272015Jan

Sciatica

Article for Cape Fear Living Magazine
Article Title: Sciatica
Submitted by: Dr. R. Todd Shaver
27 January 2015

Recent analysis of our website revealed that sciatica was one of the most common search topics in 2014. This is not surprising as the condition is very common … and very painful. What exactly is sciatica? What causes it? How is sciatica best treated? Let’s discover answers to these important questions.

The term “sciatica” describes pain felt along the course of the sciatic nerve. The sciatic nerve is the longest and widest nerve in the body. It runs from the lower back, down through the buttock, and into the lower leg. It is responsible for control of muscles in the lower leg and also for sensation (feeling) in the thighs, legs and the soles of the feet. As the sciatic nerve has its origins in the lower back, it usually involves lower back pain as well as leg pain.

Sciatic symptoms can be characterized by sharp pain, aching, burning, tingling/numbness, weakness or some combination of these. Patients with sciatica may have pain across the entire lower back but usually only one leg. Sciatic pain often begins mildly and then gradually grows more intense over time; sciatica can be quite debilitating when at its most severe. The pain can be aggravated by long periods of sitting, or by bending at the waist, bearing down for a bowel movement, sneezing, coughing, or other sudden movements.

It is important to note that sciatica describes a common set of symptoms within the general category of low-back pain … but it is not a diagnosis which explains what is causing the pain. Sciatica occurs most commonly in adults between 30 and 50 years of age. It is not typically the sudden result of a single-event injury; rather, it most often results from irritation of nerves in the lower spine due to gradual deterioration of structures in the lower spine (structures such as vertebrae and spinal discs). This gradual wear-and-tear of the spine is due to chronic misalignment of the spine which results in posture asymmetry and weight-bearing inefficiency … very much like when tires wear out due to front-end misalignment of a car.

Back pain (to include sciatica) is the single leading cause of disability worldwide and, in the United States, it is the second most common cause for visits to the doctor. This is a big problem. As the nerve irritation which causes sciatica results from improper alignment and function of the spine, doctors of chiropractic are uniquely suited to provide the solution to this problem.

For a patient suffering with sciatica, chiropractic care would begin with a thorough medical history followed by physical and neurological exam with special attention to the spine and legs. Most commonly x-rays will be utilized to help evaluate the spine’s structure & alignment and to rule-out more serious issues such as tumors or infections. Chiropractic treatment would include spinal adjustment and possibly adjunctive physiotherapy procedures such as therapeutic laser, interferential muscle stimulation, or special exercises. Your chiropractor may also recommend natural anti-inflammatory agents such as curcumin or arnica.

In the unusual circumstance where patients with severe symptoms might fail to show improvement after four weeks of chiropractic treatment, your chiropractor might order advanced diagnostic imaging such as CT or MRI and/or make referral to other specialists (i.e. pain management, neurosurgeon, orthopedic surgeon) to coordinate potential co-management of the case. Consideration of surgery, as most spine surgeons would agree, should be a last resort. Why? Although surgery may ultimately be indicated in some cases after a failed trial of conservative care, surgery always involves great risk and no guarantee of success. Medicare in 2006 studied the use of spinal fusion surgery in patients with degenerative disc disease (one of the most common causes of back pain and sciatica). The authors of that evidence review, led by a Duke University physician, reported that there was no conclusive evidence that spinal fusion offers “short term or long term benefits compared with non-surgical treatment.” More than 465,000 spinal fusion surgeries were performed in the United States in 2011; experts assert that as many as half of them were unnecessary.

On the other hand, there is plenty of research suggesting that chiropractic care is the treatment of choice for sciatica and back pain. The British Medical Journal reports that manual therapy (i.e. chiropractic spinal adjustments) “resulted in faster recovery than physiotherapy and general practitioner care. Moreover, total costs of the manual therapy-treated patients were about one-third of the costs of physiotherapy or general practitioner care”.

The spine-oriented Journal of Manipulative and Physiological Therapeutics reports that, after one month of care, “a higher proportion of chiropractic patients (56% vs. 13%) reported that their low-back pain was better or much better, whereas nearly one-third of medical patients reported their low-back pain was worse or much worse.”

The American Journal of Public Health reports that “chiropractic patients were found to be more satisfied with their back care providers after four weeks of treatment than were medical patients. Results from observational studies suggested that back pain patients are more satisfied with chiropractic care than with medical care. Additionally, studies conclude that patients are more satisfied with chiropractic care than they were with physical therapy after six weeks.”

To help prevent the spinal deterioration which causes sciatica, the American Chiropractic Association offers these tips:

• Maintain a healthy weight and diet

• Exercise regularly

• Maintain proper posture

• Avoid prolonged inactivity (especially extended periods of sitting)

• If you smoke, seek help to quit

• Use good body mechanics when lifting

Your chiropractor can help you with these strategies and more. Remember, it is better (and cheaper) to stay well than to get well. Schedule regular check-ups with your chiropractor!