- Sciatica can be an extremely disabling condition.
And it typically refers to pain that radiates
down the leg, often into the calf,
and sometimes into the foot.
If we just look at a spine, we can talk about
some of the sources and causes of sciatica.
This is the lumbar spine, or the low back.
The skin of the back would be right here.
And then here is the tail bone as a point of reference.
The hips are here, and these are the little bones
that you would feel sticking out of your back.
The sciatic nerve actually exits just off to the side
below your hip, and that is a group of nerves then
that travel down the leg to the calf,
and even into the foot.
If we look to the front we can see a little bit more
of the anatomy of the spine.
These are the large bones that stack up
to make the spinal column.
In between the bones we have cartilage discs
that separate the bones.
And then turning again to the back, we see the spinal canal
inside and in between these bones.
Sciatica can occur for a number of reasons.
First, if we have a large disc herniation
or one of these discs ruptures,
it can push back into the spinal canal,
compressing the nerve and resulting in sciatica,
or pain that radiates down the leg.
Secondarily, we can also have a pinched nerve
occurring inside the spinal canal.
As arthritis grows or there's a thickening of the ligament,
it can begin to crush these nerves inside the canal.
As the nerves become irritated and compressed,
the sciatic nerve also is inflamed, and a person
will experience severe pain that radiates down the leg.
Finally, sciatica can occur as a direct contusion
or a blunt blow to the sciatic nerve
as it exits through the gluteal muscles right here.
Sciatic patients often present complaining of
severe leg pain.
They often say the pain is electrical burning,
like a terrible toothache in their leg.
Many times these patients present,
and they're very uncomfortable.
They haven't slept at night.
They can't sit for very long in the car.
They can't stand or walk for more than 20 minutes.
It's an excruciating pain.
In fact, I've had many women tell me that
it's more severe than giving childbirth.
So that's pretty bad.
Sciatic pain is a very severe pain.
And it needs to be addressed pretty quickly in an attempt
to try and give them some pain relief.
I look to physical exam.
We wanna make sure first that the sciatic nerve
has not been severely injured.
And so we look for atrophy of the muscles,
weakness of the leg.
If they're not able to lift their foot,
that would indicate that the nerve has been
severely injured, and we need to address it
much more rapidly.
We measure sensation in the leg to determine
whether or not the sensation is the same
from one leg to the other.
And we test reflexes.
Finally, we always use imaging to correlate
with our physical exam, and that includes an MRI,
looking at the lumbar spine,
which allows us to evaluate the soft tissue,
including the discs and the nerves and the spinal canal.
And from an MRI we can get a very good idea
of where the nerve root is being compressed,
and to what degree it's being compressed.
And that really helps us to lay out a treatment plan.
The treatment of sciatica is very broad.
And really it's driven by how much the symptoms
are affecting someone's life.
If the symptoms are relatively mild,
we always start conservatively.
And that can include the use of anti-inflammatories
to try and reduce swelling around the nerve roots
and within the spinal canal.
We can use muscle relaxers to help assist in reducing
some of the muscle spasm which is causing
pain and dysfunction.
And then I always will revert to some physical therapy
to begin stretching and strengthening the body
in an attempt to take pressure off of that nerve.
Chiropractic is another non-invasive treatment
that can be very helpful, and our chiropractors
use something here at Coordinated Health called
flexion distraction, where they're able to push down
on the pelvis and open up the spine
and take pressure off of the nerves.
If the pain is more severe or they haven't responded
to conservative treatment, we have some other options.
One are cortisone injections called epidural injections.
And this is an injection that is directed under
x-ray guidance above the nerve root,
and then we're able to put cortisone
right on top of the inflamed nerve.
And oftentimes one or two or even three epidural injections
will calm things down and allow people
to move forward without pain.
And then finally, if symptoms don't get better,
there are a couple of options.
We have a machine that does traction, and traction works
on the lumbar spine by pulling and opening up the space.
And finally, if people don't get better with this
host of conservative treatments,
I will recommend minimally invasive spinal surgery
in an attempt to take the pressure off the nerve,
minimize the pain, and allow them
to get on with their lives.