Sciatica: A Misunderstood Condition

spinal stenosis

Sciatica is known clinically as pain feeling like an electric shock that travels from the back or buttock down the leg past the knee all the way to the foot. This pain can feel strongest in the buttock, the hamstring, the calf or the bottom of the foot. A common misconception is that any pain that moves down the leg is sciatica. However, there are other conditions that cause pain to travel in this manner and treatments will differ depending on the primary cause of the pain. A good chiropractor will talk to the patient and will perform a proper physical exam to determine the true cause of their pain.

More about Sciatica
Sciatica is named after the nerve that is causing the pain. The sciatic nerve originates from the spinal nerves that exit the spine at the L4, L5 and S1. These three nerve roots converge to form the sciatic nerve. Further down the leg, the sciatic nerve branches into all the nerves that innervate the leg. In addition to pain, symptoms can include tingling, burning, muscle weakness and difficulty controlling the leg. Sciatica usually affects one leg or the other.

Piriformis Syndrome
The most common type of true sciatica is the pain associated with piriformis syndrome. The piriformis is a muscle located deep within the buttocks. It originates from the anterior part of the sacrum, the superior portion of the greater sciatic notch, the sacroiliac joint capsule and the sacrotuberous ligament. The muscle runs laterally to insert into the greater trochanter of the femur. Depending on the individual, the piriformis muscle may have a different relationship with the sciatic nerve. With some, the muscle lies on top of the nerve and with others the nerve runs directly through muscle. Symptoms arise when the muscle begins to spasm or tighten due to injury, overuse or compression. Physical modalities such as muscle release techniques, electrical muscle stimulation and chiropractic manipulation are best used in this clinical situation.

Disc Herniation
Another cause for pain going down the leg is a disc herniation. Between each vertebrae in the spine lies a gelatinous vertebral disc. We can compare the disc to a jelly donut. On the outside of the disc is a ring of thicker connective tissue called the annulus fibrosus. Within this ring lies the jelly filling called the nucleus pulposus. When too much pressure is placed on the disc, the nucleus pulposus can protrude through the annulus fibrosus to place pressure on outside structures. Not all injuries lead to complete extrusion of the jelly center. Minor protrusions are referred to as bulges, where as major protrusions are referred to as herniations or extrusions. The most common herniation occurs posteriorly into the spinal canal usually off to one side or the other. Compression is most commonly seen on spinal nerves within the lateral canals. The most common method of injuring a disc is lifting a heavy load while only using the muscle of the back, followed by twisting with the heavy load. Ninety percent of disc bulges and herniations will resolve spontaneously within 4-8 weeks even without treatment. Conservative options such as massage, chiropractic, and physical therapy can be used with good results. If the herniation is too large or if it does not resolve, surgical options are available.