Sciatica is a common presentation to the chiropractor. We often hear a patient saying they have a ‘pinched nerve’, but sciatica is normally not that simple as there are a number of factors that can cause it.
We will start of with some simple anatomy – The sciatic nerve arises from several segments in the lower back, in the lumbar and sacral spine, joining together to form one big nerve which travels through the hip, buttock and all the way down to the toes, branching out as it goes.
Symptoms are often varied, although the main one is pain down the leg, with the ‘classic’ sciatica causing pain in the calf and foot. Other symptoms can include pins and needles, numbness and weakness of the muscles. Very rarely, losing function of the bowel and bladder can occur, which requires urgent medical intervention.
Causes: There are a number of causes for sciatica, here are the most common ones:
- Disc – A herniation or rupture to a disc can cause leakage of disc contents into the spinal canal and thus place pressure on the nerve. Furthermore, inflammation associated with the injury can also irritate the nerve.
- Bony growths – These can narrow the canal of where the nerve exits the vertebral column, reudcing the amount of space for the nerve to exit
- Piriformis syndrome – In a small percentage of individuals, the sciatic nerve passes through the middle of the piriformis muscle (gluteal region). When it is tight it can compress the nerve
- Joint strain – Inflammation from a joint sprain can irritate the nerve
- Spondylolistesis – A forward slippage of the vertebra which can compress the spinal cord or exiting nerves
Diagnosis – Here at Mona Vale Chiropractic Centre we will perform a thorough history and examination involving orthopaedic and neurological testing to come to a diagnosis. If we believe you require imaging such as x-ray or MRI this can be arranged and we will refer accordingly. Communication with your GP will also occur and if we feel chiropractic treatment is not appropriate for your condition, a referral to the appropriate healthcare professional will be done.
Treatment – There are a number of different treatment options, some of the ones we use include: Adjustments and mobilisations, muscle releases, dry needling, stretching and rehabilitation exercises. The treatment will be aimed to address the cause of the sciatica through improving movement, decreasing inflammation and strengthening surrounding muscles.
What can be done in the meantime for sciatica? Keep moving is the simple answer! Avoid aggravating movements such as bending,twisting and prolonged sitting. Moving encourages blood flow through the joints and muscles to reduce the chances of the lower back from tightening up. Heat is recommended if the injury has been longer than 24 hours.
Mitchell Roberts – Chiropractor