By Abby Dante, DC, CCSP
Sciatica appears to be a buzzword when it comes to low back pain. Rarely does a day in the life of a chiropractor passes without a patient presenting with sciatica or telling a story of past sciatica woes. In fact, research tells us that 10-40% of adults will experience sciatica at some point in their lifetime. But what exactly is sciatica, and is it as common as it sounds? Let’s dive in.
What are the symptoms of sciatica?
The definition of sciatica is “pain and paresthesias in the sciatic nerve distribution or an associated lumbosacral nerve root.” Fancy, I know. The sciatic nerve is the largest nerve in the body and can be irritated in multiple points along its travels from the low back down to the foot. Chances are, if you have experienced a bout with severe sciatica, you shiver just thinking about it.
Meet the Sciatic Nerve
Sciatica can cause significant pain, numbness or weakness into the leg, as well as heightened or diminished sensations. The sciatic nerve is composed of the L4 through S3 nerve roots and can be up to 2cm in diameter. Of course, a nerve that large must play many roles.
The sciatic nerve provides electricity to the hamstrings, adductors, calf muscles, lower leg and even some intrinsic foot muscles. Additionally, it feeds sensation to the posterior and lateral lower leg and the plantar aspect of the foot.
Sciatic Pain Examples from Our Patients
I recently had a patient present with severe sciatic pain into her right leg. She expressed that she couldn’t wear a sock on her right foot because it hurt too badly.
Or how about a 34 week pregnant mama-to-be who presented recently with “burning” from the posterior thigh down to the calf.
I could go on for pages with different clinical presentations we have seen from this nerve, but let’s talk about why this happens.
What are the Causes of Sciatica?
So now we know what the sciatic nerve is, where it travels and what it supplies. But what causes irritation of this big nerve, and what can we do to prevent it?
Bulging/Herniated Discs and Stenosis
The most common cause of sciatica is a herniated or bulging lumbar disc. If you have ever had an MRI of the lumbar spine, you may be aware of your own disc herniations.
Does that mean you have sciatica? Absolutely not! There are plenty of cases of asymptomatic disc herniations in the human spine. Sciatica is diagnosed based on symptomatology, not structure. So unless you are experiencing any of the symptoms described above, don’t fret.
Sciatica can also come from lumbar spine stenosis, which we typically see in the older crowd. Disc herniations and stenosis are the two most common etiologies of sciatica originating in the lower back.
The Piriformis Syndrome
But as we learned earlier, the sciatic nerve is quite large and travels a long distance. To reach the leg, it must travel through the buttock region underneath a flat and narrow muscle called the piriformis. The piriformis originates on the sacrum and attaches to the greater trochanter of the femur. If the piriformis is tight, it can compress the sciatic nerve as it passes through to reach the lower extremity, thus causing sciatic nerve symptoms. This is called Piriformis Syndrome.
How to Find The True Cause of Your Sciatic Pain
With anatomy like that, you can imagine that a large part of our role when somebody enters the office complaining of sciatic symptoms is to figure out the origin. A series of orthopedic tests will help us determine if the pain is originating in the lumbar spine or piriformis region.
Oftentimes, there will be a complaint of associated low back pain or glute/hip pain to accompany the lower extremity discomfort. I often tell my patients to pay attention to what irritates pain and what does not. The more information you can tell us, the more pieces of the puzzle we have, and therefore the quicker we can zone in on the issue. But as always, the best bet is to get assessed. By pinpointing the origin of dysfunction, treatment can be more specific and thus, more effective!
Can a Chiropractor Help with Sciatica?
I learned early in my career that if you can relieve sciatic nerve pain for a patient, they will love you forever. My mom experienced sciatica when pregnant with me (30+ years ago) and still raves about her chiropractor fixing it. I may be biased, but chiropractic care is a great first step in getting relief.
Sciatica Pain Relief Protocols in the Office and At Home
Specific treatment plans vary based on the origin of pain, but oftentimes it follows the same recipe. A visit to True Sport Care for sciatica will often consist of the following:
- manual muscle work,
- low back and hip adjustments, and
- a home exercise prescription.
The combination of these three is intended to relieve pain, mobilize the joints (a “reset”, if you will), and then strengthen and stabilize to prolong periods of relief.
If you know us, you know that we love our patients….. but don’t want to see you a lot.
- Our number one priority is to figure out what went wrong and get you out of pain.
- Number two is to figure out how to ensure this does not happen again. I often provide my patients with what I call my “Oh Sh*t Protocol”. The purpose of this protocol is that if one day you find yourself saying oh sh*t, my pain is coming back- you have assigned exercises and stretches specific to you that you can initiate immediately. If this fails to provide relief, then you come back in for a tune up.
Early stages of rehab often consist of the following therapeutic exercises:
1. Diaphragmatic Breathing
2. Core Stabilization
3. Piriformis and Glute Stretches
4. Piriformis Exercises
These are slow and intentional and prioritize decreasing pain.
As pain diminishes, exercises can ramp up. Depending on the patient and their goal, they may progress to tempo movements (box squats, goblet squats), dead bugs (legs only, arms only, combination of both), hamstring strengthening (good mornings, Romanian deadlifts), or carries (farmers, unilateral). Throughout all exercises, we remain focused on breath and muscle engagement, as well as strengthening and stabilizing the core, glutes and extremities. Trust the process, start slow and controlled, and earn your right back to activity. And of course, consult a doctor for assistance throughout the process.
Conclusion
If you are a frequent flier when it comes to sciatica, or the symptoms in this article sound oddly familiar, just know this is not a life sentence. With the right team (cough cough, hello ;-)), there are exercises, stretches, modifications and so forth that will keep you on the move. We preach prevention at True Sport Care and with the correct recipe, you will be able to keep doing what you love pain free!
References:
- Systematic review of studies suggesting that chiropractic care can help with sciatica and other types of back pain. Alireza Salehi, MD, MPH, PhD, Neda Hashemi, MSc, Mohammad Hadi Imanieh, MD, and Mahboobeh Saber, MD, PubMed.
- Sciatica. David Davis; Kushagra Maini; Arvind Vasudevan, PubMed.
- The clinical features of the piriformis syndrome: a systematic review. Kevork Hopayian, Fujian Song, Ricardo Riera, and Sidha Sambandan, PubMed.
Dr. Abby Dante is a Certified Chiropractor and Chiropractic Sports Practitioner who’s been a part of the True Sport Care team since high school. She is a former soccer and basketball player who takes pride in helping patients prevent injury and stay in the game. She holds additional certifications in exercise programming for prenatal and postpartum care. When not working, you can usually find her playing with her daughter or hiking with her ferocious yorkie.
