What is Sciatica?

Many people use the term sciatica incorrectly. Sciatica is pain along the path of the sciatic nerve which extends from the lower back down each leg. Sciatica is a symptom (like itching), it is not a diagnosis (like Parkinson’s disease). Sciatica can range from an occasional nuisance to excruciating pain that makes walking near impossible. There can be multiple underlying reasons for your sciatic nerve pain. A chiropractor can help find the root cause of the problem with an exam and may also order some diagnostic imaging such as an x-ray, MRI or CT scan to examine the underlying structures.

To answer the question, ‘what is sciatica’ it is helpful to explain some of the relevant anatomical structures. The sciatic nerve is both the longest and the widest nerve in your body. It begins in the lower back as five separate nerves that extend from five different vertebrae – L4, L5, S1, S2, and S3. These nerves meet up to form one large bundle which runs through the buttocks and down the entire length of the leg. The sciatica nerve is responsible (directly or indirectly) for nearly all the sensation in your leg including the skin of the thigh and gluts.

Sciatica occurs when there is compression or irritation of the sciatic nerve. The pain is felt in the low back and leg, but the site of the pain isn’t always the site of the underlying issue. Since the sciatica nerve is so long and travels around or through the large muscles of the buttocks, it takes an expert to determine if the pain is coming from disc compression, from muscle spasms or from something else. Again, sciatica is a symptom, not a diagnosis.
While sciatica is most often associated with pain, other symptoms may be present such as tingling, numbness, or muscle weakness. The pain can be nearly constant or intermittent. If you think you are experiencing sciatic nerve pain, keep a record of the location, duration and intensity of the pain. Your specific history plays an important role in determining the cause of the pain.

Treatment for sciatica depend on the underlying cause, so there is no one recommended course of treatment for all sciatic pain sufferers. Chiropractors use a variety of non-invasive approaches that include spinal manipulation, physical therapy, targeted stretching and active muscle release. They’ll also discuss the role that nutrition and hydration play in reducing tissue inflammation and keeping discs healthy. The spine, discs, muscles and soft tissue all have a role to play in sciatica and should be evaluated and treated as a connected system.

The most important thing to take away from this article is that sciatica (sciatic nerve pain) is a symptom of an underlying condition. You’ll only start to get better once the underlying condition is identified and this is done through a combination of an exam, history and recommended diagnostic imaging.

sciatica manhattan: Chronic Sciatica;

Chronic sciatica is a torturous and difficult to resolve back and leg pain syndrome.  Sciatica is not a diagnosis, but a symptom of an underlying causative condition.  True sciatica is sourced by a spinal abnormality, while pseudo-sciatica can come about due to muscular, circulatory or even psychosomatic reasons.  No matter what the actual cause of sciatica, chronic symptoms can make life very difficult for affected patients.

Chronic means long lasting or recurring.  For sciatica sufferers, there are a great number of different chronic patterns associated with their symptomatic expressions.  Some patients endure the same pain everyday, while others endure a variable symptomology which can change hour to hour in some cases.  Many patients endure constant back and leg pain, while others suffer only at certain times of the day, or with certain activities or positions.  Some patients have a little or a lot of pain everyday, while others will have good days without pain and bad days with hellish symptoms.  Finally, recurrent bouts of acute sciatica or “flare ups”, as they are often called, can be one of the most agonizing clinical profiles possible and can create a tremendous amount of anxiety in every sciatic nerve pain sufferer.

Statistically, the most common diagnostic conclusion used to explain sciatic nerve symptoms is a herniated lumbar disc, typically at L4/L5 or L5/S1.  These are the levels which suffer the greatest and most universal degeneration in the human spine, so it is easy to see why herniations at these locations are common diagnostic scapegoats.   However, in order for these bulging discs to enact symptoms, they would have to affect surrounding neurological tissues through the processes of spinal stenosis or foraminal stenosis.  This is because the spinal discs themselves do not feel pain, as they do not have blood supply or nerve endings.

Foraminal stenosis is the usual diagnosis for herniated discs theorized to cause sciatica.  These “pinched nerves”, as they are often called, go on to form the sciatic nerve, so it is thought that compression of one or more nerve roots can enact sciatica pain.  Clinical research has decisively shown that actual compressed nerves stop signaling altogether, causing a condition of true objective numbness and weakness in the regions served by the affected nerve structure.  There would be no lasting pain or tingling, as well as no subjective numbness and weakness common to the vast majority of sciatica complaints.  This makes the pinched nerve theory lose tremendous credibility as a true source of sciatica.  Additionally, in order for a herniated disc to actually have any effect on the nerve at all, the bulge would have to virtually completely close off the neuroforaminal space, which is a very rare scenario indeed.

Spinal stenosis as a source of sciatica is more complicated, since stenosis anywhere in the spine can create a variable pain pattern, along with the typical neurological symptoms in the legs.  Stenosis in the lower back can create sciatica, as can stenosis far up in the cervical spine.  This makes diagnosis very difficult, when the causation is indeed structural.  Add to this fact that most stenosis is not symptomatic in anyway, even though anatomical alteration is evident upon diagnostic imaging, and you really have a hard time differentiating between potentially troublesome stenosis and innocent spinal canal narrowing.  Many herniated discs, for example, may impinge on the thecal sac surrounding the spinal cord, but do not have any effect on the cord itself.  Even herniations which do press into the cord typically may displace the cord (creating a frightening image on MRI films), but usually do not cause any pain or sciatica.  However, in some cases, spinal stenosis can be problematic and truly enact lower back, buttocks and leg pain syndromes.

Despite all this doom and gloom, there is some good news about sciatica.  Structural causations which are accurately diagnosed and truly do create symptoms most commonly respond very well to indicated medical and complementary treatment.  This means that most true anatomical issues responsible for enacting pain can be completely cured.  For patients with long term symptoms which have proven themselves to be unresponsive to various forms of treatment, the answer is simple.  In these cases, the condition is virtually always misdiagnosed, leading the sufferer on a wild goose chase using treatments which are all targeting mistakenly identified causes of pain.  No wonder the treatments fail…