Sciatic pain is a very common problem that many people experience in their lives. Chances are that even if you’ve never had this type of pain you can name someone in your family or group of friends that has complained of pain traveling into their legs. While this is a very common problem, there seems to be a fairly wide misunderstanding of what exactly sciatic pain means or even why so many of us suffer with it.
First, let’s take a moment to describe why the name “sciatica” is used. When patients present with this type of pain they often have a collection of symptoms. These symptoms can be numbness/tingling, pain, or even weakness/tightness in the muscles of the leg and glutes. As you can see from this image, the sciatic nerve is quite long and has many branches going to the various muscles of the posterior leg. It’s easy to understand why a small irritation to this nerve could give us such big problems.
With the nerve traveling under all of these big muscles in the buttocks, isn’t it easy to imagine that it could get “stuck” in that area? The nerve lays underneath of the piriformis muscle and can become stuck there– we simply call this “piriformis syndrome”. But the most interesting part of sciatic pain is that this muscle is rarely the main cause of the pain. In fact, about 90% of sciatic pain comes from the nerve roots in the lumbar spine.
As we take a look at the bony anatomy above, we can see the way that the spine is structured. Between every two vertebral bones there is an intervertebral disc. Normally, this structure is very soft and pliable and allows the joints of the spine to move and support weight without much difficulty. Just behind the disc you can see an area we refer to as the “intervertebral foramen”, or IVF (it’s a fancy way to say the hole between the vertebra). This little opening is the area where the spinal nerve roots pass through. These nerves carry all of the information going to and from your body (the skin, the organs, and even the muscles). This is the area where we are most likely to put pressure on the nerve and suffer from sciatic pain. The sciatic nerve is formed from the L4, L5, S1, S2, and S3 nerve roots (the bottom of the spine or the “low back”). If any of these nerve roots are irritated or damaged, we can feel the symptoms travel along the path of the sciatic nerve.
Now that we understand where the problem occurs, let’s talk about a few reasons why the problem occurs. The most common cause of a problem in the IVF is degeneration or bulging of the intervertebral disc. When the disc undergoes heavy amounts of stress (lots of sitting, lots of driving, or lots of heavy lifting of objects with improper form) there is a good chance that early degeneration will occur. There is also a higher chance of degeneration with tobacco smoking. Genetics are important to consider as well. The disc tends to move backward which sometimes leads to it pressing against, and irritating, the nerve roots.
The next most likely cause of sciatic pain is IVF stenosis. Stenosis is a fancy way to say that your IVF is becoming smaller. As we grow older our bodies tend to become less stable. Our normal response to stabilize our spines is for the body to build more bone. We generally refer to this phenomenon as degenerative joint disease (sometimes still called osteoarthritis). When our body builds more bone, there can be a tendency to build around the IVF. When this happens it can cause an increased pressure on the nerves and sciatic pain can result.
When you visit your doctor with complaints of pain in the back that travels down buttocks and/or leg, you can expect an examination that involves neurologic testing as well as some orthopedic testing. Your doctor may test to see if your sensation in your legs and feet is different from one side to the other, check your reflexes, and also have you push against them with some muscle tests. This gives your doctor a good idea of how much pressure or irritation the nerve is feeling.
Be sure to give your doctor as much information as you can about when the pain started and what movements or positions make the pain better or worse. The findings in your personal history combined with the doctor’s physical examination should lead them to a diagnosis. At this point your doctor should offer you a form of treatment or perhaps ask you to go for some medical imaging in order to select the correct form of treatment for you.
Treatment for sciatic pain depends on the diagnosis that your doctor makes while working with you. Generally, conservative treatment such as chiropractic care or physiotherapy can be very effective at reducing sciatic pain in a safe and timely manner. However, a small percentage of cases do require surgery. Your doctor should be able to recognize these cases when they arrive.
If you suffer from symptoms of sciatica or know someone who does, schedule an appointment with a doctor who specializes in physical medicine (a chiropractor or orthopedist) so that a proper diagnosis and treatment plan can be made specifically for you.
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Attention: If you or someone you know has symptoms of low back pain/sciatica and has noticed incontinence or loss of feeling/burning near the groin then make sure to see a physician right away. This is usually a medical emergency.
Have a Safe and Happy Week,
Stephen Shinault DC
