Sciatica

A lot of us have heard of sciatica and we all know someone who suffers from it. If you haven’t heard of it here is the nitty gritty: sciatica is irritation of the sciatic nerve which starts at the fourth lumbar vertebrae down to the third sacral (tailbone) segment to then travel down the back of the leg to provide nerve supply to the majority of the area. The sciatic nerve and its branches are responsible for providing control of many of the muscles of the back of the leg as well as sensory information back to the spinal cord. Considering the fact that the sciatic nerve has such a broad influence it is no wonder why it can be so debilitating for some people to have irritation of this nerve.

What are the common symptoms? Pain in the low back, buttocks, down the back of the leg, as well as in the foot. Along with the pain there is often muscular weakness, numbness, tingling, and difficulty moving/controlling the leg. Sciatica is often only felt on one side but can occur on both sides of the lower body. It is important to note that the term “sciatica” is only referring to the symptoms, not the cause.

What might cause sciatica? A bulging disc at the fourth or fifth lumbar vertebrae, narrowing of the spinal canal between the vertebrae (spinal stenosis), compression of the sciatic nerve between the fourth lumbar vertebrae and the third sacral segment, or piriformis syndrome (15% of the population has their sciatic nerve running directly through the piriformis muscle which leads to compression of the nerve by the muscle). Some of the causes can be from repetitive behavior such as poor sitting posture or a highly repetitive job.

What can be done about sciatica? Many people opt for surgery if the root cause is believed to be a disc herniation (most of which resolve themselves – the body is self healing and self regulating). Surgery has its pros (it works fast) and its cons (over the long term there is no significant difference in outcomes). Analgesics, muscle relaxants, and other common therapies rarely work better than a placebo so I might avoid them due to the other effects they may have on the body (especially the digestive system).

As an Osteopathic Manual Practitioner and a Certified Kinesiologist who has seen many cases of sciatica not be resolved by common methods I would suggest ensuring that the imbalances that have caused the compression of the nerves be removed. If it is mechanical (ie bones out of place), muscular (the muscles are pressing on the nerve), or a combination of both (most likely situation because bones and muscles move together), the treatment needs to be fairly holistic. As far as physical treatment is concerned ensuring proper passive mechanics of the spine (primarily the lumbar spine but the causative issue may be somewhere else) as well as a level pelvis and well balanced muscles in the legs should do the trick. Sounds simple enough right? It is for an Osteopathic Manual Therapist. The treatments should be between 20 and 30 minutes long, they should be gentle, and the pressure should be removed from the nerve fairly quickly. The job of the Osteopathic Manual Therapist is to reset the balance and then the body will take over the healing process. Each person is different so their recovery time will vary but it will be sped up comfortably by seeing an appropriate therapist.