Many patients come to my office and tell me they have sciatica, but just what is sciatica?
First, a little background: the sciatic nerve is the largest nerve in the body and arises from a group of nerves exiting the spinal column called the lumbosacral plexus. It goes down the back part of our leg to the back of our knee where it splits and forms two other nerves. The sciatic nerve is responsible for voluntary control of the hamstrings, a groin muscle and one other muscle that sits behind the knee. It also is responsible for sensation of the skin in those areas.
Now, many people believe that any severe low back pain is sciatica, and tend to use the term to indicate that. However, I have both personal and professional experience, that pain from muscle spasm or joint issues in that area can be just as painful. True sciatica is a pain that is like a flash of lightening down one’s leg that they can trace with a finger, showing the exact route. Pain of muscle, joint or disc origin is more diffuse and generally harder to pinpoint. Patients can show where this type of pain is, but cannot trace it, as it tends to cover more area.
Causes of sciatica are many. It could be due to a disc bulge that is putting pressure on a nerve root in the spine that then causes pain to radiate down the leg. Sciatica could be due to a lack of mobility in the low back and an indirect nerve compression due to that. It could be due to a tight piriformis muscle, which the nerve must (usually) pass under before it heads down the leg. In a worse case scenario, it may be due to some type of space-occupying lesion (cancer) which compresses the nerve. Due to these myriad of causes it is important to be properly diagnosed and then treated accordingly. Fortunately, chiropractors have great success with this condition and it can be managed. Recent treatment guidelines out of the UK acknowledge this and recommend chiropractic for sciatica. Click here for more on these guidelines. I have found that many cases of sciatica are a combination of a mobility issue and tight piriformis muscle. Adjusting the lumbar spine to restore mobility and release of the tight muscles alleviates the problem. Sciatica of disc-origin is more complicated and typically requires more time to sort out.
Dr. Mark Strudwick is a third-generation chiropractor in Victoria, B.C.