Sciatica

Sciatica

Pain with numbness & tingling radiating down the back of the leg is associated with Sciatica. Sciatic Pain can be from disc involvement and your symptoms will run down to your feet. Sciatica can also be from a nerve entrapment in the Piriformis muscle and this is called Pseudo Sciatica. It will give you many of the same symptoms but usually the symptoms stop at the knee versus the foot.

Sciatica is a term that the public will use for an assortment of meanings. When a nerve is compressed exiting the lower lumbar spine causing a radiculopathy down the posterior aspect of the patient’s thigh, radiating below the knee and into the lateral foot….this is sciatica. There are other types of back pain. The types may include disc pain, sacro-iliac pain, biomechanical pain, nerve root compression pain and muscle pain such as piriformis syndrome.

The same process applies as it does with other musculoskeletal symptoms. The process starts with a complete history, consultation and examination. This gives the clinician a very good indication of where the damaged tissue is. 

Diagnostics are next and start with the x-ray. Standing, functional films not only give us fracture, pathology and infection but also gives you a functional component as to how your joints function under a load. This is a critical piece to a diagnostic puzzle and sciatica is misdiagnosed many times. If the clinician continues to be divided between a disc diagnosis and a biomechanical diagnosis then we would put the patient on the lumbar decompression table. If the symptoms improve then we have disc involvement. If the symptoms increase in decompression then we have a biomechanical symptom generator as a cause of the symptom.

Treatment of sciatica is multifaceted to include chiropractic adjustments, stretching hypertonic muscles, facilitating flacid or weak muscles; possibly ice and stim modalities, trigger point injections, kinesiotaping, bracing and possibly orthotics. The focus of treatment needs to be on functional restoration of the lower kinetic chain (low back, hips and legs). If treatment only focuses on the symptom, the condition will become episodic and chronic in nature.

Inflammatory foods should also be avoided due to the exacerbation of this low back condition. ALWAYS make sure to get the correct tissue involved giving you the symptoms. MRI alone is not enough to correctly diagnose Sciatica.


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