What is Sciatica and how do you treat Sciatic nerve pain?
For anyone who has ever had sciatica, you know how excruciatingly painful it can be. If you’ve ever wondered what is causing the pain, what can be done to fix it, and what you can do at home to help, then this article will help you to better understand what sciatica is and how to treat it safely and effectively without surgery.
What is sciatica?
Sciatica is a problem that affects the sciatic nerve, which is the largest nerve in the human body. The sciatic nerve begins in the lower back and sacral area, specifically from the nerve roots from vertebral levels L4-S3. The nerve then travels from the lower back, through the buttocks down the back of both legs and eventually into the feet.
Sciatica is a condition that typically causes pain in the lower back and down into the legs, sometimes travelling as far down as the feet. It’s typically caused by some type of pressure on the sciatic nerve, often because of inflammation or swelling, which may lead to sensations of numbness, tingling or pain into the lower back or down into the legs.
Sciatica has become increasingly common over time, and is estimated to affect as many as 40 percent of people during the course of their lifetime, becoming increasingly common as people age.
What causes sciatica?
Sciatica is most often caused by compression of the sciatic nerve as it exits from the spinal cord. This compression can take place locally at the spine, or may occur further down as the nerve passes down the buttocks and legs.
One of the most common causes of sciatica is from a bulging disc, herniated disc or slipped disc pressing on the sciatic nerve in one of three ways:
- Direct pressure from a protruding spinal disk
- Compression from inflammation
- Compression from swelling
Sciatica may also occur from advanced arthritis or degeneration in the lumbar spine (degenerative disc disease), and from other conditions like a spondylolisthesis (slippage of one of the lumbar vertebra). In addition, misalignment of the lower lumbar spine or sacrum can result in decreased motion and localized inflammation, resulting in localized muscle spasm. Such misalignment may contribute to sciatica.
Muscular hypertonicity, such as piriformis syndrome in the gluteal area, may also contribute to sciatica, when there is direct muscular compression on the sciatic nerve caused by spasm of the piriformis muscle.
Other cases of acute trauma or injury, fracture, tumours or infection may also be responsible for sciatica, although these are far less common.
With severe spinal arthritis in the lumbar spine, lumbar spinal stenosis may also cause sciatica.
Many of these causes of sciatica are caused by excessive physical lifting or repetitive and overuse injuries involving the lower back, over many years. These flexion or forward bending type actions increase the likelihood of lumbar disc injuries and arthritis, leading to inflammation and an increased probability of compression of the sciatic nerve.
To fully understand what the underlying cause is, following a thorough history and physical examination, it is often recommended to have additional diagnostic testing done, in the form of x-rays, CAT scans, or MRIs.
What are the symptoms of sciatica?
Sciatica symptoms vary significantly between patients, but often involves sharp or shooting severe pain in the lower back or leg area. This pain may be more localized in the gluteal or hip area, but as the sciatica worsens will often travel more distally down the leg, towards the knee, and even beyond to the feet.
Symptoms of sciatica may also be experienced as a tingling sensation, pins and needles, numbness or even a weakness in the legs or feet.
The pain or other symptoms may often be aggravated with prolonged sitting, with bending forwards to pick up items, with heavy lifting, or when twisting in bed a night. This may make sleeping very difficult, getting out of bed very painful, and may limit the ability to walk long distances.
In some rare cases, these symptoms may also be associated with problems like bladder control or bowel movements. If you experience any of these symptoms, sometimes also combined with altered sensation on the inner portions of your thighs, this may be a rare but serious condition considered a medical emergency termed Cauda Equina Syndrome. If you are experiencing these symptoms, please go to your local Emergency Department immediately, as there may be direct and serious compression on your spinal cord.
Treatments for sciatica?
Treatment options for sciatica vary significantly depending on the underlying cause and on the level of severity of symptoms.
While in the past bed rest and inactivity were recommended, current research shows that for the vast majority of patients, staying upright and active provides more relief and better long-term patient outcomes. Bed rest may feel good initially, but prolonged inactivity has been shown to worsen the condition and slow down recovery, as well as resulting in muscle weakness over time.
Walking and Activity
Ideally, sciatica patients are encouraged to stay upright in the morning after waking from bed and to try to walk and move as much as possible. Walking has been shown to be one of the most effective forms of movement for sciatica patients. Minimizing forward bending and prolonged sitting has also been shown to help recovery and prevent flare ups.
Sciatica treatment may also include medication such as NSAIDs (non-steroidal anti-inflammatory drugs) which may be helpful in the early stages of sciatica to reduce pain. Although not curative in nature, they may provide some temporary relief.
Other alternative treatments like massage therapy, physical therapy, acupuncture, chiropractic treatment and traction have all been shown to have benefit with sciatica patients, depending on the specific cause of sciatica.
For more severe cases, doctors and orthopaedic surgeons may recommend surgery to remove the cause of inflammation or blockage of the sciatic nerve, although any surgical intervention comes with significantly higher risk of potential complications.
Tips to help treat Sciatica naturally at home
- The first step in self care is to avoid the cause of your sciatica pain. You should avoid aggravating factors that may be responsible for your sciatica pain such as sitting or standing for long periods of time, or excessive forward bending, which can worsen sciatica pain. Avoid prolonged sitting on anything that is soft that may compress the low back, and minimize any hunched or slouched posture.
- Staying upright and moving around, ideally walking, will help with sciatica pain relief. Movement in your lower back is important to minimize the strain on the intervertebral discs and nerves in your low back. Movement is important, so you should only lay down if walking or standing is too painful, or you are becoming tired. Laying down is preferable to sitting.
- If you have to lay down, the best option is on your back with a small pillow under your knees, to help keep your hamstrings relaxed. Alternatively, you can lay on your side with a pillow between your knees.
- It is important to avoid or minimize how much sitting you do in the first hour of the morning, particularly after getting out of bed. It is important to stay upright and moving for the first 30-60 minutes in the morning, to minimize the pressure on the lumbar discs for pain relief. There is more pressure in your lumbar discs at first when you get out of bed, so this is the time of the day you must be most careful with sciatica.
Hot or Cold Treatment for Sciatica?
The most current research shows that cold treatment or ice treatment is likely most effective in the initial stages of acute sciatica, the first 24-48 hours, after the onset of sciatic pain. Beyond this initial symptomatic stage, research shows that the vast majority of sciatica patients benefit more from heat therapy application for pain relief, particularly if the sciatic nerve pain is beyond 48-72 hours in duration.
For most people, applying the heat over the lower back and gluteal/pelvic area seems to be most effective, and will help to release some of the muscle tension in the area, which may be part of the cause of the pain.
Can a chiropractor help sciatica?
There is strong research evidence for chiropractic care to help sciatica pain relief, with more limited evidence for other conservative treatments like massage therapy and acupuncture. Chiropractors use spinal manipulation and gentle mobilization exercises to treat the nerve roots that are pinched or damaged by inflammation or swelling, or by a herniated disc in the lower back.
Chiropractic treatments are designed to restore proper mobility and movement into the irritated areas of the spine, most often the lower lumbar spine. By restoring movement, which is critical for all sciatica sufferers, this helps to decrease inflammation and swelling, and helps to restore proper muscle function in the area.
At our chiropractic clinic in Toronto, Transform Chiropractic, we also focus on restoring proper posture to minimize any flexed hunched posture, which will help to take tension off of the sciatic nerve roots, helping to decrease pain. Research also shows that restoring proper joint movement helps to block some of the local inflammatory pain signals, helping with recovery.
Furthermore, our chiropractic doctors recommend certain exercises or stretches for sciatic nerve pain that help to alleviate some of the pain, accelerate recovery, and potentially prevent relapses in the future. For more information on our chiropractic sciatica treatment, please visit our sciatica treatment page at https://www.transformchiropractic.com/sciatica-toronto/.
Sciatica Exercises and Stretches
As with any injury, the goal is not “no pain, no gain” but initially to manage pain. Start out gently, and do not push the exercise if there is increased pain. Sciatica stretches and exercises are a critical part of self-care treatment.
Sciatic Nerve Flossing:
Developed by Dr. Stuart McGill, this exercise is designed to floss the sciatic pinched nerve, to help to remove any restrictions to its passage in the spinal canal or foramen, and to minimize any associated inflammation or tension on the nerve root.
Piriformis Muscle Stretch:
The Piriformis stretch is intended to take pressure off of the sciatic nerve. The piriformis muscle crosses the sciatic nerve, and if it becomes chronically shortened and inflamed, it can compress and irritate the nerve. By stretching and taking tension off the muscle, it is intended to release tension from the sciatic nerve, at one of its most likely impingement points.
What makes sciatica flare up?
Sciatica generally flares up when the activity directly irritates the inflamed tissues surrounding the sciatic nerve. In the majority of cases, prolonged sitting or in particular forward bending tend to cause sciatica flare ups. This will depend on the underlying cause of sciatica, but with disc bulges or a herniated disk being common causes of sciatica, both sitting and forward bending aggravate lumbar discs, and would contribute to flare ups. Try to avoid prolonged sitting, and avoid excessive forward bending, particularly early in the morning.
How do you know when sciatica is getting better?
Sciatica is generally recognized to be improving when there is less pain, but particularly when there is less pain down the legs or into the feet. This term is called centralization, meaning that if the leg or foot pain is gradually disappearing, this indicates that there is less irritation of the sciatic nerve. There may still be back pain, and in some cases the back pain may slightly worsen, but if the leg pain is slowly improving, or moving from lower in the leg to higher up the leg, back towards the lower back, this is a sign of healing and improvement of sciatica.
How long does it take for sciatic nerve pain to go away?
The duration of sciatica will vary significantly, based on the underlying cause of sciatica. If the sciatica is caused by muscle tension or piriformis syndrome, is will tend to improve much faster than a more complicated cause, such as a herniated disc, disc bulge, or spinal stenosis.
In general, for the majority of people, sciatic pain may last for about four to six weeks, and then gradually improve over time. However, in some cases of more complicated origin, sciatic nerve pain may last for month, particularly if the underlying cause is being continually re-aggravated.
If you have any further questions about sciatic nerve pain, or if we can help, please don’t hesitate to contact our Toronto chiropractic clinic at www.transformchiropractic.com, or at 416-604-4184.
Dr. Byron Mackay
Published first here: https://www.transformchiropractic.com/sciatica-nerve-pain-treatment/