Sciatica is a term we hear frequently in the clinic, but is often used as an umbrella term to describe a variety of symptoms. People will typically use the term to describe pain located in the low back, hip, or pain that may radiate down the leg into the foot.
So what really is sciatica?
Sciatica is a general term describing pain that is caused by inflammation of the sciatic nerve. The sciatic nerve is quite large- about the size of your thumb. It originates in the pelvis deep the the gluteal muscles and travels down the back of the thigh to the knee before it continues on as smaller nerves that innervate the lower leg.
General use of the term is to describe any pain going from the back into the leg. A Google search will bring up a plethora of stretches, tips and tricks, supplements, braces, and gimmicks of all sorts claiming to fix your sciatica! But if it is a general term that only describes a symptom and not a defined injury- how can they actually it fix the pain?
What’s causing my back and leg pain?
While there are a ton of different conditions and causes to low back and leg pain, there are two conditions that we see in office making up about 90% of back and leg pain. These two are lumbar disc bulges and/or herniations, along with sacroiliac joint dysfunction.
Disc injuries come in two main forms - a disc bulge and disc herniation.
A disc bulge is when the disc is squeezed on the front side of the spine, which happens with prolonged sitting, bending, or traumatic impact, causing a ballooning of the disc. The ballooning or protrusion becomes a problem when it compresses or touches the nerve root coming off your spinal cord. A typical disc bulge commonly results in local irritation in the back with some radiation into the buttock. The symptoms are typically the result of hours of repetitive motion and can be resolved more easily than if we wait until it becomes a full blown disc herniation.
A disc herniation occurs when the disc ruptures, leaking the disc material into the area of the spinal nerve roots. This causes massive inflammation resulting in pain down the leg in a dermatomal pattern, usually past the knee with numbness, tingling, weakness and muscle atrophy if it is severe enough. Herniations can be from a bulging disc that finally ruptures or a trauma that caused severe compression to the disc. These take longer to heal and are more serious than a bulge.
The sacroiliac joint sits at the belt line. It is where the tailbone (sacrum) meets the ilium bone. Most people feel these as “the dimples on my low back”. This joint is responsible for hip flexion (lifting the leg) and hip extension (reaching the leg back) or you use both sides together to bend forward and touch your toes. Commonly this joint will radiate pain down the leg without crossing the knee or around the hip toward the groin. SI joint issues are usually caused from bending, extending, or falls onto the buttocks. Less commonly, SI injuries can occur from staying in a prolonged position for too long, enough to cause irritation to the surrounding local structures.
With both injuries we see muscle guarding or spasming around the lower back and hip. The muscles tend to go into protection mode; tightening up to keep you from going into a position that will make it worse.
Treatment for both disc and sacroiliac injuries involves extensive muscle work to restore normal muscle tension in the spasming tissues, we do this using a number of tools such as: active release technique, graston technique, and trigger point dry needling. With disc injuries we use flexion distraction therapy to decompress the disc and core stabilization exercises to accompany the muscle work. Sacroiliac injuries are often treated using a drop table, chiropractic adjustments to restore normal joint movement, core and hip stabilization exercises, and muscle work.
If you’re suffering from an injury involving sciatic symptoms, let us help you get back to what you love - pain free, ASAP. Call or email us today for an appointment.