Sciatica

(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!