There’s nothing more painful, uncomfortable and limiting than to experience sciatica. The first step is to identify whether or not what you are experiencing is sciatica. It might not change the course of the treatment but it will impact your expectations.
Sciatica is also called lumbar radiculopathy and is an inflammation of the sciatic nerve which exits the lower lumbar spine and sacrum and travels down the leg to the foot. Sciatica always travels down the back of the thigh. Depending on the degree of inflammation it can travel all the way to the foot. Here are the common symptoms of sciatica:
- Low back pain that radiates into the buttock and down the back of one thigh
- Pain from the buttock as far down as the foot
- Numbness in the leg or foot
- Weakness in the leg, ankle, or foot
If the pain is radiating down the side or front of the thigh it is not sciatica or not only sciatica. Pain down the side of the thigh is typically a sign of a less severe condition than sciatica.
What Causes Sciatica?
Anything that causes an irritation and inflammation of the sciatic nerve can cause sciatica. The first step is to identify the cause or at least rule out what is typically called a space occupying lesion.
This typically means x-rays to evaluate degenerative arthritis and bone spurs, and an MRI to assess for the presence of a disc herniation. Some disc herniations are definite surgical cases while the majority can be treated conservatively.
Red Flag: If you lose control of your bowels or bladder it is an emergency and you should proceed to the hospital immediately.
Regardless of the presence of arthritis or disc involvement, sciatica is an indication of significant dysfunction in the lower lumbar spine and pelvis. Any hope of resolving the sciatica hinges on identifying and correcting the dysfunction.
Sciatica is an indication of a mechanical dysfunction and you cannot solve a mechanical dysfunction with a pharmaceutical solution. While you might opt for short term pain control with medication, unless you correct the mechanical dysfunction you will experience some recurrence of the consequences of the mechanical imbalance.
Top 4 Keys to Successful Sciatica Treatment
Key #1: Accurate Diagnosis – It is critical to perform a comprehensive exam and the appropriate diagnostic tests in order to formulate an appropriate treatment plan. If there is any significant muscle weakness in the leg that is a caution that must be carefully monitored. An MRI is the gold standard in assessing whether or not a disc bulge or herniation is putting pressure on the sciatic nerve, or whether there is a disc fragment floating free in the spinal canal.
Only with a thorough exam and diagnostic testing can you decide what is the best course of treatment. While the majority of sciatica can be successfully treated conservatively, severe disc herniations often require surgery.
Key #2: Structural Balance – Sciatica is due to some imbalance causing irritation and inflammation to the sciatic nerve. The first step in restoring balance is to bring the structure of the body back to greater balance. What does this mean? Your pelvis should be level from the front or back and should not be tipped too far forward or back from the side.
When the pelvis is imbalanced it puts more pressure on the pelvis and lower lumbar spine, causing a sequence of reactions that can put significant tension on the sciatic nerve.
Key #3: Pelvic & Lumbar Joint Function – Joints in the pelvis and lumbar spine have a single primary purpose, to provide for movement. This movement is necessary to navigate even the simple movements and positions of life. When joints become stuck and lose proper motion it causes other joints to move more in an attempt to compensate.
Both the restricted joints and those moving more become inflamed and painful. This can put additional tension on the sciatic nerve. Over a longer time this imbalance in movement is a prime driver of the development of degenerative arthritis. As arthritis develops the space for the nerves exiting the spine narrows and can result in sciatica.
Key #4: Movement & Posture – It’s not enough to solve the acute problem of sciatica. To avoid a recurrence you must correct as many imbalances as possible. One common imbalance is common daily postures along with how we move in the low back, pelvis and hips.
Most people do not properly use the largest and strongest muscles of the body to move and rely instead on much smaller muscles of the lower back. Learning how to move correctly will greatly reduce the stress to the lower back and pelvis and go a long way in both correcting sciatica as well as avoiding future episodes.
Sciatica is a sign of longstanding imbalances in the lower spine and pelvis. Anything out of balance is exposed to excess stress and wears at an accelerated rate. Restoring and maintaining balance is the best way to not only correct sciatica but to feel good and perform your best.
The intent of chiropractic care is less about fixing something and much more about helping the body return to a state of balance where it can heal whatever is going on.
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