Sciatica is defined as any irritation of the sciatic nerve that creates a symptom. Symptoms can range from numbness in the back of the leg, to severe leg pain and an inability to walk. Because the sciatic nerves are the thickest and longest in the body, there are many causes of sciatica. Depending on the cause, chiropractic treatment can be effective against sciatica, because it usually focuses on the joints, muscles and ligaments of the low back and buttocks, which are the most common culprits.
Facet Adjustments
The main focus of most chiropractic treatment is adjusting or "unjamming" the small vertebral facet joints that connect the vertebrae to each other and allow movement. Facet joint dysfunction is the most common cause of sciatic nerve irritation, so moving or repositioning these joints away from the sciatic nerve is immediately helpful. In some cases, the "sciatic pain" is not from the sciatic nerve at all, but rather referred pain from the facet joints or another structure.
Sacroiliac Adjustments
On its journey originating from the lumbar spine, the sciatic nerve passes above and near the sacroiliac joint, which is a large pelvic joint below the "dimple" of the upper buttocks. Dysfunction or inflammation of this joint can directly irritate the sciatic nerve, or it can mimic sciatica via referred pain. Either way, adjusting and repositioning this joint often affords near-immediate relief.
Muscle Stretching
As the sciatic nerve passes above the sacroiliac joint, it dips under or runs through the piriformis muscle. Dysfunction and tightness in the piriformis (especially from chronic leg crossing) can directly pinch the sciatic nerve and create pain in the buttocks and down the back of the leg. A tight or injured hamstring muscle can also cause sciatica further down the posterior thigh and behind the knee. Specific piriformis and hamstring muscle stretches or massage can be effective in these cases.
Electrical Modalities
Sometimes when muscles and tendons are the cause of sciatica, stretches are not effective or even possible. In these cases, electrical devices such as electronic muscle stimulation, ultrasound, microcurrent or a TENS device can be applied to the injured muscle or even directly above the irritated sciatic nerve. The main purposes of these devices are inflammation control, reduced spasms, and accelerated tissue healing.
Shoe Lifts and Orthotics
Sometimes the cause of sciatica is an anatomically short leg, which creates an uneven pelvis and pressure in the lumbar spine, which affects the sciatic nerve. Chiropractic treatment in this case would be to insert a heel lift, or to manufacture custom shoe inserts called orthotics in an effort to align the pelvis.
Exercises
Sometimes the cause of sciatica is from a herniated disc or bone spurs. As long as the disc is not ruptured or too badly degenerated, various exercises can be prescribed before a surgical consult is necessary. These exercises usually involve pelvic tilts, lumbar extensions, use of an exercise ball, or some sort of traction or decompression chair.
Gels and Creams
For purely symptomatic pain relief, chiropractic treatment might involve the application of certain gels, creams, ointments, or sprays. Arnica, menthol, aloe vera or eucalyptus are some of the active ingredients in these products.
References
- "Sciatica Solution: Diagnosis, Treatment, and Cure of Spinal and Piriformis Problems"; Carol Arman; 2007
- "Chiropractic Management of Spine Related Disorders"; Meridel I. Gatterman D.C.; 2002
