What Is Sciatica?

Like it or not, 80% of you will experience an acute bout of low back pain at least once in your life. Of those who get this back pain, many will also experience a mild to severe pain and/or numbness, called “sciatica”, which often travels down one of your legs and potentially as far as your toes. To really understand what sciatica is and how it occurs, you need to first understand a little about the nerves exiting between the vertebrae of the spine.

 

The term “sciatica” comes from the name of the largest nerve in the entire body – the “sciatic nerve”. The low back, called the lumbar spine, consists of five vertebrae. Between each of these vertebrae, a nerve exits from the spinal cord. These nerves eventually combine to form one large nerve, called the sciatic nerve. It is responsible for controlling the muscles in the leg. It also tells the brain when the leg is being touched or if it has been injured and is in pain. Therefore, the sciatic nerve carries messages and instructions from the spinal cord to the entire leg and vice versa.

 

If one of the nerves of the spine that make up the sciatic nerve, or the sciatic nerve itself, is being irritated or pinched even slightly, problems arise. The messages and instructions passing to and from the leg will be weakened or altered. This may result in your leg, ankle or toes not being able to move with their normal strength, the skin possibly feeling numb when touched, or even mild to severe pain at specific areas of the leg.

 

So, what does sciatica have to do with all this? Normally, the messages that travel back and forth between the brain and the leg are very calm and quiet. If there is a pinching or irritation of the nerves at the spine, these messages can become either highly amplified or weakened. In the case of sciatica, the calm and quiet messages that travel from the leg to the spine and brain become increased to that of a roar. This amplified message travels up the spinal cord to the brain. The brain assumes that this roar of a message is legitimate and that the leg is injured. This is why you feel mild to severe pain in your leg when there is really nothing wrong with it. Therefore, sciatica is really just mild to severe pain or numbness felt in the leg when one or more of the nerves in the low back are being irritated or pinched.

 

It is not difficult to determine if a person is experiencing sciatica or not. The real challenge is determining where the pinching or irritation of the nerve is occurring. Only then can the actual cause of the sciatica be treated. This is something that chiropractors do in their office all day every day. In fact, no other health care practitioner cares for more patients with low back pain than chiropractors. Regardless of who you decide to consult for your sciatica, just make sure he or she does a thorough examination and makes an accurate diagnosis.

 

For more information on sciatica and its common causes, refer to the article “piriformis syndrome and sciatica” in the blog section of this website.

 

Piriformis Syndrome

“Piriformis syndrome” is caused by an entrapment (pinching) of the sciatic nerve as it exits the back of the pelvis, deep within the buttock. The sciatic nerve typically exits the back of the pelvis immediately below a muscle, called the piriformis muscle, deep within the buttock. In rare situations, the nerve actually passes right through the piriformis muscle. For various reasons, the piriformis muscle can go into spasm and entrap or pinch the sciatic nerve. This will result in pain along the back of the thigh and knee, with further pain and/or numbness extending as far down as the sole of the foot, called “sciatica”.

 

Piriformis syndrome can result in “sciatica”. These same sciatica symptoms feel very similar to that of a herniated disk. A herniated disk typically pinches directly on one of the five nerves that eventually make up the sciatic nerve. Because the resulting symptoms of both of these problems are very similar (pain, numbness and tingling below the knee and into the foot), it is not hard to misdiagnose what is actually going on if you don’t look for both potential causes.

Specific diagnostic tests performed by your chiropractor are what distinguish a herniated disk from piriformis syndrome. In simple terms, with piriformis syndrome your chiropractor will not find many positive test results that indicate that the lumbar spine is involved. More often, the acute pain or tenderness is localized to the buttock and hip, while the low back appears quite normal.

Many weekend athletes and people who spend long hours sitting are prone to this syndrome. The athlete’s cause is primarily due to improper stretching and warm-up exercises as well as overuse during activity. In this case it is most likely that the piriformis muscle is irritated and usually in spasm. For the patient who sits for extended periods of time, their primary cause is due to contracture or tightening of the piriformis muscle. In this case the piriformis muscle is shortened and does not allow for the smooth movement of the sciatic nerve during leg motion.

Any treatment plan must include stretching of the gluteal or buttock muscles as well as stretching of the piriformis muscles. Your chiropractor or health care practitioner can help you by instructing you on the proper stretches to perform. Many Chiropractors may also perform some form of deep tissue massage to the piriformis muscle in the gluteal region in order to relax these muscles. A series of spinal and hip joint adjustments may also be required to relieve your symptoms.

If you are currently diagnosed with a disk herniation but are wondering if the symptoms you are experiencing may at least be partially from piriformis syndrome, call my office for an appointment to have it checked thoroughly. It is always a good idea to rule out other possible causes of your sciatica before simply having surgery.

 

One Leg Longer Than the Other

A particularly pleasant gentleman entered my office recently with left sided low back pain after raking up the pine needles throughout his entire yard. He had spoken to a physiotherapist who had described his problem as “a rotated hip”, which resulted in “one leg longer than the other”. He had heard that chiropractors commonly treat a problem like his, so he entered my office seeking help.

First of all, I had to clarify that it was not really his hip joint that was causing his problems. The “hip joint” is the ball and socket joint between the bone of his thigh (femur) and a bone in his pelvis (ileum). I continued by telling him that his pain was actually being caused by the “sacroiliac joint”, which is located in the back portion of his pelvis. Health care practitioners and patients alike mistakenly call the “sacroiliac joint” the “hip joint”. In fact, the sacroiliac joint is much different than your hip joint. There is one sacroiliac joint on each side of the back portion of your pelvis, made up of a sacrum bone in the middle (where the bottom of your spine attaches to and your tailbone projects downward from) and an ileum bone (the large bone you feel at the side of your waistline).

 

The sacroiliac joint on each side of the pelvis is a very common and often misdiagnosed source of low back pain, which may or may not cause pain or numbness to travel down into the groin or leg (sciatica). This particular gentleman put too much stress on his left sacroiliac joint as he repetitively reached forward and twisted his lower back with each stroke of his rake. Although he was not in any pain prior to raking his lawn, it was likely that the individual mobility of his low back and sacroiliac joints were not at their full potential to begin with. Therefore, when he challenged these joints by working long and repetitively, they could not handle the stress and inevitably became sore and inflamed.

 

As for the leg length difference, this is a complicated topic to explain accurately. However, I will do my best to help you understand it. I would suggest you first watch a short video that I found on YouTube, by Sam Visnik to start with. Now that you have done this, I will continue. The relatively small movement within the sacroiliac joints allow the ileum bones at each side of the pelvis and the sacrum at the center of the pelvis to rotate or “tip” forward and backward. This motion occurs when you walk, run, bend forward, bend backward, or raise your knee to your chest.

 

In the past, it was thought that the sacroiliac joints did not move at all. However, studies have shown that they do move and actually play an important role in actions I just mentioned. Either of the sacroiliac joints can become “restricted” or “jammed” due to general joint stiffness or when injured even mildly. This can result in the affected side of the pelvis “rotating forward” or “rotating backward”, which results in the appearance of one leg longer than the other. As we discussed above, the real “hip joint” is made up of the pelvic bone (ileum) and the thigh bone (femur). Therefore, if the left ileum were rotated forward or backward, it would have a direct effect on the left leg. For example, if this gentleman was lying down and his left sacroiliac joint was jammed or restricted in a position that had the left ileum “rotated forward”, his left leg would appear shorter than the right when you compare the bottom of his heels. The other possibility, and what this gentleman actually had, is when the left ileum is rotated backward. This made his left leg appear longer than the right. I hope this explanation makes sense to you.

 

For me, as the chiropractor, the task is to restore the proper positioning and mobility of the sacroiliac joints. I do this by performing a series of treatments consisting of “manipulating” or “adjusting” the affected joints and restoring their mobility. Once this mobility is restored, the remaining treatments are done to maintain it that way until the joint is able to heal fully and naturally

 

Piriformis Syndrome and Sciatica

“Piriformis syndrome” is caused by an entrapment (pinching) of the sciatic nerve as it exits the back of the pelvis, deep within the buttock. The sciatic nerve typically exits the back of the pelvis immediately below a muscle, called the piriformis muscle, deep within the buttock. In rare situations, the nerve actually passes right through the piriformis muscle. For various reasons, the piriformis muscle can go into spasm and entrap or pinch the sciatic nerve. This will result in pain along the back of the thigh and knee, with further pain and/or numbness extending as far down as the sole of the foot, called “sciatica”.

Piriformis syndrome can result in “sciatica”. These same sciatica symptoms feel very similar to that of a herniated disk. A herniated disk typically pinches directly on one of the five nerves that eventually make up the sciatic nerve. Because the resulting symptoms of both of these problems are very similar (pain, numbness and tingling below the knee and into the foot), it is not hard to misdiagnose what is actually going on if you don’t look for both potential causes.

Specific diagnostic tests performed by your chiropractor are what distinguish a herniated disk from piriformis syndrome. In simple terms, with piriformis syndrome your chiropractor will not find many positive test results that indicate that the lumbar spine is involved. More often, the acute pain or tenderness is localized to the buttock and hip, while the low back appears quite normal.

 

Many weekend athletes and people who spend long hours sitting are prone to this syndrome. The athlete’s cause is primarily due to improper stretching and warm-up exercises as well as overuse during activity. In this case it is most likely that the piriformis muscle is irritated and usually in spasm. For the patient who sits for extended periods of time, their primary cause is due to contracture or tightening of the piriformis muscle. In this case the piriformis muscle is shortened and does not allow for the smooth movement of the sciatic nerve during leg motion.

 

Any treatment plan must include stretching of the gluteal or buttock muscles as well as stretching of the piriformis muscles. Your Chiropractor can help you by instructing you on the proper stretches to perform. Many Chiropractors may also perform some form of massage to the piriformis muscle in the gluteal region in order to relax these muscles. A series of spinal and hip joint adjustments may also be required to relieve your symptoms.

 

If you are currently diagnosed with a disk herniation but are wondering if the symptoms you are experiencing may at least be partially from piriformis syndrome, call my office for an appointment to have it checked thoroughly. It is always a good idea to rule out other possible causes of your sciatica before simply having surgery.

 

Leg Pain From the Hip

Last week I had an elderly male patient enter my office complaining of “sciatica” (leg pain that refers from the low back). He simply assumed that the pain in his groin and front of his thigh was originating from his back because he had experienced symptoms similar to this before and ended up having low back surgery to correct it. Although the leg pain he was describing could have been originating from his low back, a detailed examination of that area revealed nothing significant. Knowing well that leg pain can be from the hip joint, I examined that next. By asking a few simple questions and moving the joint around in different directions, it was very obvious that there was a problem. By turning the leg inward and outward, the leg and groin pain could be reproduced or intensified. It was then obvious that the past treatments he was given should have been directed to the hip joint and not the low back. This article will focus on leg pain from the hip.

Once this gentleman’s hip was x-rayed, my suspicion of osteoarthritis (“wear and tear” arthritis) was confirmed. I then explained to him that just because he had arthritis does not mean he should “baby” the joint. In fact, an arthritic joint will not last longer and the arthritis will not slow down if the joint does not get used. Because of the leg pain, he had not been getting hardly any exercise. This would have made the problem even worse. Any joint, arthritic or not, must get as much movement as possible to prevent further stiffness and pain. So, I started him on a light stretching and strengthening program for the muscles in and around the hip joint. He also received some chiropractic treatment of the muscles and the actual joint. This gentleman could also have benefited from losing a few pounds. For every pound extra he carried, it is three pounds more stress on his hip joint when walking. Jokingly, we decided that he should not consider taking up sprinting but instead should start a pool exercise program. This allowed him to use the muscles and move the joint without putting too much pressure on the arthritic joint. Within two weeks, his ability to walk was significantly improved and the intensity of the leg pain was much less.

 

If you are experiencing leg, thigh, groin, or knee pain, consider having the hip joint examined by your chiropractor or other health care practitioner.