Things that we treat.
What is sciatica?
The sciatic nerve is a collection of several nerve roots that arise between your spinal bones (vertebrae). These nerve roots join together and form the largest nerve in the body, the sciatic nerve. This nerve travels down from the low back under the buttock muscles all the way down the legs and feet. Sciatica is a term to describe an irritation or pressure on the nerve, which is commonly caused by a herniated or bulging disc (also referred to as a ruptured disc, pinched nerve, or slipped disc) in the lumbar spine. The pressure or irritation leads to a complex of symptoms that include sharp, radiating pain, burning, and/or numbness and tingling. This is a very debilitating condition that affects thousands of people every year.
Generally, herniated or bulging discs are the cause of the problem. The herniated material of the disc will compress or contact the exiting nerve root producing the symptoms. Sometimes central canal stenosis, lateral canal stenosis, spondylolithesis, or degenerative disc disease can cause this nerve compression as well. The problem is often diagnosed as a “radiculopathy”, meaning that one or more intervertebral discs have herniated or protruded from its normal position in the vertebral column and is putting pressure on the nerve root in the lower back, which forms part of the sciatic nerve. Sciatica occurs most frequently in people between 30 and 50 years of age. On many occasions this condition slowly develops as a result of general wear and tear on the structures of the lower spine and discs. Rarely is this condition surgical. Unless there is a progressive neurological deficit, or cauda equina syndrome, the majority of people who experience sciatica get pain relief with non-surgical treatments. Non-Surgical Spinal Decompression is very effective for these conditions. Physical therapy and Chiropractic can help sometimes as well.
Understanding sciatica pain
First, everyone responds differently to pain. For some people, the pain from sciatica can be severe and debilitating. For others, the pain might come and go intermittently, and not be so intense. Usually, sciatica only affects one side of the lower body, and the pain often radiates from the lower back into the deep buttocks all the way through the back of the thigh and down through the leg. Sometimes the person experiences calf or foot pain. It is quite variable. One or more of the following sensations may occur as a result of sciatica:
- Pain in the buttocks or leg that is worse when sitting
- Burning or tingling down the leg
- Weakness, numbness or difficulty moving the leg or foot , with the
- Leg pain being a little worse than the back pain.
While sciatica can be very painful, it is important to keep in mind that the main problem may be with the intervertebral discs. Most likely the discs are dry and weakened due to “wear and tear” injuries. Treatment goals should be to minimize pain, minimize the disc herniation, re-hydrate and re-nourish the discs and nerve roots, and to strengthen and rehabilitate for permanency and prevention of re-injury. This is where spinal decompression therapy can be very effective.
Symptoms that may constitute a medical emergency include progressive weakness in the leg or bladder/bowel or incontinence. As mentioned above, this may represent a rare condition called cauda equina syndrome. You should seek immediate medical attention if you are experiencing these signs.
In general, patients with complicating factors should contact their doctor if sciatica occurs, including people who have been diagnosed with cancer; take steroid medication; abuse drugs; have unexplained, significant weight loss; or have HIV.
Since sciatica nerve pain is caused by a combination of pressure and inflammation on the nerve root, and treatment is centered on relieving both these factors, typical sciatica treatments should include:
Non-surgical sciatica treatments:
- Non-Surgical Spinal Decompression Therapy
- Physical Therapy
- Massage Therapy
Non-steroidal anti-inflammatory drugs (such as ibuprofen, naproxen, or COX-2 inhibitors), or oral steroids can be helpful in reducing the inflammation and pain associated with sciatica.
Epidural steroid injections
The goals of non-surgical treatments should include both relief of sciatica pain and prevention of future sciatica problems. Injections are invasive and are usually only a temporary solution.
When reading the medical literature, it is generally agreed upon that nearly all cases do well with non-surgical management.
For severe cases that just don’t respond, the following options are available for surgery:
Microdiscectomy or lumbar laminectomy and discectomy, remove the portion of the disc that is irritating the nerve root. This surgery is designed to help relieve both the pressure and inflammation and may be warranted if the sciatic nerve pain is severe and has not been relieved with appropriate manual or medical treatments.