Is sciatica a disorder or a symptom? The term sciatica is commonly used to describe pain that travels along the distribution of the sciatic nerve. Sciatica is a symptom caused by one or a series of disorders occurring in the lumbar spine or surrounding area. The sciatic nerve is the largest nerve in the human body. About the diameter of a finger, it affects more females than males at a 6:1 ratio. There are certain theories that exist to explain why it affects more females than males. Sciatic nerve fibers begin at the 4th and 5th lumbar vertebra (L4, L5) and the first few segments of the sacrum in front of the SI joint. The nerve passes through the sciatic foramen just below the Piriformis muscle (rotates the thigh laterally) (there are other anatomical anomalies of the nerve in relation to the Piriformis muscle) to the back of the extension of the hip and to the lower part of the Gluteus Maximus (muscle in the buttock, thigh extension). The sciatic nerve then runs vertically downward into the back of the thigh, behind the knee, branching into the hamstring muscles (calf) and further downward to the feet.
Usually, sciatica affects one side of the body. The pain may be dull, sharp, burning or accompanied by intermittent shocks of shooting pain beginning in the buttock traveling downward into the back or side of the thigh and/or leg. Sciatica then extends below the knee and may be felt in the feet. Sometimes symptoms include tingling and numbness. Sitting and trying to stand up may be painful and difficult. Coughing and sneezing can intensify the pain.Sciatica symptoms are a classical example of where we can have 20 patients exhibiting the same symptom, but have 20 different reasons or combination of reasons producing the same symptoms. Sciatica symptom can be caused by:
1) Piriformis Syndrome
This is the most common cause of sciatic pain and is created when pressure is placed on the sciatic nerve by the Piriformis muscle. Muscle imbalances, especially in the lumbo-pelvic area, pulls the hip joints and pelvis out of place. This change of position typically shortens and tightens the Piriformis muscle/ lengthens and weakens, which then places pressure on the sciatic nerve.
2) Lumbar herniated disc
Although this is the end result, this could be due to muscle imbalance. According to a presentation to the American Academy of Orthopedic Surgeons on March 10, 2001, by Dr Ahn of the Johns Hopkins University, smoking, high blood pressure and high cholesterol are important risk factors for lower back pain. These are the same risk factors for heart attacks and strokes. He theorizes that smoking, high blood pressure and high cholesterol damage the inner linings of arteries to form plaques that shut off the blood supply to discs resulting in disc herniation.
3) Sacroiliac joint dysfunction
Irritation of the sacroiliac joint at the bottom of the spine can also irritate the L5 nerve, which lies on top of it, and cause sciatica type pain. This is not a true radiculopathy, but the pain can feel the same as sciatica caused by a nerve irritation. Many times a dysfunctional pelvis secondary to an unstable sacroiliac joint can put undue stress on the sciatic nerve. Sometimes it is associated with supra pubic tenderness.
4) Isthmic Spondylolisthesis
This condition occurs when a small stress fracture allows one vertebral body to slip forward on another vertebral body (e.g. the L5 vertebra slips over the S1 vertebra). With a combination of disc space collapse, the fracture, and the vertebral body slipping forward, the L5 nerve can get pinched as it exits the spine and cause sciatica. The common spinal segment in which this occurs is the L4-5 secondary to this being the most mobile segment. A dysfunctional segment above or an unstable sacroiliac join can put undue strain on the segment.
5) Lumbar spinal stenosis
This condition commonly causes sciatica due to a narrowing of the spinal canal. It is more common in men over age 60 and typically results from a combination of one or more of the following: enlarged facet joints, overgrowth of soft tissue or a bulging disc placing pressure on the nerve roots as they exit the spine. (In the past, surgery was the only option; now with traction assisted manual therapy techniques we are able to reduce symptoms).
6) Pain in MS or some other types of peripheral neuropathy
This pain is related to the demyelinating process (nerve get strip of off insulation) itself. This neuropathic pain is often characterized as having a burning, gnawing or shooting quality. As this is the largest nerve in the body, it can be affected by diabetic neuropathy. (Research and in clinic, we have seen that low level laser helps with this type of pain to some extent but we are uncertain as to how)
As we discussed earlier, sciatic pain affects more females than males by a 6:1 ratio. Research is starting to link together the anatomical, physiological, biochemical and hormonal factors responsible for gender based differences in pain perception and response to treatments. Anatomically, women are built differently. Since pelvic organs play a big role in maintaining pelvic integrity, the strengthening or retraining of pelvic muscles becomes a key factor for a better outcome in the presence of certain weaknesses.
At Synergy Therapeutic Group we don't use a "one-size fits all" approach to treating lower-back pain or sciatic pain. We develop a system to match certain characteristics of back pain with specific treatment options while keeping gender specificity in mind.
People want the fastest way to get better and that's what we do!
When we use our method of treatment and everything aligns well, you can see a 50 percent improvement of pain in a couple of visits. We know that patients responded differently to treatments. Some patients had good results from manual manipulations, such as the high-velocity thrust procedures often performed by chiropractors. Other patients had good results from either McKenzie exercises or core-stabilization exercises. Some people responded well to muscle energy techniques. Sometimes treating the shoulder relieved back pain.
Our challenge is to figure out what type of patient responds best to which treatment. For example, if we found a tight Piriformis muscle and immediately started to stretch we have found this may not be the best option. It can increase pain. There are well documented studies regarding patients' treatment responses. These studies determined that patients who had certain characteristics of pain responded well to the procedure. For instance, people who had been experiencing pain for less than 15 days had no pain below the knee and had a hypo-mobile or stiff spine, a benefit from certain manual techniques.
Our back pain program has been referred to as a miracle!
We say this is neither a wish list nor a miracle. It's a matter of matching a patient's back pain characteristics with the appropriate and specific treatments in a logical and intuitive fashion with the highest amount of skill producing GREAT RESULTS.