Sciatica is one of the more common types of problems I see in my office. Many people, and even some doctors, are confused about what sciatic is and what causes it, so I thought I’d take a minute to provide a few facts about sciatica and how it can be helped.

Sciatica refers to pain, numbness, and/or tingling along part or all of the sciatic nerve. The sciatic nerve is the largest nerve in the body. It runs from the buttocks region, down the back of the thigh to the knee, and splits and runs along the center and outside portion of the calf region. When the sciatic nerve is irritated, a person will feel symptoms at one or more of those areas along the course of the nerve. That’s it. If there is pain anywhere else, it’s probably not sciatica. I often have people tell me they think they have sciatica or their doctor told them they have sciatica, only to have them point to the front of their thigh or leg or low back.

Here’s a picture showing where the sciatic nerve is located.

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What causes sciatica?

Irritation of the sciatic nerve can be due to a variety of causes. In general, it’s caused by compression of the nerve, stretching of the nerve, or chemical irritation of the nerve. This can occur anywhere along the length of the nerve, so it’s important to evaluate all potential causes when deciding on a treatment strategy.

Compression and stretching usually go hand in hand. If the nerve is compressed, it can’t move or slide as we move and bend our lower body. As a result, it becomes pulled tight or stretched. This irritates the nerve and causes a sharp, biting type of pain to shoot down the back of the thigh and calf.

The sciatic nerve is most commonly compressed by the piriformis muscle, which runs from the side of the hip, across the buttocks, and attaches the sacrum. This muscle can go into spasm due to injury or irritation from daily activities (like sitting many hours at a time). This is called piriformis syndrome. Here is a photo showing the piriformis muscle and its relationship to the sciatic nerve.

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The sciatic nerve can also be “caught” or compressed at other sites along the back of the thigh and leg, like the hamstrings and the calf muscles. Review the first photo above to see how it passes through the hamstrings and along the calf region muscles.

Another area where the sciatic nerve can become compressed, as well as chemically irritated, is before it even becomes the sciatic nerve. I didn’t mention it above, but the sciatic nerve actually starts at the lower part of the lumbar spine. At this point it is not called the sciatic nerve, but is part of five different spinal nerves. If any of these spinal nerves are irritated, there is a potential to have symptoms along the sciatic nerve. The most common causes of spinal nerve irritation are disc bulges, disc herniations, and slightly misaligned vertebra (the bones of the spinal column).

Disc bulges (also commonly called a “slipped disc”) can pinch the nerves as they exit the spinal column. This can be very painful. In addition to pinching the nerves, if any disc material leaks onto the nerve, it causes chemical irritation. The material from inside the disc is a very strong nerve irritant. It’s like spraying mace in your eyes!

Here’s a few photos depicting a disc bulge and pinching of the nerve, as well as a disc herniation with leaky disc material.

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How can sciatica be fixed?

First things first, it is necessary to find out what is causing the sciatic nerve irritation. If it’s a lumbar disc herniation with nerve compression and chemical irritation, treatment is going to be very different vs. irritation due to a piriformis muscle spasm. Description of your pain, how it started, etc. along with a proper physical examination is often enough to determine the cause of the irritation. In some circumstances, xrays or an MRI may be needed to further evaluate the situation.

For sciatica caused by a lumbar disc issue, spinal decompression by using a specialized chiropractic table or traction machine is often very effective. Performing muscle therapy to the low back is also helpful to reduce pressure on the low back, which can often make matters worse. Once the pain is minimal, a low back strengthening program is used to help prevent the area from being re-injured.

For sciatica caused by tight muscles, massage therapy, stretching, and strengthening exercises are used to help correct the situation. For instance, if it’s due to piriformis syndrome, stretches like the one depicted in the video below are given to help loosen up the piriformis muscle.

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Regardless of the exact cause, other pain relief therapies like e-stim therapy can be used to help reduce pain and inflammation along the nerve. In the rare cases where chiropractic care and the therapies do not help reduce the pain within a few days, medications such as pain relievers and an anti-inflammatory can be administered to help keep the person comfortable during the recovery process.

In even rarer cases (I’ve had to send patients for these options less than 10 times in the past 5-6 years), a referral can be made to a spine specialist or a pain management specialist for injections or surgery. Spine injections can be used to apply a strong anti-inflammatory solution to the area where disc material is irritating or compressing the spinal nerve. Spine surgery may be required to remove this material when the injections and all other care options fail. Trigger point or muscle injections can be given to problem muscles that won’t relax.

What should I do if I have leg pain that may be sciatica?

Unlike other types of pain, like simple low back pain for example, it’s best to have this type of issue evaluated sooner than later. Leg pain, even if it follows the description above, can be caused by issues that are not sciatica (like blood clots and infection). Waiting may only cause these problems to become much worse. Even if it is “just sciatica”, waiting is still not a good idea. This is a nerve issue, and letting nerve issues persist can cause damage to the nerve. Nerves take a long time to heal (this is why spinal cord issues are so serious, some nerves never heal), and allowing the nerve to stay irritated worsens the situation and makes it harder to correct once care is initiated.

For mild cases of sciatica, usually all it takes is a few visits to work out the problem areas and give you exercise and stretches so that you can effectively manage it yourself when it comes back.

For more severe cases, especially involving disc bulges and herniations, it may take several visits over the course of a few weeks. The average ‘severe’ case take around 4-6 weeks and 12-16 visits to correct. If care is initiated and pain is very severe and not responding within a few treatments, referrals for medical co-management is initiated.

Whether you’ve only had leg pain for a few days or have been struggling with it for many months or even years, give us my office a call to see what I can do for you. I’ve been helping people from Orwigsburg, Pottsville, Hamburg, and other parts of Schuylkill County and Norther Berks County for the past 5-6 years overcome leg pain due to sciatica and other causes. Call 570-366-2613 now to schedule your appointment.

Thanks for reading and feel free to post questions or comments.

(Dr. Touchinsky is a chiropractor in Orwigsburg, Schuylkill County. He focuses on the treatment of muscle and joint related issues, including migraines, headaches, neck and back pain, sciatica, disc bulges, chronic pain, etc. For a free consultation to discuss your issues and determine if chiropractic care can help, call the office at 570-366-2613.)