(published in Dockline Magazine May 2013)
One of the most common reasons for visits to our office in Kingwood is
sciatica. However, sciatica is not
actually a diagnosis but a description of symptoms. The term sciatica is well recognized and
popular, so it is often overused and inaccurate, similar to the term Carpal
Tunnel. Sciatica can include any symptoms related to the compression of any one
of the five nerve roots (from the spine) that make up the sciatic nerve. It gets used a lot for any back, leg or butt
pain. There are many different causes of
these symptoms and not all patients with these symptoms have sciatica. Getting to the root cause is important in
treating sciatica and not just treating the symptoms with pain killers, etc.
When somebody comes in with symptoms of sciatica, the next step
is evaluating the actual cause. This
often includes orthopedic and neurological tests with x-rays to evaluate the
spine and pinpoint the potential cause instead of just treating the symptoms. After a thorough exam and evaluation then it
can be determined if an MRI is necessary for further evaluation. In most cases it is not and the condition
that is causing the symptoms responds well to non-invasive conservative
chiropractic care.
So what are the causes?
Potential causes of sciatica symptoms include spinal disc herniations,
piriformis syndrome, pregnancy, spinal stenosis, localized nerve entrapments,
trauma, or in rare instances, tumors.
Spinal discs over time can began to bulge and herniate causing compression
of the nerve at that level. It can happen
anywhere along the spine, but the most common level is at L5-S1 (or the last
disc in the spine) and can cause pain down the back of the leg. Surgery for these cases is a last resort and
should not be considered unless not responding to conservative care. Piriformis syndrome is compression of the
sciatic nerve by the piriformis muscle.
This usually responds very well to conservative care and includes
evaluation of the causes such as leg
length, spinal and pelvic rotations, muscle imbalances and postural
modifications. Pregnancy may cause
symptoms of sciatica from the weight of the fetus on the sciatic nerve,
swelling or piriformis syndrome. Spinal
stenosis is narrowing of the canal that the spinal cord passes through from
usually a combination of factors that may include bone spurs, disc herniations,
inflammation, spondylisthesis (forward displaced vertebra) and spinal ligament
thickening. Some severe cases of spinal
stenosis may require surgery. Other
localized nerve entrapments can occur in the legs that can mimic sciatica
symptoms and often respond very well to conservative non-pharmalogical
treatment.
Every patient’s structure is different and no two cases are
exactly the same, so the treatment of sciatica varies from patient to patient
due to these factors. Live well and God
Bless!
