This is a re-post of a blog from www.academia.edu
Authors: Greg Millar, DC CCEP; Dana Berthiaume, DC; Jamie Bunis DC; Adam Shafran, DC; Jack Langston, DC; Marie Krause, DC; Sherri Hogendobler, DC.
Authors: Greg Millar, DC CCEP; Dana Berthiaume, DC; Jamie Bunis DC; Adam Shafran, DC; Jack Langston, DC; Marie Krause, DC; Sherri Hogendobler, DC.
Sciatica
Pain that radiates from your lower (lumbar) spine to your buttock and down the back of your leg is the hallmark of sciatica. Occasionally, sciatic pain in men is caused by sitting on a wallet. The sciatic nerve is the largest nerve in your body. It starts in the low back, runs into the pelvis, through your hip area and buttocks and down each leg. The sciatic nerve branches into smaller nerves as it travels down the legs providing feeling (sensory) to your thighs, legs, and feet as well as motor control to many of the muscles in your lower legs. The term sciatica refers to pain that radiates along the path of this nerve that runs down the leg.
What causes Sciatica?
Sciatica is actually a sign that you have an underlying problem (pathology) putting pressure on a nerve originating in your lower back. The most common cause of this nerve compression is a bulging or herniated lumbar disc. Piriformis syndrome, a nerve entrapment, is another common cause of sciatica. The piriformis is a muscle that lies directly over the sciatic nerve. If this muscle becomes tight or if you have a spasm in this muscle, it puts pressure directly on the sciatic nerve. In about 10% of the population the sciatic nerve actually courses through the piriformis muscle. In those patients sciatica is more common. Occasionally, sciatic pain in men is caused by sitting on a wallet or simply sitting too much. it can also be caused by standing too long, pelvic injury or fracture or even tumors. However the last two causes are rare findings in most doctors offices.
How do I know if I have sciatica?
Pain that radiates from your lower (lumbar) spine to your buttock and down the back of your leg is the key symptom of sciatica. Sciatica may be accompanied by numbness, tingling, and muscle weakness in the affected leg. This pain can vary widely, from a mild ache to a sharp, burning sensation or excruciating discomfort. Sometimes it may feel like a jolt or electric shock. Sciatic pain often starts slowly or gradually and intensifies over time. It's likely to be worse when you sit, cough or sneeze. In some cases, the pain is severe enough to make a person unable to move. The pain most often occurs on one side. Some people may have sharp pain in one part of the leg or hip and numbness in other parts. The pain or numbness may also be felt on the back of the calf or on the sole of the foot. The affected leg may feel weak.
Sciatica Pain May Get Worse:
After standing or sitting any length of time
At night with laying down
When sneezing, coughing, or straining
When bending backwards
Walking especially if caused by spinal stenosis
Signs and Test:
Your Chiropractor will perform a thorough history and physical exam. This may show:
Weakness of lower extremity or foot
Difficulty bending the foot inward or down
Abnormal or weak reflexes
Pain when lifting the leg straight up off the examining table
Tests may help determine the suspected causes. They are often not needed unless pain is severe or long lasting. They may include:
Blood tests
X-rays
MRIs or other imaging tests
Home Treatment for Sciatica:
Apply heat or ice to the painful area. Try ice for the first 48 - 72 hours, then use moist heat after that.
If you can safely get in and out of a tub try an Epsom salt bath
Consider taking short course (no more than 7 days) of non steroidal anti-inflammatory medications such as over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol) if your stomach can tolerate them.
Bed rest is not recommended.
Reduce your activity for the first couple of days. Then, slowly start your usual activities after that. Avoid heavy lifting or twisting of your back after the pain begins. If you get better, you should start exercising again after 2-3 weeks. This should include exercises to strengthen your abdomen and improve flexibility of your spine.
If at-home treatment measures do not help after 3 days or if you get worse see your Chiropractor immediately.
How is Sciatica Treated?
The vast majority of the time, sciatic pain can be relieved through a combination of stretches, deep tissue massage of the piriformis muscle and chiropractic care. We often utilize cold lasers, ultra sound and deep e-stimulation. Occasionally, in cases where chronic spasm of the low back or piriformis muscles is causing the sciatic pain, it may be necessary to do a procedure called a dry needling or a steroid injection, where a medical pain specialist injects a small amount of anesthetic directly into a spasmed muscle to break the spasm cycle. However, this is typically not necessary. When the cause is a bulging or herniated disc, decompression traction may be indicated. First we need to locate the point of nerve compression and then treat that compression. Your Chiropractor has many tools in his treatment toolbox to properly diagnose and treat your sciatica.
Sciatica is actually a sign that you have an underlying problem (pathology) putting pressure on a nerve originating in your lower back. The most common cause of this nerve compression is a bulging or herniated lumbar disc. Piriformis syndrome, a nerve entrapment, is another common cause of sciatica. The piriformis is a muscle that lies directly over the sciatic nerve. If this muscle becomes tight or if you have a spasm in this muscle, it puts pressure directly on the sciatic nerve. In about 10% of the population the sciatic nerve actually courses through the piriformis muscle. In those patients sciatica is more common. Occasionally, sciatic pain in men is caused by sitting on a wallet or simply sitting too much. it can also be caused by standing too long, pelvic injury or fracture or even tumors. However the last two causes are rare findings in most doctors offices.
How do I know if I have sciatica?
Pain that radiates from your lower (lumbar) spine to your buttock and down the back of your leg is the key symptom of sciatica. Sciatica may be accompanied by numbness, tingling, and muscle weakness in the affected leg. This pain can vary widely, from a mild ache to a sharp, burning sensation or excruciating discomfort. Sometimes it may feel like a jolt or electric shock. Sciatic pain often starts slowly or gradually and intensifies over time. It's likely to be worse when you sit, cough or sneeze. In some cases, the pain is severe enough to make a person unable to move. The pain most often occurs on one side. Some people may have sharp pain in one part of the leg or hip and numbness in other parts. The pain or numbness may also be felt on the back of the calf or on the sole of the foot. The affected leg may feel weak.
Sciatica Pain May Get Worse:
After standing or sitting any length of time
At night with laying down
When sneezing, coughing, or straining
When bending backwards
Walking especially if caused by spinal stenosis
Signs and Test:
Your Chiropractor will perform a thorough history and physical exam. This may show:
Weakness of lower extremity or foot
Difficulty bending the foot inward or down
Abnormal or weak reflexes
Pain when lifting the leg straight up off the examining table
Tests may help determine the suspected causes. They are often not needed unless pain is severe or long lasting. They may include:
Blood tests
X-rays
MRIs or other imaging tests
Home Treatment for Sciatica:
Apply heat or ice to the painful area. Try ice for the first 48 - 72 hours, then use moist heat after that.
If you can safely get in and out of a tub try an Epsom salt bath
Consider taking short course (no more than 7 days) of non steroidal anti-inflammatory medications such as over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol) if your stomach can tolerate them.
Bed rest is not recommended.
Reduce your activity for the first couple of days. Then, slowly start your usual activities after that. Avoid heavy lifting or twisting of your back after the pain begins. If you get better, you should start exercising again after 2-3 weeks. This should include exercises to strengthen your abdomen and improve flexibility of your spine.
If at-home treatment measures do not help after 3 days or if you get worse see your Chiropractor immediately.
How is Sciatica Treated?
The vast majority of the time, sciatic pain can be relieved through a combination of stretches, deep tissue massage of the piriformis muscle and chiropractic care. We often utilize cold lasers, ultra sound and deep e-stimulation. Occasionally, in cases where chronic spasm of the low back or piriformis muscles is causing the sciatic pain, it may be necessary to do a procedure called a dry needling or a steroid injection, where a medical pain specialist injects a small amount of anesthetic directly into a spasmed muscle to break the spasm cycle. However, this is typically not necessary. When the cause is a bulging or herniated disc, decompression traction may be indicated. First we need to locate the point of nerve compression and then treat that compression. Your Chiropractor has many tools in his treatment toolbox to properly diagnose and treat your sciatica.
