Sciatica isn’t a word anyone wants to hear, especially those who have been victim to its burning, shooting pain. It refers to a wide variety of symptoms and causes, usually lower back pain and accompanying leg pain.
"Sciatica is very relevant for doctors of chiropractic because studies show that between 50 and 75 percent of their patients seek care because of back pain," says Gert Bronfort, DC, PhD, and professor in the Department of Research at Northwestern Health Sciences University, "A substantial proportion of those patients will have sciatica, which is the popular term for pain radiating into the back of the leg, and that is commonly associated with a nerve root irritation in the lower back."
Causes of Sciatica
But there are many variations of such leg pain conditions, which is why Dr. Bronfort prefers to categorize them as "back-related leg pain." "Patients can experience pain in the front of the leg, which technically is not a true sciatica," he explains. "Sciatica refers to any pain in the distribution of the sciatic nerve, which means that any nerve root that contributes to the sciatic nerve could produce that pain. The problem can also be due to referred pain from other structures in the low back, such as the disks, the small joints, and the muscles or ligaments."
And such pain does not originate only in the lower back region . "The term sciatica is a catch-all term representing multiple causes of leg pain that may or may not be due to a problem from the lower back," adds Frederick Carrick, DC, PhD, DACAN, DABCN, DACNB, FACCN. "Leg pain 'sciatica' may be referred from problems elsewhere in the human body, ranging from tumors to vascular diseases.
The definition of sciatica extends further yet, beyond biomechanics to include chemical neuritis. "We see chemical neuritis when the disk has been torn, and some of the degradation products from the tearing, including phospholipase All and other similar byproducts of the injury, are very toxic to the nerve," says John Triano, DC, PhD. "As a result, you can have flaming sciatica, yet the MRI will not show very much. That's because there is an internal disk derangement. This means that the inside of the disk, which may or may not show up as abnormal on the MRI, is torn up and there is a chemical neuritis on the nerve." Dr. Triano practices at the Texas Back Institute in Plano, Texas.
Effects of Sciatica
Don’t casually blow off leg pain that doesn’t go away – it could be indicative of sciatica. A dull pain or numbness in the buttock, leg, or foot is often the first indication of sciatica. "That's the body's way of saying you better take care of it, or something worse might happen," adds Tim Mick, DC, an associate professor and chair of the Department of Radiology at Northwestern Health Sciences University. "Untreated, sciatica can lead to a loss of muscle strength and muscle size that may be irreversible. Eventually, there can be problems with gait.
Patients may trip and stumble, or they may have a foot drop in which muscle weakness related to diminished nerve conduction causes an inability to flex the foot backward. And because the same spinal lesions that commonly produce sciatica may also affect the nerves supplying the sphincter muscles of the bowel and bladder, incontinence (loss of bowel or bladder control) can result."
Diagnosing sciatica can be as complex as defining it. James Cox, DC, DACBR, and author of the textbook Low Back Pain: Mechanism, Diagnosis, and Treatment," has focused much of his 37year practice on low-back pain and sciatica and considers it one of the greatest challenges in the clinical practice. "We know that back pain is the most expensive ailment treated in the United States in people from age 20 through 50," he says. "It costs billions of dollars to treat every year, and to compound things, 10 percent of those who have back and sciatic pain will take 90 percent of the cost of treatment. This is due to the fact that they are more likely to have disk herniations or spinal stenosis, conditions that commonly result in sciatica and are more difficult to diagnose, and even more difficult to treat. The other 90 percent of people who come in with just back pain, or maybe pain into the buttock or the thigh, usually are not as difficult to diagnose and treat as sciatica patients tend to be." Dr. Cox practices in Fort Wayne, Indiana.
Dr. Cox adds that differential diagnosis of back and sciatic pain is an extensive topic that includes consideration of other less common etiologies than disk herniation and stenosis. These include piriformis syndrome, pregnancy, developmental and acquired stenosis, spinal primary and metastatic tumor, infection, tethered cord, neuropathies, endometriosis, epidural hematomas, and other less common causes. Because chiropractors focus on the whole body, they are well suited to diagnose sciatica.
Fortunately, sciatica isn’t impossible to treat. With the right treatment, you can lead a pain-free life and enjoy all the activities you used to! Sciatica treatment usually includes physical therapy, stretching and certain exercises. Surgery is always an option as well, but for those interested in surgery and drug-free alternatives, chiropractic could be exactly what you need. Advanced Spine & Wellness Center offers chiropractic as well as physical therapy, acupuncture and more.
If you are in the Montgomery County, Maryland area and are experiencing persistent leg pain, it could be indicative of sciatic nerve damage, a serious issue. Don’t suffer through your sciatica pain – visit our Rockville, Maryland chiropractic office today for sciatica treatment!