Treatment for Sciatica
What Is Sciatica?
Sciatica is characterised by pain, numbness and or tingling experienced down the back of the leg. The pain follows the path of the sciatic nerve which originates from the lumbar nerve roots in the low back. Sciatica is not a diagnosis, it’s a symptom. Meaning that something is causing pain to run down the back of your leg such as a disk bulge or herniation, piriformis syndrome or spinal stenosis.
Chiropractors are able to treat the underlying cause of sciatica, allowing you to return to your normal activities. Most cases of sciatica can be treated successfully using hands-on joint and soft tissue techniques, home stretches and exercises.
What Is The Sciatic Nerve?
The sciatic nerve is the thickest and longest nerve in the body. You have two sciatic nerves, one running down the back of each leg. It’s formed by the spinal nerves of L4, L5, S1 – S3. These individual nerves join and form a single nerve, now known as the sciatic nerve.
The sciatic nerve exits the pelvis and runs deep behind the hamstrings. Just above the level of the knee, it divides into the tibial nerve and the common peroneal nerve.
What Does Sciatic Nerve Pain Feel Like?
Sciatic neuropathy can be described as tingling, numbness, sharp, burning, electric pain or weakness felt in the hip, the hamstring and down to the foot.
Mechanical irritation of the sciatic nerve is a common cause and can occur as the nerve passes between the lumbar vertebrae, as is passes between the muscles in the pelvis or by a herniated intervertebral disk
Sciatica Symptoms
Sciatica can be felt from the low back, down the hamstring to the foot. Patients often report that the symptoms in their leg are more severe than the symptoms felt in their back.
Common sciatica symptoms include:
- Numbness & or tingling in the leg and foot
- Leg and foot weakness which makes balancing and walking more difficult
- Shooting pain down the back of the leg
- Pain in the buttock that is made worse with sitting (piriformis syndrome)
What Causes Sciatica?
As mentioned earlier, sciatica is a symptom which means that there is another condition causing the symptoms in your leg.
One of the most common causes of sciatica is a bulging or herniated intervertebral disk. The mechanical irritation of the disk bulge pressing onto the affected nerve root causes inflammation of the sciatic nerve resulting in neurological symptoms.
Another issue with an intervertebral disk herniation is “chemical radiculitis”. This is when the gel-like centre of the disk (nucleus pulposus) herniates out of the thick fibrous exterior of the disk (annulus fibrosis). The body’s immune system doesn’t recognise this substance and launches an immune response against the nucleus pulposus which causes further chemical irritation of the adjacent nerve root.
Other causes of sciatica can be:
- Piriformis syndrome: When the piriformis muscle is excessively tight and compresses or irritates the sciatic nerve.
- Deep gluteal syndrome: This is when the other short rotators of the hip that assist the piriformis with rotation of the hip (superior and inferior gemelli, obturator internus and quadratus femoris) compress or irritate the sciatic nerve. This is sometimes difficult to distinguish from piriformis syndrome.
- Lumbar spine stenosis: There is narrowing of the spinal canal and compression of the spinal nerves due to anatomical or progressive degenerative changes within the spine.
- Spondylolisthesis: Slippage of one vertebrae on top of another closes up the space where the spinal nerves run.
What If It’s Not A True Sciatica?
True Sciatica is leg pain, numbness, or tingling running down the back of the glutes, hamstring and sometimes down the leg to the foot. It’s due to irritation of the sciatic nerve due to a mechanical or chemical stimulus.
There are musculoskeletal conditions that mimic the referral pattern of true sciatica but don’t involve irritation of the sciatic nerve. These are sometimes referred to as “pseudo sciatica”.
- Sacroiliac Joint (SI Joint) dysfunction: The Sacroiliac joint is a large joint between the sacrum and the ilium (pelvis). When this joint is affected, pain can be felt in the lower back, the glutes, the groin, posterior lateral thigh (hamstrings). SI joint pain typically doesn’t refer into the calf or cause neurological sensory, motor or reflex changes.
- Gluteal trigger points: Myofascial trigger points (knots) in the Gluteus medius muscle refer pain and tenderness into the buttock, hamstring, back of the knee and outer part of the calf.
- Bursitis: Trochanteric bursitis in the hip can travel down the lateral part of the thigh to the knee
- Lumbar spine facet joint dysfunction: The joints of the lumbar spine, specifically the lower lumbar spine L4-L5, L5-S1 can refer symptoms into the thigh. Similar to sacroiliac joint syndrome, the lumbar facet joints won’t cause any neurological changes on examination. Lumbar facet dysfunction is a common cause of low back pain. Click here to read more about back pain.
Sciatica During Pregnancy
Low back, hip and leg pain is a common symptom during pregnancy. The stats show that about 70% of women have had an episode of back pain or sciatica symptoms during pregnancy.
The female body undergoes many hormonal and biomechanical changes during pregnancy. An increase in the hormone relaxin is necessary for allowing the ligaments, tendons and joints to increase in elasticity allowing for movement of the pelvis during pregnancy. These are all normal physiological changes that occur.
As a result of the ligaments and tendons becoming more elastic, the joints of the spine and pelvis become hypermobile. Hypermobility of the sacroiliac joint can cause referred pain into the buttock, and back of the thigh which may mimic a disk bulge or herniation causing sciatica. In these cases there wont be any changes in sensation, muscle power or reflexes in the leg compared to if there was irritation of the sciatic nerve from a disk bulge or herniation.
Chiropractic treatment of sciatica during pregnancy is extremely effective and safe. Gentle joint mobilisations combined with soft tissue therapy of the surrounding muscles, ligaments and tendons can provide relief from sciatica symptoms.
We would prescribe simple strengthening exercises to help strengthen the muscles which support the pelvic girdle. Some stretches may be beneficial, others may be making the sciatica symptoms during pregnancy worse which is why it’s important to work with a chiropractor or healthcare professional who has further training in dealing with sciatica in pregnancy.
What Are The Best Exercises For Sciatica?
Without knowing what the cause of your sciatica, it’s difficult to recommend specific exercises that can be beneficial.
The McGill big 3 are our go-to exercises for most spinal conditions as they maintain the spine in a neutral position while strengthening and increasing the endurance of the core muscles around the spine.
It’s always important to consult with a healthcare provider before attempting any stretches or exercises as some may make your condition worse.
