The term sciatica refers to pain along the course of the sciatic nerve. Typically that would be from the lower back, into the buttock and down the back side of the leg. Statistics from the National Board of Chiropractic Examiners indicate that about 9 percent of patients who consult a chiropractor have a complaint of leg pain. Chiropractors manage about 70 percent of these cases independently while referring about 30 percent for medical/surgical treatment or co-management.
Identifying the Cause
Sciatica is a symptom and not a disease. It is important then for the chiropractor to identify the underlying cause of the symptom. In a case of true sciatica, there is usually a physical source of inflammation or compression on the sciatic nerve or one of its roots. An article published in the July 2009 Journal of the American Medical Association lists herniated spinal discs as the most common cause of sciatica. Other causes include degenerative bone spurs, tumors, vascular abnormalities in the spine, trauma, infection, and regional muscle spasms or inflammation.
Assessing the Severity
The degree of pain does not always coincide with the severity of the compression or damage to the sciatic nerve. Associated findings such as numbness, muscular weakness and loss of normal reflexes may be better indicators of the severity of the condition. These findings largely determine whether the chiropractor will choose to proceed with conservative care or whether a prompt referral to a surgeon is in order.
In rare cases, a herniated disk may compress certain nerves, causing a loss of bowel or bladder control. It may also produce numbness or tingling in the groin or genital area. In cases such as these, the American Academy of Orthopaedic Surgeons advises an immediate surgical referral.
Selecting the Treatment
In cases of sciatica where immediate surgery is not indicated, a chiropractor may recommend conservative treatment. This often includes some form of spinal manipulation to maximize the mobility of the spinal joints and to relax the muscles in the region. Ice or electrical modalities may be applied to reduce inflammation, and traction may be used to reduce the pressure on the spinal discs. As progress allows, exercises may be introduced with initial goals of regaining mobility and eventual goals of increasing the strength and stability of the lower spine.
Monitoring the Progress
Since chiropractors generally work closely with their patients, they are in a good position to recognize changes over time and to make prompt clinical decisions based on their observations. Changes in pain severity, quality and frequency are important as are changes in strength or sensitivity to touch. These changes will often be reflected in activities of daily living such as walking, bending, sitting or working. A trial of spinal manipulation should be stopped if symptomatic and functional improvements are not seen within four weeks.
Prevention
Though it is not always possible to prevent sciatica, the American Chiropractic Association recommends maintaining a healthy weight, engaging in regular exercise, maintaining proper posture, avoiding prolonged bed-rest or inactivity, abstaining from smoking and using good lifting techniques. These measures may not guarantee freedom from sciatica, but should help to protect the back and improve spinal health.
References
- "Practic Analysis of Chiropractic;" National Board of Chiropractic Examiners; May 2010
- Journal of the American Medical Association: Sciatica
- American Academy of Orthopaedic Surgeons: Sciatica
- "Acute Low Back Problems in Adults: Assessment and Treatment;" US Dept. of Health and Human Services; Agency for Health Care Policy and Research; Publication # 95-0643; December 1994
- American Chiropractic Association: Sciatica
