whats going on. You'd be surprised at how few people actually do listen to their bodies and try to work through this pain or cover it up with meds. The chiropractor treats the disc in this case by inducing movement into the intervertebral joints either by manual adjusting, activator or flexion/distraction therapy to return fluid and nourishment to the disc in order to reduce inflammation. This type of sciatica takes the longest to heal but is the most satisfying for the patient to heal, and myself to treat as it is one of the most painful conditions the spine can have.
In extreme circumstances, esp. if the pain and symptoms have been "covered up" with certain medications, injections or temporarily "exercised" through, the disc will degenerate to the point where there is direct pressure on the cord or nerve. This results in spinal stenosis from the disc. If patients got evaluated when the pain was simply local, this part of the problem could most likely have been avoided or significantly pushed off. Note treatment at this level is still possible and successful but there is a significant decrease in success rate. Nutritional adjustments are extremely helpful in these cases and yield the best outcomes at this office. Acutely traumatic disc injury (usually bending with twisting, auto injury, falls, etc.), esp. if the disc is already degenerated or "bulging" can also cause sciatica. This type of sciatica is actually easier to heal in my opinion because the spine was previously at a healthier level before the outside force and influence of trauma. It's the long standing degeneration which takes the longest to achieve results. Both are manageable.
The important message here is sciatica is rarely "something that just happens." It can also be perfectly managable when the cause is determined. The spine usually undergoes long term subluxation and degeneration before a symptom like this occurs. Usually through a lifetime of accumulative injury day to day which leads up to the symptoms. Patients often associate the onset of sciatica with an act that set it off like bending over, picking something up, etc. but fail to take into consideration that their spine was not completely healthy to begin with. The bending over in many cases was the "straw that broke the camel's back" so to speak. It appears most of the time that the trauma caused it because of the patient's lack of education on how important the health of the spine is at the time of the trauma; as not all people see the chiropractor yet for prevention. These types of problems typically happen from lack of spinal hygiene and can be pushed off and avoided. This is one of the reasons why regular checkups are necessary for everyone because true health is about prevention. When sciatica does appear the chiropractor has a unique knowledge and understanding of the condition and plenty of techniques to encourage the healing of the patient's spine. Unlike medications our adjustments go directly to the cause of the sciatica and address what lead up to it in the first place!
We use the latest low force, gentle techniques for sciatica at this office and we have an extremely high success rate.
If you have any other questions please call us we will be happy to answer them.