The Great Sciatic Nerve is the largest peripheral nerve in the entire body. It originates from the bottom three nerve roots coming out of each side of the spine, and then these nerve roots coalesce into one large nerve as it passes through the buttock area and courses down the back of the thigh and into the lower leg. When this nerve is pinched, symptoms can range from mild numbess or tingling in the back or side of the leg to intense pain from the lower back all the way down to the foot.
If left untreated it can also result in loss of reflex and even loss of strength in the muscles of the leg.
There are five primary causes of sciatica. The first is a disc pathology such as a bulging disc, in which the cartilage wall of the disc becomes weakened and bulges out to the side, pinching the nerve root. The other disc pathology that can cause sciatica is a ruptured or herniated disc in which the wall of the disc becomes torn and the soft, gel-like nucleus pulposus extrudes out of the disc and can press against a nerve root causing sometimes significant pain. The second cause of sciatica is Degenerative Disc Disease, or DDD, which is where the discs and other spinal joints have degenerated and thinned out over time. This then causes reactive bone over-growth (bone spurs) and sclerosis and this can pinch a nerve causing sciatica. The third cause of sciatica is muscle entrapment, in particular the Piriformis muscle. As the sciatic nerve passes through the buttock area it can be irritated by a shortened or spasmed Piriformis muscle. The fourth is stenosis. The term “stenosis” simply means narrowing. So any condition that can cause a narrowing of the openings that the nerves come out of can cause sciatica or also pinched nerves in other parts of the body. Stenosis may be congenital or may be caused by degenerated discs or bone spurs. The fifth primary cause of sciatica is spinal misalignment, also called Vertebro-Spinal Subluxation Complex or VSC which can cause painful dysfunction of the spinal joints and nerves.
Vertebro-Spinal Subluxation Complex (VSC) is a misalignment of the segments of the spine, the vertebrae, causing irritation of the joints, discs or nerves coming out of the spinal cord. VSC describes what happens when spinal bones lose their normal position or motion from stress, trauma or chemical or postural imbalances. Accidents, injuries, improper lifting, drugs, emotional stress, postural stress and long periods of sitting can all cause VSC. In the lower back, VSC can cause localized lower back pain or even sciatic nerve pain.
The Chiropractic Approach to treating sciatica is to try to locate the cause of the pain and then address it with appropriate treatment. This starts with a complete case history and a thorough examination which may include spinal X-rays. Special attention is given to the structure and function of the spine and its effects on the spinal joints and the nervous system. While most of the above-referenced causes of sciatica may respond favorably to Chiropractic care, a herniated disc may be the most problematic because it may not respond to Chiropractic Manipulative Therapy. It may, however, respond to traction therapies or acupuncture. If a herniated disc is suspected, and especially if a patient is not responding to conservative treatment, an MRI may be needed to refine the diagnosis.