What Is Sciatica and How Can We Treat It with Chiropractic Care?
Learn the Causes, Symptoms, and Treatments for Sciatica
Do you or a loved one suffer from low back pain and pain, pins and needles, tingling, and numbness starting in the buttocks and running down to your foot? If so, you may be suffering from sciatica. This condition describes a set of symptoms typically felt along the sciatic nerve, which runs from the lower back down through the buttock and into the lower leg and foot.
So, what causes sciatica, and how do we treat it? Here’s a breakdown of sciatica’s symptoms, causes, preventative measures, and treatment options.
For a deeper investigation into this topic, Download The Sciatica Survival Guide by Dr. Anthony Galante!
What Is Sciatica and What Causes It?
Sciatica isn’t a disease, but rather a common set of symptoms. Thus, it can’t really be labeled as a diagnosis—rather, it’s a symptom of another condition. The physician treating you has to find the underlying cause that’s creating these symptoms.
The symptoms include persistent pain, tingling, and numbness felt along the sciatic nerve. This is the longest and widest nerve in the body, running from the low back to the buttocks down to the foot. It controls the muscles in the lower leg and provides sensation to the legs, thighs, and soles of the feet.
Sciatica most frequently affects people aged 30-50, but we also see it in patients as young as 18 or older than 60.
What Causes Sciatica?
Since sciatica describes a set of symptoms and not the source of the pain, there are a variety of underlying causes that can lead to this condition. Those include:
- Disc Herniation—This is the most common cause of sciatica. It develops in the lower lumbar spine. Here, discs sitting between the bony vertebrae act as shock absorbers. The outer cartilage of those discs can wear down, weaken, bulge, or tear, causing a herniation where the inner gel-like fluid breaks through and compresses the sciatic nerve, causing pain, weakness, and numbness. That wear and tear can result from lifting, coughing, bending, falling, motor vehicle accidents, or any other sort of trauma. Many patients aren’t sure what was the specific cause of the herniation.
- Slipped Disc— The term “slipped disc” is a common layman’s term for disc herniation. The discs discussed above can sometimes come out of their normal position. In such a case, the disc begins pressing against the nerve root, causing the symptoms associated with sciatica.
- Lumbar Degenerative Disc Disease (DDD)—As you age, the discs in your lower back weaken, and deteriorate. This irritates the nerve root, creating pain.
- Lumbar Spinal Stenosis—In spinal stenosis, the spinal canal narrows. As a result, the nerve roots become compressed. This causes pain that’s usually positional, meaning it appears during activities like standing up and walking around, and relieved by sitting or lying down. This occurs more commonly in people over the age of 60.
- Spondylolisthesis—This describes an instance where one vertebra slips forward over the one below it. This can cause stenosis, compresses the spinal nerves, and causes pain.
- Trauma—An external force like an injury, fall, or car accident can directly impact the spinal nerves and result in sciatica symptoms.
- Piriformis Syndrome—In most people, the sciatic nerve runs under the piriformis muscle in the buttock. However, in 15% of people, it goes through the muscle instead of under it. As a result, if the muscle shortens due to overuse or trauma, it compresses the sciatic nerve. It can also get compressed if you carry a thick wallet in your back pocket and sit on it often.
What Are the Symptoms of Sciatica?
The symptoms of sciatica vary from excruciating pain, burning, and sharpness to more mild tingling and numbness. These symptoms can be felt anywhere along the sciatic nerve, including the lower back, buttock, leg, and foot. While it’s rare for a sciatica patient to experience pain only in a leg and not in the back as well, it’s possible, and still indicates a problem originating in the back.
However, these symptoms can also indicate a different condition called peripheral neuropathy. If you’re unsure whether your symptoms are caused by sciatica or peripheral neuropathy, consult our guide to telling the two apart.
When these symptoms are present due to sciatica, they’ll often vary based on your level of activity. Sciatica pain tends to flare up:
- When You Wake Up in the Morning—When lie down at night, you don’t bear any weight and pressure is removed from the spinal discs. The discs then absorb fluid. This stretches the already irritated disc fibers, increasing your pain.
- When You Sit Down—Sitting increases pressure on your lumbar discs, causing you more pain. Patients with sciatica and disc problems feel better when they stay moving and walking around, because prolonged periods of sitting, such as in a car or at a desk, intensify the symptoms.
- When You Cough or Sneeze—These actions create spikes in pressure in your spinal canal, which can push a herniated disc out into sensitive nerve fibers. If you have sciatica, you may have to brace yourself to get ready when you feel a cough or sneeze coming.
- When You Bend Over—Imagine that the sciatic nerve is a rubber band running down your back and into your feet. Anything to stretch that rubber band, so to speak, will cause you pain. That includes bending over, taking too big of a stride while walking, stretching your leg out while seated, etc.
- When You Roll Over in Bed—Movement in bed can increase the pressure on your discs as well, which can push on your sensitive sciatic nerve. This is why you may frequently wake up throughout the night.
What Can I Do for Pain Control?
There are things you can do to relieve the pain. Here are the best home treatments, sleeping positions, and ways to change bodily position for people with sciatica.
- Avoid Bed-Rest—This may be your first instinct, but resist it! Sitting or lying down for long periods will only intensify the pain and weaken your muscles. The fastest way to decrease morning pain is to get moving. Work your way up from knee-to-chest stretches and pelvic tilts to getting up and walking. The weight you bear will force fluid out of the disc, decreasing pressure on sensitive disc fibers.
- Cold Therapy—You can use an ice massage, cold pack, ice cubes in a baggie, or even a bag of frozen vegetables such as frozen peas to deliver cold therapy. The most convenient method is to strap an ice pack around your waist. This way you can still perform daily activities. If you don’t have a proper strap, you can secure it with an elastic bandage or a towel. Keep it on for 15 minutes, then off for 1-2 hours at a time.
- Topical Analgesics—Apply these where it hurts, and they can take the edge off a bit and make your pain more tolerable when you’re trying to sleep or perform daily activities. Our favorite brand at Algonquin Chiropractic Center is BioFreeze, but you can try over-the-counter brands as well.
- Tennis Ball Exercise—If you’re having pain in your hip or buttock area, get a tennis ball. Lie on your back and place the tennis ball under your buttock on the side that hurts. Relax and let your body weight compress the muscles. Proceed with caution, and if your muscles are tender, start on a bed instead of the floor. Leave the ball in place for 20-30 seconds before moving it to the next affected area.
- Gentle Stretches—As a rule, if any exercise aggravates your pain, stop immediately. That’s a sign you’re irritating the sciatic nerve, so this isn’t the time for aggressive strengthening exercises and stretches. Here are some good stretches you can do at home to relieve sciatic pain:
- Knee-to-Chest Stretches—Lie on your back. Interlock your fingers over one knee, and pull it gently toward the same shoulder. Hold for 10-30 seconds. Then, do the same but pull the knee toward the opposite shoulder. Repeat this exercise 2-3 times.
- Figure-4 Stretches—Lie on your back. Cross one leg over the other, placing the outer side of the ankle on the knee. Interlock your fingers under that knee and pull. If done right, you’ll feel a strong stretch in the buttock. Hold for 10-30 seconds and repeat 2-3 times.
- On Your Back—Lie on your back. Place a pillow under your knees. This will gently flex your back, relieving some pressure on your intervertebral discs.
- On Your Side—Lie on your side. Bend your knees up into a fetal position and place a pillow between your knees and ankles. The pillow will help keep your pelvis properly aligned and avoid pelvic rotation.
Other Bodily Positions and Transitions
- Getting Up from a Laying Position—To get up from lying down, roll onto your side by the edge of the couch or bed. Slowly and carefully, slide your legs off, then push up with your arms. Alternatively, roll onto your stomach. From there, rotate your body until your legs are off the couch or bed, then push up with your arms.
- Getting Up from a Seated Position—To get up from sitting, scoot yourself to the edge of your chair. Plant your feet firmly below you, staggered. Place your hands on your thighs, then stand straight up. Avoid bending forward at the waist.
- Getting In and Out of a Car—To get in, face away from the car seat. Slowly and carefully lower your torso and sit down. Then, turn your whole body so you face the steering wheel. To get out, perform the same motion in reverse, first rotating in place to face the door, then getting out without bending forward.
- Staying Comfortable While Driving—There are many things you can try to make driving more tolerable. Move your seat forward an inch to flex the knees and lower back. Try moving your backrest either further up or further back. Place a rolled towel or small pillow behind your lower back to support the lumbar spine. Put a towel 2-3 inches thick under the buttock on the non-painful side to open the spine up a bit.
What Are the Treatment Methods for Sciatica?
Home treatments aren’t enough, though. Sciatica is an especially serious form of low back pain and leg pain, and back pain is the number one cause of disability worldwide. You should get professional help.
Will you need surgery? Not necessarily. Only 1-5% of sciatica patients ever actually need surgery. You may need surgery to prevent further loss of muscle strength and to reverse significant loss of function or severe pain, but surgery should only come as a last resort after conservative, non-surgical treatments haven’t worked.
A major factor regarding whether or not you’ll undergo surgery is what type of provider you go to first. For example, one Spine Journal study reported that starting your sciatica treatment with an orthopedic or neurologic surgeon leads to a 43.7% chance of getting surgery, while going to a Doctor of Chiropractic first leads to only a 1.5% chance of surgery.
So, let’s compare the various types of healthcare providers you can go to, and how each of them would approach treatment for sciatica.
Medical Doctors and Pain Medication
Your primary doctor, a Medical Doctor (MD), uses medicine to treat illnesses. When it specifically comes to sciatica and other forms of back pain, they commonly recommend over-the-counter painkillers like acetaminophen, muscle relaxants, anti-inflammatories, and prescription pain medications.
That last category includes dangerously addictive drugs like oxycodone, hydrocodone, and methadone. Those are all opioids—the same category of drugs that’s causing a nationwide epidemic of addictions and overdoses. In 2016, about 14,400 overdose deaths were linked to prescription opioids like OxyContin and Percocet, not to mention the additional tens of thousands linked to synthetic opioids and heroin, which opioid users often transition to.
Medical doctors often prescribe drugs as their first line of treatment, even when the condition is musculoskeletal rather than chemical. Yet, although medication may cover up your symptoms a bit, it clearly isn’t a viable long-term solution.
For more on the opioid crisis and why medication isn’t always the best route for treatment, see this post we wrote on the subject.
Pain Doctors and Epidural Steroid Injections
Your MD might send you to a specialist who provides medications and injections for controlling pain and inflammation. However, of patients who receive these epidural steroid injections, 50-75% experience short-term relief but only 25-57% experience long-term relief.
That’s because epidural steroid injections don’t heal the nerve or repair damaged tissue—they just dry up inflammation.
These injections have their place, but it’s not as a first line of defense. Read this guide to see how a Doctor of Chiropractic might use epidural steroid injections as part of their treatment plan.
Orthopedic Surgeons and Spine Specialists
If you go to an orthopedic surgeon or spine specialist, they should spend most of their time suggesting various treatment options and turn to surgery as a last resort.
A 2012 study in the Spine Journal found that for patients who received spine surgery, 10.5% had complications during surgery, 73.5% had complications after surgery, 39% had their stay extended due to complications, and 1% died.
Yet, for all those risks, patients who receive surgery don’t have substantively better outcomes than conservatively treated patients one and two years later. To be sure, there are specific red flags that may signal a need for surgery, but for most sciatica patients, surgery is expensive, risky and ultimately not the best route.
Physical Therapists and Active Exercise
Physical therapy might be recommended by your MD or orthopedic surgeon. However, research published in the European Spine Journal in 2006 showed that patients with leg pain and numbness did significantly better when treated with the Cox Technic (chiropractic care) than when treated with active exercise (physical therapy), exhibiting “significantly lower pain scores” after one year. Other studies have produced similar results for patients with persistent back and neck pain.
The conclusion to be drawn is that while physical therapy can be useful, chiropractic therapy provides more lasting results.
Doctors of Chiropractic and the Cox Technic
One of the most important tools in the chiropractic arsenal, and our primary treatment when dealing with sciatica at Algonquin Chiropractic Center, is the Cox Technic. This natural, nonsurgical, drug-free treatment gently stretches the spine to decompress the spinal discs and nerves relieving pressure and pain.
The Agency for Health Care Policy and Research published its AHCPR Guidelines, which state that the Cox Technic is safe and effective.
Numerous high-profile athletes have spoken on the effectiveness of chiropractic care to not only relieve their pain but boost their performance: Joe Montana, Scottie Pippen, Evander Holyfield, Max Scherzer, Tom Brady, Jonathon Toews, and the list goes on.
Using the Cox Technic, Doctors of Chiropractic achieve some of the highest patient satisfaction ratings of any health care provider. Research shows that about 91% of patients report finding the relief they were looking for, and pain ratings on average decrease from an average of 7.6 to an average of 1.9 after treatment.
For a closer look at how chiropractic care relieves sciatic nerve pain, read our summary of the research on the subject here.
So, what can you expect from a visit to Algonquin Chiropractic Center?
- A warm welcome from sympathetic staff.
- A consultation with a licensed chiropractor discussing how the sciatica is affecting your life.
- A chiropractic examination that measures body alignment, range of motion, muscle strength, and more.
- An orthopedic and neurological evaluation that includes testing of deep tendon reflexes, sensory and motor functions, and nerve root tension, as well as diagnostic imaging and lab work as needed.
- A complete report of all findings.
- An individualized treatment plan designed for your specific situation, that may include but isn’t limited to:
- The Cox Technic
- Spinal Manipulation
- Physical Therapy Modalities
- Orthotic Therapy
- Muscle and Soft Tissue Treatment (including Massage Therapy)
- Home Exercise Programs
- Diet and Nutrition
If you or your loved one are suffering from symptoms that you think may be related to sciatica, it’s time you consulted a professional. Algonquin Chiropractic Center has been effectively treating sciatica in Algonquin, IL and Lake in the Hills, IL for years—give us a call today at (847) 854-2000 and take the first steps to relieving pain, restoring function, and taking your life back.
For more information on causes and treatment for sciatica, please download our FREE ebook: The Sciatica Survival Guide by Dr. Anthony Galante!