Sciatica is one of the most common complaints seen in our chiropractic practice. Sciatica refers to pain that travels along the path of the sciatic nerve. The sciatic nerve travels from the buttocks and down each leg. Many doctors talk about sciatica as though it’s a diagnosis, “Aha, I think you have sciatica!”
Sciatica refers to pain, weakness, numbness, or tingling in the leg. It is caused by injury to or pressure on the sciatic nerve. Sciatica is a symptom of a medical problem. It is not a medical condition by itself. Your doctor probably just repeated in latin to you what you already told him. You’re right – you have a pain in your leg!
Chiropractors understand that sciatic pain travelling down the sciatic nerve must derive from pressure or irritation to the origin of the nerve roots that nake up the sciatic nerve. The sciatic nerve is the confluence of nerve roots from the lower back. There are, in fact, about six different nerve root levels that make up the sciatic nerve so there are several areas, including the sacroiliac joints and gluteal muscles that can refer pain into the lower limb.
In most cases, it is caused by compression of one of the nerve roots that make up the sciatic nerve, usually the last lumbar nerve root L5, or the first sacral nerve root, S1, as they exit the spine.
For many years, we’ve seen hundreds of patients with low back pain, many with lower limb pains, who have vague, if any, diagnoses. They’re often left to their own devices after an MRI or CT scan shows a disc bulge and they’re told that they have sciatica. After all, you can only take anti-inflammatory medications for a week before your stomach lining is at risk of being irritated.
Without good direction, it can become a frustrating journey and simply being told that you have sciatica gets you knowhere quickly! We know that the many lumbar facet joints, sacroiliac joints, ligaments, tendons and muscles, nerve roots and disc structures can all lead to pain down the legs.
That pain might be anterior, posterior or lateral, sometimes accompanied by pins and needles or numbness. That can really confuse the situation!
A good physical examination is essential, following a thorough health history, to make sense of it all. Imaging findings can help, but sometimes even complicate the situation if a red herring or incidental finding is seen. It can take years of experience to put the pieces of the puzzle together! Each day and with each patient, we get better at it.
Dr. David Black, Chiropractor at Armadale, discusses a case of sciatica. He explains more about the origins of this symptom and how a chiropractor approaches it. David is 89 years old, entering his fortieth year of practice.
He loves practising chiropractic and his patients enjoy his company and conversation. He loves to record podcasts and share his passion of healing with his hands. Some things don’t have to change after decades, especially if they work!
