Sciatica is a nerve compression syndrome that can be extremely painful and difficult to manage for both the patient and practitioner. Sciatic pain often affects the lower back, gluteal region, and various areas of the leg and foot. Often, the symptoms effect only on one side of the body.
Sciatica can be caused by a disc herniation, compression of the lumbar nerve roots, spinal stenosis, and/or entrapment of the sciatic nerve along its path from the lumbar spine down the leg.
Most cases of sciatica are mechanical in nature (98%) and are not secondary to some other pathological process (Infections, tumors, blood clots).
What Are Typical Sciatica Symptoms?
The sciatic nerve is a very long nerve that extends from the hips down the back of the leg, to the heels. Sciatica symptoms vary depending on just where the sciatic nerve is impinged or restricted. Symptoms include:
Pain when you sneeze or cough
Pins and needles in your legs
Burning or tingling down the leg
Pain in the rear of the leg that gets worse when sitting
A continuous, constant pain on one side of the buttocks and leg
Weakness, numbness or difficulty moving the leg or foot
A shooting pain that makes it difficult to stand up
Pain that feels like a bad leg cramp, but which can last for weeks
Sciatica and Disc Herniation
Sciatica that is caused by a disc herniation is often precipitated by a lifting or twisting injury. This type of injury will often cause pain to shoot down the leg when a person coughs or sneezes. This pain can be reproduced by what is called a Valsalva maneuver. In this test you cough or bear down, as during a bowel movement. If you have a herniated or bulging disc, you will get pain shooting down the affected leg.
Fortunately the majority of cases of sciatica caused by a disc herniation do not require surgery. Only 5% of disc cases require surgery. Most of these cases can be treated with manual therapy (ART, Manipulation), lifestyle management, and exercise.
Sciatica and Foramina Compression
Sometimes the nerve roots in your lumbar spine can get hung up or restricted at an area called the vertebral foramina. These foramina are the passages in the bones of the vertebra through which nerve roots pass. Each foramina varies in size depending on location.
In conventional medicine, when this foraminal compression occurs a medical operation called foraminotomy is performed to remove the pressure on the nerve roots. This nerve root compression can be caused by bone compression (from arthritic changes), disc herniation, scar tissue, or excessive ligament development
In many cases where the restriction is caused by a soft-tissue obstruction, Motion Specific Release procedures can release the restriction. If the sciatica and related symptoms are due to a soft-tissue restriction the patient will often see some immediate improvement.
Sciatica and Spinal Stenosis
Spinal stenosis is a condition in which the spinal canal narrows (MRI photo), compressing the spinal cord or the nerves that branch out from the spinal cord. Serious cases of stenosis do require surgery. Milder cases of spinal stenosis can be treated non-surgically.
Spinal stenosis can be caused by numerous factors such as disc herniations, thickening of ligaments, trauma (motor vehicle accidents), and spinal tumors.
Symptoms of spinal stenosis are:
Leg pain that gets worse with walking and improves with bending forward or sitting. Generally the pain will only be on one side of the body. The degree of pain will depend on the amount of impingement.
Muscle cramping in the legs. This cramping is usually worse going down hill and much better when the patient leans forward.
RED FLAG – Loss of bowel or bladder function is an indication of cauda equina syndrome. This is a medical emergency, seek medical attention immediately.
To determine if you have spinal stenosis an MRI (Magnetic Resonance Imaging) test may be needed. Normal X-rays will not rule out spinal stenosis.
Mild to moderate cases of spinal stenosis usually respond very well to a combination of manual therapy, exercise, and activity management.
Manual therapy cannot remove the cause of spinal stenosis, but it can remove a considerable amount of mechanical stress from the spine and improve spinal stability. This is often enough to help the patient reduce pain and improve overall function.
Sciatic Nerve – Peripheral Compression Syndromes
Of all the causes of sciatica, in my opinion peripheral nerve entrapment is the most common. The piriformis muscle is one of the external rotators of the hip and leg. This muscle helps to turn the foot and leg outward. If the pirformis muscle is overworked it can become tight and restricted, compressing the sciatic nerve.
This type of compressive syndrome can actually happen anywhere along the entire length of the sciatic nerve. Motion Specific Release procedures can be effective at releasing these restrictions. I have used these procedures in my clinic for many years with very good results in the majority of cases.