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. After this is explained, I will clarify “what does a chiropractor do for sciatica?”.
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 (read my article: What is Sciatica?). The real challenge for a chiropractor 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.
In regards to treatment of sciatica in my office, the first goal is to identify where exactly the nerve is being irritated or pinched. This pinching or irritation can happen as the nerve roots that make up the sciatic nerve pass by any inflamed “facet” joints that are between the vertebrae. As well, a herniated disk or arthritic changes in the joints of the spine can both directly pinch or irritate these nerves. Another joint problem that can cause sciatica is the “sacroiliac joint”. There is one of these joints at each side of the back of your pelvis. My patients often mistakenly call these joints their hip joint. The hip joint is further to the outside of each side of the pelvis.
The most common treatment that I use for most of the problems listed above is manipulation of the sacroiliac or facet joints, in conjunction with loosening the muscles, and some specific muscle stretches. As well, I teach my patients other general low back stretches and exercises. When the patient is ready, a full core strengthening exercise program is available. This program uses a piece of equipment called a “TRX”. Finally, I also have a “spinal decompression” or traction table which provides a negative pressure to the disks, muscles, and ligaments of the spine in order to take pressure off of any affected nerves. This treatment is also commonly used to accelerate the healing and recovery from an acute herniated disk.