By Dr. Rich Raigoza
I. Introduction
Sciatica, by definition, refers to pain and/or dysfunction arising from injury or irritation to the sciatic nerve. Unlike popular belief, the term isn’t a diagnosis, but rather a description of an underlying problem that results in pain along the sciatic nerve.
The sciatic nerve is a large nerve formed by other smaller nerves combining. The smaller nerves come directly from the lumbar and sacral spine, and form in an area near the buttocks. Anything which damages these smaller nerves that have joined together may also produce similar symptoms of ‘sciatica’.
II. Causes of Sciatica
Understanding the root of your pain is important when dealing with this issue. The goal of the treatment should be to address the underlying problem, rather than the symptoms. By doing so, you may prevent future exacerbations, and have a shorter recovery time.
Here are some of the most common causes of sciatica. Each of these conditions is treated differently and varies in expected recovery time. This is why an accurate diagnosis is key!
Lumbar disc herniation
There are discs between each spinal segment. The discs have a jelly-like material, which could break through the disc shell, resulting in what’s known as a herniation. Whenever these occur, they may compress one of the smaller nerves that comprise the sciatic nerve and result in pain.
Spinal stenosis
This issue typically affects individuals older than 55 years of age. As we age, wear and tear on our body makes arthritis development a common occurrence. The condition may lead to a narrowing of the canals where the nerves pass through, making it a very uncomfortable passageway. If one of the smaller nerves becomes entrapped within those restricted spaces—you guessed it—symptoms of sciatica may appear.
Piriformis syndrome
This is a common and unique case where a muscle located within the buttocks area might tighten and compress the sciatic nerve. In some situations, the nerve pierces through the piriformis muscle, making compression probable.
Other possible causes
There are many other situations which could cause patients to experience this type of nerve pain. At Ottawa Health: Performance and Rehabilitation, the three listed above are some of the most common reasons we see in our clinic.
III. Symptoms of Sciatica
Understanding the symptoms is simple when you understand the functions of the nerve! To put it simply, there are two main functions—
- Motor—helps the muscle of the legs and feet move
- Sensory—helps you feel sensations in the legs, mostly along the back of the thigh and calf
—which leads to the most common symptoms of sciatica:
- Pain in the buttocks, posterior thigh, calf, and sometimes into the foot
- Numbness and/or tingling sensations in the back of the legs
- Weakness in the legs, inability to lift the foot
- Difficult standing, walking, and especially bending forward
IV. Diagnosing Sciatica
In most cases, a qualified and astute healthcare provider should be able to identify the root cause of your pain through physical examination. In some cases, special imaging, such as MRIs or CT scans, is necessary to investigate a more complex situation. Some tools we use to help identify the cause include
- MRI, CT, or X-ray to diagnose disc herniations, spinal stenosis, or other causes
- Nerve conduction testing helps assess the integrity of the nerve and confirm the diagnosis
V. Treating Sciatica
The good news is that most cases may be resolved with focused physical therapy and/or chiropractic services with a rehab focus. These are some methods our team at Ottawa Health: Performance and Rehabilitation uses with great success:
- Chiropractic and physiotherapy manual therapy—focuses on releasing any tightness or obstruction along the path of the nerve
- Chiropractic manipulations help restore proper spinal function and relieve pressure on the smaller nerves
- Electroacupuncture is a great tool we use to restore normal electrical conductivity and release any pressure along the nerve’s course
Medications such as NSAIDS and muscle relaxants are sometimes used to relieve pain and allow a more comfortable therapy session, and at the end of the day’s activities - Rehabilitation is the key to success. Our evidence-based approach involves targeted exercises to the areas responsible for damaging the nerve
In extreme cases, surgical treatment may be required to physically remove the obstruction to the nerve. Common surgical treatment options include
- Discectomy—removing a part of the disc
- Laminectomy—removing a piece of the bone in the spine in cases of spinal stenosis
- Spinal fusion—fusing areas of the spine with limited functionality
VII. Conclusion
- The term “sciatica” is often misused. It is not a diagnosis, but rather a consequence of an underlying problem
- Symptoms may occur for various reasons, but are commonly the result of lumbar disc problems, lumbar spinal stenosis, and/or muscular compression
- In most cases, symptoms should resolve through focused physical therapy and targeted exercises
For more information, or if you or anyone you know is dealing with sciatica, our team of chiropractors, physiotherapists, nurse practitioners, massage therapists, and more, prides itself on offering an evidence-based and collaborative approach to rehabilitation.
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This blog should not be taken as medical advice. Please consult with a medical expert and seek medical attention if you’re experiencing any of the symptoms.
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