A
sensation that runs down the leg may be coming from a condition called
sciatica. The pain, burning, numbness, or tingling is due to
inflammation or irritation to the Greater Sciatic Nerve, the largest
nerve that exits our spine. The part of this nerve that causes problems
down the back of the leg or into the gluteal area exits the spine at
the level of the fifth lumbar vertebra. This is the last of the five
lumbar vertebrae and is the area of the spine that carries the most
weight, and stress. The opening for this large nerve is also the
smallest opening in the spine. The discomfort of sciatic neuritis
(sciatica) can range from a mild irritation to an inability to function.
Sciatica
is a common condition and is experienced by many. Although it is less
common than lower back pain, many sciatic conditions actually come from
a problem in the lower back. The irritation that begins in or near the
spine is actually referred down the nerve, so the symptoms are felt in
the buttock, leg, and even into the foot. Your doctor can test you for
the sciatica by performing certain stress motions on the lower spine,
which will demonstrate increased symptoms in the affected leg.
The
Sciatic nerve can be pinched either at the level of the spine or where
the nerve passes near or through a muscle in the buttock called the
piriformis muscle. Compression at either of these levels can cause
symptoms of sciatica. The piriformis muscle can pinch the sciatic nerve
by being in spasm. A piriformis muscle spasm can be related to a
nutritional deficiency, a circulation insufficiency or from irritation
of the portion of the sciatic nerve that supplies this muscle.
Your
Doctor of Chiropractic can help determine if you have sciatica and if
so, where the underlying cause of nerve irritation is coming from. A
careful history and examination of the leg, hip, and lower back is the
key to the diagnosis of this condition. Imaging of the spine (x-rays or
MRI) often reveal the source of nerve irritation. Soft tissue swelling,
bony impingement (arthritis) degenerative disc conditions (worn disc)
or a bulging or herniated disc are just some of the possible findings
that imaging may uncover.
Treatment
for this condition
is largely based on the examination findings. Sciatic neuritis caused
from a bulging or herniated disc will usually require the greatest
amount of treatment. This form of sciatica is generally reported by the
patient to feel like a pain or burning sensation that travels in a
straight line down the center of the back of the leg like a string,
possibly as far as the little toe. In contrast, sciatica due to a bony
irritation in the spine, such as facet syndrome (irritation in the
joints of the spine) usually presents as a more diffuse and hard to
describe pain pattern. The patient often will grab the back of his or
her leg and exclaim that it hurts in the area being held. In either
case, the extent the sciatic irritation travels gives an indication as
to how involved the problem actually is; the further the pain or
sensation of burning, numbness, or tingling travels down the leg, the
worse the condition usually is.
The
symptoms of
sciatica generally get worse when seated, especially for extended
periods of time. Sitting actually places more weight on the lower back
than standing. This causes further irritation to the sciatic nerve.
Also, since the nerve passes either behind or directly through one of
the muscles that you sit on, the decreased circulation from sitting
also contributes to this problem.
If
your sciatica
actually gets better or goes away when you are sitting, even for a long
period of time, but worsens shortly after you stand up and start
walking, you may have a condition known as spinal stenosis. The word
stenosis means narrowing. People with this condition have bony build
that enters the central spinal canal. When standing, compression to the
nerve is increased because the ligament that runs near this nerve is
relaxed and takes up too much space in the narrowed canal it shares
with the nerve. However, compression is decreased the moment you become
seated or bend forward. Either of these two postures stretches the
ligament, which give the nerve in the narrowed canal more room.
Chiropractic
manipulation is successful in many cases of sciatica including spinal
stenosis if the condition is discovered soon enough. Adjustments
(manipulation) can be applied by either moving the vertebra surrounding
the irritated nerve or through other methods, such as
flexion-distraction, which works to improve the condition of the disc.
Treatment
goals are to reduce the irritation to the sciatic nerve and to improve
the circulation to the muscles and soft tissue that support and
surround this nerve. Initially ice, ultrasound, or galvanic stimulation
(an application of painless mild current) may be needed to reduce or
remove the swelling and waste products that accumulate from tissue
injury. As the swelling is reduced, further treatment is generally
initiated to stretch the muscles along the path of this nerve. Specific
exercises and massage therapy may also be utilized to and improve
circulation. Moist heat or a combination of moist heat and ice may be
used during this phase of treatment.
When
sciatica
improves, the patient usually notices that the sensation of pain,
burning, or tingling does not extend as far down the leg as it used to.
This is a common sign of healing. The degree of healing is further
supported by changes in lifestyle. Anything that will decrease stress
to the spine helps. With proper exercise, good nutrition, spinal
manipulation, and continued therapy, if needed, your condition should
continue to improve.