Sciatica: What is it?

First, let’s be clear, sciatica is not a diagnosis, it is a symptom; specifically it is a descriptive term used to describe irritation of the sciatic nerve. Treatment for sciatica will vary depending on the cause of this irritation, but many of the typical causes of sciatica can be managed effectively by chiropractors, physiotherapists, massage therapists, and traditional Chinese medicine practitioners, and acupuncturists.
So what exactly does it mean when someone says they “have sciatica?” It means that their sciatic nerve is compressed, stretched, inflamed or otherwise irritated causing symptoms, sometimes severe, to occur along the course of the sciatic nerve. This nerve is the largest and longest nerve in the human body and extends from the lower back where it is formed all the way down to the feet, meaning symptoms can occur anywhere along the course of this nerve: the low back, the buttocks, hamstrings area, lower legs, and feet. Symptoms will vary depending on the location and degree of irritation and can include a dull achy pain, shooting/electrical pain, numbness, tingling, pins and needles sensation, muscular weakness, twitches, and/or difficulty walking or moving the legs. Usually these symptoms occur on one side, but in rare cases, may occur on both sides.

What causes sciatica?
Sciatica is usually caused by the compression of the nerve roots that exit the spine forming the sciatic nerve or by compression of the sciatic nerve itself. There are a number of causes of this compression including:

  • Lumbar disc bulge or herniation – the disc compresses the nerve roots as they exit the spinal cord
  • Spinal Stenosis – a narrowing of the spinal canal, usually due to degeneration, compressing the lower spinal cord or nerves as they exit the spinal cord
  • Piriformis Syndrome – a tightening and compression of the sciatic nerve in the buttocks region due to the piriformis muscle
  • Osteoarthritis / Bony Degeneration – causing a narrowing of the spinal canal or tunnel that the nerve exits the spinal canal through
  • Soft tissue entrapment – can occur at several locations along the course of the sciatic nerve
  • Spinal or pelvic tumours – although rare, tumours in the spine or pelvis can enlarge, pressing on the sciatic nerve

The reasons for developing sciatica may be obvious, such as a recent accident, fall, or injury. However, sciatica can also result from cumulative stress or injuries, which are small, seemingly insignificant stresses to the body resulting in degeneration or irritation of the joints and soft tissues near the sciatic nerve. Examples of these cumulative stresses include: poor posture, lack of movement/exercise, excessive weight, job requirements (prolonged sitting, lifting, twisting, etc.), faulty biomechanics, emotional stress, or other physical and chemical stresses that all can lead to an unhealthy spine and possibly sciatica.

There is also a type of back pain termed pseudosciatica, which is a referred pain from irritation of the spinal joints in the lower back. These joints can refer pain through complex mechanisms into the low back, buttocks and back of the thigh; however the referred symptoms do not generally extend below the knee.

As was mentioned above, many forms of conservative therapy, such as physiotherapy, massage therapy, traditional Chinese medicine, and acupuncture are extremely effective at addressing the causes of sciatica. Described below is how one of those forms of conservative therapy, chiropractic, can help, but keep in mind, it is not the only option available to you.

How do Chiropractors Help?
Your chiropractor will locate the specific cause of your sciatica and develop a treatment plan to address the cause, not just the symptoms. To do this, the chiropractor will review your health history with you, perform a physical and neurological exam, and determine if further testing, such as x-rays, CT scan, or MRI are needed.

Many of the patients that come to see chiropractors may also be prescribed bed rest and painkillers by their medical doctors. Although medication is effective for pain control in short term, rest is generally not recommended by chiropractors as it usually does more harm than good. Instead relative rest is recommended, meaning resting from certain activities that aggravate the condition, but not from all activities. In fact, your chiropractor will often recommend light stretches, walking, and exercises specific to the cause of your sciatica to promote proper mechanics and relieve pressure on the nerve roots or sciatic nerve.
Once the cause is identified, your chiropractor will talk with you and outline how they want to tackle the problem. In most cases, the chiropractor will adjust the joints causing the problem, recommend icing the area, prescribe exercises and stretches, and perform or recommend soft tissue therapy. If co-management with other healthcare professionals is warranted, your chiropractor at Optimum Wellness will also discuss these
options with you. For example, Physiotherapy may be recommended for pain control and rehabilitation; Massage Therapy may be recommended to release soft tissue adhesions compressing the sciatic nerve or to relax the muscles in the low back; Acupuncture treatments may also be performed or recommended by certified chiropractors or acupuncturists; Traditional Chinese Medicine may be recommended to control inflammation and promote proper nerve flow; Nutrition and weight loss strategies may be recommended as well, and a naturopath or nutritionist may be recommended for this.

At Optimum Wellness, we have all these services available for our patients so that we can help them feel better and return to full health and function. If you are experiencing sciatica, we encourage you to speak to an Optimum Wellness healthcare provider near you.
Dr. Stephen Zwart, Chiropractor
Dr. Zwart Practices at the Shawnessy Location with Optimum Wellness Centres