Sciatica

Sciatica is a condition that can stem from various causes, such as inflammation, herniated discs, spinal bone spurs, spinal stenosis, or cysts on the spine that compress the lumbar nerve roots. Among these, the L5-S1, L4-L5, and L3-L4 nerve roots are the most commonly affected by compression, leading to pain radiating down the hip, buttock, and leg. Sciatica affects approximately 10% of adults throughout their lifetime. According to research from the Spine Journal, the incidence of sciatica is higher in men aged 30 to 50. Of these, around 20-30% of patients with sciatica are at risk of symptom recurrence after treatment. If left untreated, the patient may face persistent pain, severe functional impairment, and even paralysis. Optimal365 Chiropractic will provide a comprehensive guide from A to Z on sciatica, including its causes, symptoms, and treatment options in the following article.

Overview of Sciatica Sciatica

Sciatica Sciatica is pain that runs along the sciatic nerve, which extends from the lower back through the buttock and down the leg. This nerve is the thickest and longest in the body, composed of five nerve roots:

2 roots from the lumbar spine (L4 and L5)

3 roots from the sacrum (S1, S2, and S3)

On each side of the body, one sciatic nerve runs through the hip, buttock, and down the leg, ending below the knee. The nerve fibers then branch off and continue running down the calf to the foot and toes.

Patients often experience symptoms ranging from mild to severe pain at any point along the path of the sciatic nerve, such as the lower back, hip, buttock, or leg. In some cases, muscle weakness in the leg or foot, tingling sensations, or numbness, like pins and needles, may also occur. Sciatica pain is often described as a sharp, electric shock-like pain that travels rapidly along the affected nerve’s path. The pain worsens when the patient coughs or sneezes, and they may also experience numbness and sometimes weakness in the affected leg.

Causes of Sciatica

Causes of Sciatica:

• Herniated Disc: A herniated disc is the primary cause of sciatica, accounting for about 80% of cases. This condition occurs when a spinal disc herniates, placing pressure on the lumbar or sacral nerve roots. When a disc slips or tears, the soft inner material leaks out through the weak outer wall, compressing the sciatic nerve and causing pain.
• Degenerative Disc Disease: Over time and through the body’s natural aging process, the discs between vertebrae wear out. When the discs wear down, they shrink, narrowing the nerve pathways (spinal stenosis). This condition often puts pressure on the sciatic nerve roots, leading to common symptoms of pain.
• Spinal Bone Spurs: Bone spurs forming on joints and vertebrae during aging can compress nerves in the lower back.
• Injury to the Lumbar Spine or Sciatic Nerve: Direct injuries (sports injuries, car accidents, or work-related accidents) can damage and put pressure on the sciatic nerve.
• Tumors in the Lumbar Spine: Tumors or cysts that form in the lumbar spinal canal can compress the sciatic nerve roots.
• Weight Gain: Weight gain, particularly obesity or during pregnancy, places significant pressure on the spine, back muscles, and sciatic nerve. This pressure increases the risk of disc herniation or spinal issues, compressing the sciatic nerve.
• Diabetes: Poorly managed diabetes can damage nerves. Diabetic nerve damage not only affects the extremities but can also impact the sciatic nerve, causing symptoms like pain, numbness, or weakness in the leg and lower back.
• Piriformis Syndrome: When the piriformis muscle deep in the buttock spasms, tightens, or is injured due to overactivity, it places pressure on the sciatic nerve, leading to pain. This syndrome is also known as “wallet sciatica” because the habit of putting a wallet in the back pocket (commonly seen in men) can compress the buttock muscles and sciatic nerve when sitting down.

What are the symptoms of sciatica?

Symptoms of sciatica can vary depending on the cause, but some common signs include:

• Pain in the lower back, radiating down the hip, buttock, leg, and toes. The pain may range from mild discomfort to sharp, electric shock-like pain.
• The patient may feel numbness or tingling along the sciatic nerve path, from the lower back to the leg.
• In some cases, patients may experience muscle weakness in the leg and foot, making movement difficult and hindering daily activities. This typically occurs when the sciatic nerve is severely compressed.
• Pain may occur in one or both legs.

Sciatica pain typically subsides over time. However, if the pain becomes more severe, lasts longer than a week, or becomes unbearable, the patient should seek immediate medical attention. Particularly, if there is sudden, intense pain in the back or leg, muscle weakness, loss of bowel or bladder control, or if the pain occurs following an accident, the patient should seek urgent care for timely treatment of sciatica.

Differentiating sciatica symptoms from other conditions

Although pain in the back or hip can occur in various conditions, the symptoms of sciatica differ from others like herniated discs or piriformis syndrome. Specifically:

• Sciatica: Patients experience sharp pain in the lower back, radiating down the sciatic nerve path to the hip, leg, and intensifying when sitting. They may feel tingling or burning in the sole of the foot, muscle weakness in the leg, numbness, and difficulty moving due to pain in one or both legs.
• Herniated Disc: Patients experience localized pain in the lower back, which can radiate to both sides of the body. The pain is dull or sharp, worsening with coughing, sneezing, or sudden movement.
• Piriformis Syndrome: Pain originates from spasms or tightness in the piriformis muscle, often not extending down the outer thigh. Piriformis syndrome mainly causes pain in the buttock, which can radiate down the leg but does not necessarily follow the entire sciatic nerve. Patients may feel relief when walking with their foot turned outward, as this position reduces piriformis muscle tightness.

Complications of sciatica if not treated early

If not treated promptly, sciatica can lead to several severe complications, including:

• Reduced Mobility: Prolonged and severe pain limits mobility, making it difficult for patients to stand, walk, or perform daily activities.
• Muscle Weakness: Severe compression of the sciatic nerve can negatively impact the muscular system, leading to muscle weakness and atrophy. Prolonged pressure on the nerve can cause weakness in the leg or foot, including foot drop (also called peroneal nerve injury), causing continuous numbness and inability to walk.
• Numbness and Loss of Sensation: Nerve compression can lead to numbness or complete loss of sensation along the sciatic nerve path, increasing the risk of injury for the patient.
• Loss of Bowel or Bladder Control: Severe compression of the nerve roots at the end of the spinal cord can lead to bowel and bladder control issues, including incontinence or difficulty urinating.

Methods of diagnosing sciatica today

Clinical Evaluation

At the hospital or clinic, doctors will ask the patient about symptoms, medical history, and perform a physical exam, including testing muscle strength, reflexes, and sensation to assess nerve damage (symptoms like pain, numbness, muscle weakness, and mobility tests). This helps screen for risks and rule out other conditions. If symptoms persist for more than six weeks or show signs of nerve damage, doctors will recommend imaging tests such as MRI or CT scans.

Assessing the body’s movement capabilities helps doctors determine the location, extent, and cause of sciatica. Common tests include:

• Patients standing on tiptoes to assess calf muscle strength.
• Patients lying on their back and raising one straight leg toward the ceiling. The doctor will ask when the patient feels pain to determine if it is related to a disc issue. This is a common test to detect pain caused by nerve compression.
• Perform muscle stretching and movement exercises to assess pain levels, as well as check the strength and flexibility of the muscles.

Diagnosis through imaging

For chronic sciatica or cases with nerve damage, the doctor may prescribe several imaging tests, including:

• X-ray: Used to detect structural problems in the spine, such as bone spurs or spinal stenosis.
• Computed Tomography (CT): Provides more detailed images of the spinal structure and helps identify the location and extent of nerve compression.
• Magnetic Resonance Imaging (MRI): The most accurate imaging method for detecting herniated discs, bone spurs, or pathological conditions causing nerve compression. MRI provides detailed images of soft tissues and nerves.
• Electromyography (EMG): Measures the electrical activity of muscles to assess the damage to one or more nerve roots and can rule out conditions similar to sciatica, including peroneal nerve palsy, multiple mononeuropathies, or polyneuropathies.
• Nerve Conduction Study (NCS): Measures the speed and intensity of nerve conduction to detect abnormalities in nerve function.
• Myelography: Shows whether a disc or vertebra is compressing the spinal cord and causing pain.

Treatment for Sciatica

Medical treatment

Some anti-inflammatory drugs commonly used to relieve sciatica pain include aspirin, acetaminophen, ibuprofen, and naproxen. However, it should be noted that if sciatica is caused by a herniated disc pressing on the nerve, simply using pain relievers will not address the root cause of the problem.

In addition, the misuse of drugs can lead to serious side effects such as liver, kidney, and stomach problems. To find an appropriate treatment method, patients need an accurate diagnosis of the cause of their sciatica and a proper treatment regimen.

Sciatica surgery

Surgery is recommended when the patient does not respond to other treatments or has developed serious complications from nerve root compression (causing muscle weakness, chronic pain, or loss of bladder or bowel control). At this point, the doctor will identify and remove the cause of the nerve compression, such as bone spurs, tumors, or herniated discs.

Chiropractic

Chiropractic care is a non-drug, non-surgical treatment for sciatica, according to U.S. standards. Chiropractors use gentle manual techniques to realign the vertebrae to their original positions, reducing pressure on the discs. This effectively relieves pressure on the sciatic nerve fibers.

Physical therapy for functional recovery

Physical therapy exercises not only help adjust the position of the spine but also strengthen the muscles, improve flexibility, posture, and reduce pressure on the sciatic nerve. This supports the recovery of musculoskeletal function and helps prevent sciatica from recurring in the future.

Combination of chiropractic care and physical therapy

Combining chiropractic care and physical therapy is a treatment method chosen by many patients. This approach not only focuses on addressing the root cause of the pain (reducing pressure on the discs and releasing pressure from the sciatic nerve) but also activates the body’s natural healing mechanism without the need for drugs or surgery.

Non-invasive sciatica treatment at Optimal365 Chiropractic

Currently, chiropractic adjustment is considered a safe and effective solution for treating sciatica. The doctor will perform gentle manual techniques to realign the musculoskeletal system, reducing pressure on the discs and thereby reducing pressure on the sciatic nerve.

At Optimal365 Chiropractic, our guiding principle is to treat the root cause of the disease to prevent the recurrence of sciatica. At the same time, we are committed to shortening the recovery time from injury, helping patients quickly return to daily activities and improving their quality of life.

At Optimal365 Chiropractic, patients will be diagnosed and treated by a team of U.S.-trained chiropractors with over 20 years of experience, along with highly specialized physiotherapists. The clinic’s medical team will assess each patient’s condition to provide the most personalized and optimal treatment plan.

The treatment solution at Optimal365 Chiropractic is divided into 4 phases:

Chiropractic adjustment: Addressing the root cause of sciatica

At Optimal365 Chiropractic, doctors perform spinal restructuring by realigning the vertebrae to their correct positions, carefully preserving the spinal nerves that pass through them. This reduces compression on the discs and nerves. Additionally, the vertebral space is expanded, allowing the disc to return to its original position.

The Chiropractic method stimulates the self-healing mechanism of damaged muscle tissues, increasing blood circulation and nutrients to speed up recovery. This reduces pain and improves the body’s resistance, contributing to comprehensive and sustainable recovery.

Specialized physical therapy: Improving flexibility and enhancing mobility

The team of physiotherapists at Optimal365 Chiropractic will work alongside patients and guide them through specialized physical therapy exercises to strengthen and increase the flexibility of the muscular system. These exercises help thoroughly address chronic pain and support the recovery of damaged musculoskeletal structures.

In addition, during specialized muscle therapy, trigger points (pain points in the muscles) will be treated to enhance mobility and reduce pain for both acute and chronic conditions. The treatment process helps improve nutrient circulation, blood flow, and lymphatic flow, effectively nourishing tissues, cells, and muscles, contributing to comprehensive recovery.

High-tech equipment: Healing sciatic nerve injuries from deep within the muscle tissue

Sciatica treatment with high-tech equipment includes spinal decompression machines, electrical stimulation therapy, and ultrasound therapy, which help regenerate damaged tissue and reduce pressure on the discs and nerves, allowing the herniated nucleus pulposus to return to its original position. These advanced therapies also help reduce pain, stimulate tissue healing, rapidly decrease inflammation, inhibit muscle spasms, and improve circulation in the affected area.

Sciatica prevention methods

To prevent and limit the recurrence of sciatica, you can follow these tips:

• Exercise regularly: Helps strengthen the muscles and improve flexibility in the back, especially the core muscles like the abdomen and lower back. Exercises such as light weightlifting, planks, and stretching exercises are very helpful for sciatica.
• Maintain proper sitting posture: Use a chair that supports your back, has armrests, and a swivel base when sitting to study or work. You can also place a small pillow or rolled-up towel behind your lower back to maintain the natural curve of the spine. When sitting, keep your back straight, face forward, and adjust the height of your knees and hips to be appropriate.
• Use the body’s mechanical movements: If you have to stand for long periods, occasionally place your foot on a chair or small box to reduce pressure on your back. When lifting or carrying heavy objects, use the strength of your legs instead of bending or leaning. Be especially mindful to keep your back straight and bend your knees when lifting. Avoid lifting while twisting, which can easily cause back injuries.

Sciatica is becoming more common and severely impacts patients’ lives and mobility. Therefore, when noticing signs of sciatica, patients should see a doctor for timely examination and treatment to effectively relieve pain and prevent serious complications, thereby improving their quality of life.