patients I see have sciatica as one of their problems.
The sciatic nerve is made up of four nerves that come out of the lower back. These
four nerves combine in the middle of the buttock and form the sciatic nerve. This
nerve is the biggest and longest nerve in your body. The sciatic nerve is as big
around as your thumb, and extends from the lower back all the way down to the toes.
When the sciatic nerve is compressed (pinched) or irritated, pain and/or numbness
travels into the buttock and down the leg. The more pressure you place on the
sciatic nerve, the farther down the leg the pain/numbness extends. A small amount
of nerve pressure will cause the pain to be only in the buttock. In the worst case
scenario a lot of nerve pressure will cause pain to go down the leg and into the toes.
This pain is most commonly described as a toothache; but it may be tingling, sharp,
shooting, burning, or numb. Because nerves carry every sensation there is, sciatica
symptoms may present many different ways.
- Bulging and herniated discs close up some of the space in the nerve canal. If one or more of the
four spinal nerves making up the sciatic nerve become compressed or irritated, pain and/or numbness
results.
- Arthritis is rarely so extreme that it pinches a nerve. Most typically the role it plays is to partially close
up the canal where the nerve comes out of the spine. This leaves less leeway for other things to go
wrong.
- Subluxations (Misalignments) are the most common factor involved in sciatica. When a bone in the
lower back or sacroiliac joint is wedged or rotated out of place it can irritate or compress a nerve.
- Swelling & Inflammation is often a factor in sciatica. Swelling is a fluid, and fluids take up space. This
combined with one or more of the other reasons can lead to a pinching of the nerve. In addition
inflammation contains harsh chemicals that can irritate the nerves around it.
Most people have two or more of these factors present - and when combined they cause sciatica.
All four of the causes of sciatica are the result of: lack of structural balance, locked-up joints, and
tight weak muscles. This causes physical stresses to accumulate, and over time leads to break down.
Treatment:
I often tell patients that getting a nerve “un-pinched” is sort of like getting a mattress into a bedroom. There
are some things you can change, some things you can eliminate, and some things you can’t change and you
just have to work around. For example if I’m trying to get a mattress into a bedroom, I can’t change the
dimensions of my hallway or my doorway. But I can move the nightstand completely out of the way. I can also
make some changes by tilting and bending the mattress. Despite not being able to change the hallway and
doorway, I should almost always be able to get the mattress into the bedroom.
As far as the compressed nerve, if there is arthritis, I can’t change the fact that the disc is thin or that there is
a bone spur. But if I reduce the bulging disc, improve or eliminate the misalignments, and get rid of the
swelling and inflammation, almost always enough of a positive change is made that we can still “un-pinch” the
nerve.
We accomplish this by using decompression traction to the lower back to help the disc bulge/herniation. We
use ice (and sometimes ultrasound) to eliminate swelling and inflammation. Spinal adjustments improve joint
mobility and alignment. And at some point we’ll incorporate exercises to strengthen and stretch the back
muscles for injury prevention. It’s important to follow your care plan until your maximum improvement is
reached and the condition is stable. Then occasionally come in to maintain your correction for prevention.
Remember: getting rid of the pain is great, but if we don’t correct the causes, future problems are highly likely.