The foundational issue that causes sciatica pain to develop is impingement of the sciatic nerve. Some of the following issues are common causes of sciatica pressure:
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- Bone spurs on the spinal vertebrae
- Herniated disk, which are nerve tissue between the vertebrae that have slipped out of place
- A tumor on or in the vicinity of the sciatic nerve
- Sitting for long periods of time
- Other nerve-related conditions such as cauda equina syndrome
- An infection that causes damage to one or more nerves in the spinal cord
- Spinal stenosis, or narrowing of the spinal canal
- Poor bowel or bladder control (in severe cases with extensive numbness and weakness)
- Dysfunction of the piriformis muscle, which surrounds the sciatic nerve in some people
- Participating in activities that involve excess twisting or carrying heavy objects
- Being overweight, since this strains the spine and increases pressure on the nerve
- Circulatory conditions such as diabetes that have caused damage to the sciatic nerve
Some risk factors for sciatica include age (which leads to structural changes in the spine), jobs that involve a lot of manual labor, and impact sports that involve twisting and undue pressure on the spine.
Your doctor can diagnose scitica after completing a full evaluation. This usually begins with a discussion where the doctor reviews your medical history and asks you about prior surgeries, medications, and your sciatica symptoms. You then may undergo a physical exam, which involves you laying on the exam table on your back.
The doctor then asks you to relax before lifting one of your legs straight up. They will ask if you feel any pain in the buttocks with that motion. If you do experience pain, this often indicates the presence of sciatic nerve impingement. Other orthopedic testing, range of motion testing, and MRS testing will be completed to further evaluate the root cause of the sciatic nerve impingement.
Other aspects of a sciatica diagnosis and evaluation include imaging. If your doctor wants to find the exact reason for the pressure on your sciatic nerve, they may perform magnetic resonance imaging (MRI), x-rays, or a computed tomography (CT) scan.
These tests are both non-invasive and they give the doctor a more detailed look at the bones, tissues, and muscles in that area. This allows them to see structures that may be placing pressure on the nerve or other issues that may be causing your pain.
Symptoms of sciatica in each person may vary depending on how long they have had sciatica and how much pressure is being placed on the nerve. People may also have different sciatca symptoms based on how often they engage in activities that aggravate their pain. Sciatica Symptoms that are commonly associated with sciatica include:
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- Sharp or aching pain that starts in the lumbar spine and shoots down one side of the lower body (this sometimes may occur in both legs)
- An increase in pain after sitting, driving, or lifting heavy objects
- Numbness or tingling (also known as pins and needles) in one or more parts of the leg
- Muscle weakness in the affected leg
- A mix of symptoms, such as numbness in one side of the leg and pain in another part
- A burning sensation in the calf of the painful leg
It’s always best to seek non-invasive approaches for any health condition before exploring other options. For sciatica pain, it’s advised that you consult a chiropractor or physical therapy provider to get treatment. Chiropractors start by completing an exam that tells them where the impingement is and what is causing it.
They do this through orthopedic tests to locate the root cause of the problem. They will also test muscle reflexes, range of motion, and sensation. Chiropractors will use x-rays to determine what structures are placing pressure on the nerve. This allows the doctor to address the underlying cause of the condition.
The most common sites of sciatic nerve impingement are the L4 and L5 nerve root and sacroiliac joint dysfunction (which connects the lower back to the pelvis). Another source of injury to the sciatic nerve is the piriformis muscle, or piriformis syndrome.
The piriformis is a deep muscle located just above the gluteus muscles in the buttocks. Someone who has piriformis syndrome will experience abnormal contraction and movement of this muscle, which cuts off the blood flow and nerve supply to the nearby sciatic nerve.
Chiropractic treatment for sciatica involves manipulative therapy and flexion distraction to open up the narrow hole in each vertebrae of the spinal column (called the intervertebral foramen, or IVF).
Your chiropractor will then lead you through exercises that strengthen the muscles of the core (in the abdominal area) and the pelvis (near the hips and upper legs). This lessens the stress on your lower back and the stress on the sciatic nerve.
Nerve flossing and additional stretches are also used to relieve tense and sore muscles and improves mobility. In severe cases a chiropractor may use spinal decompression to take pressure off of the sciatic nerve impingement, especially if there is disc involvement. An inversion table may also be recommended by your doctor.
Individuals who are experiencing severe symptoms of sciatica pain that don’t improve with other treatments may be a good candidate for surgery. It is usually advised to get sciatica surgery if you have serious symptoms such as bowel and/or bladder changes or conditions such as cauda equina syndrome that are known to cause sciatica.
Doctors often recommend this type of intervention for people who have a bone spur or herniated disks, as surgery can alleviate sciatica symptoms (and other issues) in these instances. If you suspect you may have sciatica or any of the other conditions we mentioned consult a doctor who can provide medical advice, diagnosis, or treatment. If you neglect this condition for too long, you are at risk of experiencing permanent nerve damage to your lower body.
Self care is the best type of prevention and aftercare. If you are at risk of or already experiencing some of these symptoms, avoid activities that make your pain worse. Seek medical attention from a chiropractor skilled in the treatment of sciatica.
