Sciatica is the shooting pain or numbness that goes down one leg to the toes due to direct irritation of the sciatic nerve, or the sciatic nerve root, that exits at the lower back from the spinal cord. Sciatica refers to the symptoms or feelings, but it’s not an actual diagnosis. It doesn’t tell us what’s causing the pain or where it’s originating from—it just tells us that the sciatic nerve is affected.
Cause & Effect
In most cases, sciatica can be associated with a disc herniation in the lumbar region of the lower back, where the disc in the spine protrudes outward and either directly compresses the nerve root or has enough inflammation associated with it to irritate the nerve that goes down the leg.
What Does It Do?
The sciatic nerve is made up of the L4-S2 nerve roots. It provides direct motor function to the muscles in the legs, as well as sensation to the skin on the back and sides of the legs and the bottoms of the feet.
When you visit a chiropractor with this type of pain, they should do a thorough assessment of motor function and sensation in these areas. This helps us identify which nerve may be the cause of the pain and rule out other conditions that could look and feel like sciatica. Finding out the cause of the pain is the most important step because this dictates your treatment options and recovery time.
In some cases, we may ask for imaging either an X-ray of the lower back to see if there is any compromise to the joints or the discs, or an MRI to view the tissues, discs, and nerves in the lower back. Having something come up on imaging will help us confirm our diagnosis, but it’s generally unnecessary unless there’s a need for surgery in the rarest and most extreme cases (e.g., symptoms that affect bowel or bladder function, or cause a loss of muscle control). Very few people need to take this route; a lot of back surgeries don’t address the cause of disc herniation, so the pain is very likely to come back even post-surgery. In most cases, imaging is not required and won’t affect the course of your treatment. If you do experience weakness in the muscles, or loss of control over bowel or bladder function, please see your medical doctor immediately.
It can be a long, tough road to recovery from a nerve or disc injury that has led to sciatica symptoms. Every case will be different, but generally speaking, at least one or more years of rehabilitation will be needed before the condition can be in a place where it’s less likely to occur again.
In a lot of disc herniation cases, the ligaments that surround the discs are weak and unable to do their job as well as before. This makes it much easier for disc herniation to occur through repetitive activities or a lot of bending, twisting, and lifting all at the same time. If an injury occurs, time will be needed to strengthen these ligaments. They require much longer to strengthen than muscles, hence the long recovery time. In my opinion, the most critical factor between an injury getting better and coming back again (usually much worse the second time), is whether people keep up with their rehab many tend to stop once they feel better. If you can incorporate rehab into your daily lifestyle and create a routine that you can stick to for many years, it will be much easier to keep up the habit. Feeling good is great, and it might be your goal, but the pain going away does not mean the injury is healed.
“A huge part of the healing process comes from the amount of effort you put into your treatment plan at home, so carving out time for yourself every single day is really important for getting better.”
Some types of treatments that may be offered depending on your exact condition are rehabilitation exercises, acute care relief (e.g., heat, ice, stretches, muscle creams), lumbar decompression or traction, chiropractic adjustments, laser, acupuncture, and/or muscle work. A huge part of the healing process comes from the amount of effort you put into your treatment plan at home, so carving out time for yourself every single day is really important for getting better. It may be helpful to work with other practitioners, depending on your needs. A therapist can help manage the stress that chronic pain can cause, or a physiotherapist can be great if you need someone to do exercises with you.
If you’ve been suffering from sciatica pain and haven’t had improvement, or just need to know what’s causing it, book an appointment with your chiropractor. You don’t have to live with this type of pain, and there’s a good chance that you can get long-term relief. This type of pain is not likely to go away on its own, and it usually gets worse over time if left untreated.