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By Michael M. Burak, D.C.
The sciatic nerve is the largest nerve in the body in diameter and length. Sciatica, by definition, is shooting pain, numbness, tingling or weakness beginning in the lower back, extending to the back of the leg to the foot. One must have nerve pain that follows the sciatic nerve path distribution to have sciatica. Dull and achy pain is not sciatica. Nerve pain in the front of the leg is not sciatica. Nerves have two functions: motor or movement and sensory or pain and sensation. One or both of those symptoms need to be met for one to have nerve pain. If the pain travels down a nerve path, it is called radicular pain or radiculopathy.
If the sciatic nerve is being pressed upon, the first thing to do is to determine the cause of the impingement. There are three main areas where the sciatic nerve can be pinched.
The first is the lumbar spine (the base of the lower back). L4 and L5 are the most common areas for lumbar-disc impingement of the sciatic nerve. Between the vertebrae are discs that provide cushion and space for the nerves to exit the spinal cord. A disc is made up of two parts. One is the outer part or the annulus fibrosis and the other is the inner or the nucleus fibrosis. If one or both of those discs become injured, the outer part can tear, and then the inner part, due to compressive forces, protrudes (sticks out). The protruding disc (also referred to as a bulge, or herniation) can pinch the nerve root that exits between the two bones. How does this happen? Trauma, injury, degenerative arthritis, accidents, falls and more can cause the aforementioned. Initially, the body reacts to a new injury with acute inflammation and swelling around the disc, which can pinch the nerve. One way to determine if a disc is touching a nerve is by way of the MRI. Just remember, even if an MRI states that one has a disc herniation, it does not mean the disc is hitting the nerve. The only way to get nerve pain is if the disc is actually hitting the nerve or if the initial swelling is pinching the nerve with the inflammatory response. Studies have shown that if one hundred asymptomatic people get a lumbar MRI, half will have a herniation. There are various orthopedic and neurological tests used during the exam to determine if the nerve is being pinched. One very important component to remember is the emergency disc situation. 4 If the disc excises or a piece of the disc breaks off, usually it will get re-absorbed into the body. However, if the piece of disc gets stuck in the spinal canal it can cause cauda equina syndrome in which one loses bowel/bladder function. This is an emergency; go to the ER immediately.
The second is the sacro-iliac (S.I.) joint. The joint is made up of the ilium (pelvis) and the sacrum. Chronic non-function of the ilium on the sacrum can cause muscular compensation and pinch the nerve. This is called sacro-iliac joint dysfunction. It is a very common cause of lower back pain. Many people think a lumbar-disc herniation is the cause of their sciatica, where many times it is just an S.I. dysfunction. Differential diagnosis can determine if the sciatica is being affected in the lumbar spine or S.I. joint
The final place is the piriformis. The piriformis is the fourth layer of muscle in the gluteal. The piriformis is a tiny muscle that lies on top of the sciatic nerve. If the piriformis goes into muscular spasm, it can cause piriformis syndrome. This is very painful and is worst when one sits down as the muscle pushes on the nerve. Many men will get this because of chronic use of putting their wallet in their back pocket. This causes unequal distribution of weight and over time, can cause the piriformis to go into spasm.
Natural non-medicinal treatments are a great way to treat sciatica. These treatments vary for each of the three causes of sciatica. Specific chiropractic adjustments to the vertebrae involved is imperative. The segments need to be in proper motion and alignment for the body to function to its optimum. Misaligned vertebrae can cause a variety of symptoms such as muscle spasms, pain, inflammation, reduced range of motion, and more. The misalignments over decades can cause degenerative arthritis. All of the above can be avoided with routine spinal adjustments.
Vertebral axial decompression or VAX-D is one way to treat the disc herniation. VAX-D is a computer-regulated traction machine that causes a negative intra-discal pressure on the disc or negative (IDP). Fifty pounds of pressure begin the suction effect where the disc begins to retract off of the nerve. It’s like a jelly donut in which the donut has a slit in it. Compressive forces make the jelly extrude or come out of the donut. Negative IDP retracts the jelly back into the donut by tractioning both halves of the donut. If the disc is hitting the nerve, as soon as that nerve is no longer touching it, patients will have pain relief. Each session lasts about fourteen minutes. One usually feels relief within eight sessions.
Laser therapy is another alternative. Class IV laser therapy uses light energy to heal at the mitochondria of the cell. The mitochondria is the “powerhouse” of the cell. Initially, with an acute or new disc injury, there is swelling and inflammation. Laser therapy can help reduce the inflammation at the cellular level. Later, when the disc is no longer hitting the nerve, laser therapy can help to heal the damaged disc. It is the only therapy than can create a healing response at the cellular level of any damaged tissue.
Understanding the cause of sciatic-nerve impingement is crucial in regards to the proper method of treatment one will undergo. Prescription and/or over-the-counter pain-relieving medication attempts to decrease the perception of pain. Chiropractic, decompression, and laser therapy address the cause of the sciatic neuropathy. Repairing the cause not only relieves pain, but fixes the problem.
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Dr. Michael Burak has been in private practice in Huntingdon Valley since 1996. He specializes in disc injuries, lower back pain and more. He is also an adjunct professor at Delaware Valley University in Doylestown, PA. For more information, please visit www.drmikeburak.com or (215) 938-6040.