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What is Sciatica?

Sciatica is pain that radiates from the low back down the back of the leg due to irritation of the sciatic nerve. The sciatic nerve is the longest nerve in the body. The sciatic nerve is a mixed-function nerve which means it is both a sensory and a motor nerve. It controls the movement of many leg muscles as well as sensation in parts of the leg.

What are the symptoms of Sciatica?

Sciatica is usually but not always accompanied by low back pain. The leg pain is usually unilateral and can be described as starting in the hip or buttock. The pain often goes down the back of the leg and can go all the way down to the foot. The pain is frequently described as shooting, sharp or burning that can make it difficult to stand up. The leg pain is often accompanied by numbness and tingles in the foot. Sciatica can also include symptoms of weakness. The weakness most commonly results in a weakness or the  inability to raise up on your toes or keep your foot from slapping down as you walk. Symptoms of progressive weakness can be very serious and you should see your doctor of chiropractic immediately. A rare condition found with sciatica is called cauda equina syndrome. Cauda equina syndrome symptoms include numbness in the groin area called saddle dysethesia and either an inability to control the bowel or bladder or an inability to eliminate bodily wastes. Cauda equina syndrome can also cause sexual dysfunction and is often considered to be a surgical emergency.

What makes Sciatica worse?

Sitting usually aggravates sciatica. Bending forward often make the sciatic pain worse. Sitting on a wallet can sometimes be a significant contributor to sciatic pain. A simple orthopedic test called Bechterew test performed by a chiropractor is often used to evaluate sciatica. Bechterew test is performed by sitting down and having the patient try to fully extend the painful leg. If this maneuver causes pain to shoot down the leg past the knee, the patient may have sciatica due to an intervertebral disc herniation. If coughing, sneezing or straining to go to the bathroom significantly increased your sciatic leg pain, your sciatica could be caused by a disc herniation. 

What Causes Sciatica? 

Sciatica is caused by irritation to one or more of the 5 lumbar and sacral nerve roots that make up the sciatic nerve. A muscle spasm of the piriformis muscle in the buttocks can cause sciatica. The sciatic nerve runs underneath the piriformis muscle and sometimes even through the piriformis muscle. Some low back muscle spasms can also cause lumbar nerve root irritation resulting in sciatica. A lumbar disc herniation is probably the most common cause for sciatica. The specific locations of numbness, tingles and weakness can often be used to diagnose the specific disc herniation causing the sciatica. For instance, weakness of the great toe usually means a L4-L5 lumbar disc bulge or herniation. Tingles in the little toe and an inability to toe raise indicate an S1 nerve compression due to an L5-S1 disc herniation. Lumbar Spinal stenosis can cause sciatica. Pain down both legs at the same time can indicates lumbar spinal stenosis. Spinal stenosis means that the space available for the nerve roots or even the spinal cord has decreased in size. Spinal stenosis is usually due to gradual degenerative changes in the discs and joints and hypertrophy of spinal ligaments. Osteoarthritis is a common cause of spinal stenosis. As the discs degenerate they lose water content and get thinner. The discs don't act as the same size spacer separating the vertebra as they did when we were young. As osteoarthritis progresses, bone spurs start to form causing the articular facets to increase in size and this contributing to stenosis.

Spondylolisthesis can also be  a cause of sciatica. Spondylolisthesis is caused by stress fractures in the vertebrae that allow one vertebral body to slip forward on the vertebral body of the vertebrae below. The stress fractures usually occur in your teen years and the spondylolisthesis can often be asymptomatic until many years after it develops. 
Back pain and sciatica are some of the most common symptoms associated with pregnancy.The postural changes associated with an enlarged abdomen and the ligament laxity due to pregnancy makes pregnant women more prone to back pain and sciatica. 

How is Sciatica Treated? 

The best treatment for low back pain and sciatica is usually spinal and pelvic adjustments. Chiropractic adjustments help to restore normal vertebral motion and relax the adjacent spinal muscle. Flexion distraction is an effective chiropractic technique designed to help patients with sciatica. Interferential electrical muscle stimulation can help control the pain of sciatica. Massage therapy is an effective treatment for sciatica, especially if a piriformis muscle spasm is contributing to buttock and leg pain. Exercises to stabilize the core muscles, improve proprioception and improve balance have been shown to help back pain and sciatica. Trigger point injections and dry needling can help to reduce trigger points and decrease muscle tension. In severe, unresponsive cases due to a disc herniation, a pain specialist can use epidural steroid injections to try and decrease the inflammation and swelling caused by compression of a spinal nerve root. In a small percentage of cases of sciatica, lumbar spine surgery, by an orthopedic surgeon or neurosurgeon, is necessary to try to help prevent permanent weakness and muscle atrophy.

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