What is Sciatica?
Have you been told you have sciatica? Are you wondering if you have sciatica?
Sciatica is pain.
In fact, the name sciatica is a latin word made up of two parts. Sciatic and the ending -a. Sciatic refers to the name of the nerve that forms from the L3, L4, L5 nerve roots as they exit the spine and are bundled together into one “nerve”. It is like a bunch of wires that are wrapped or bundled together so they are organized in a nice neat pathway. The sciatic nerve pathway travels down the back of the leg.
The latin ending -a means pain. So take sciatic and add -a and you get sciatic pain or pain coming from the sciatic nerve.
Which means when you recieve the sciatica diagnosis you have just been told you have pain running down the back of your leg.
Isn’t that what you told the doctor when you came in in the first place?
Is A Diagnosis Of Sciatica Really Helpful?
It’s always good to get the accurate diagnosis. This way the proper treatment can be found. However, in the case of sciatica the diagnosis needs to be further explored and the cause of the sciatica needs to be found. Just naming it sciatica is not good enough.
The Three Most Common Causes Of Sciatica
There can be many causes of sciatica and the correct cause should be found out so that the correct treatment can be applied. So at this point it is recommended you seek a chiropractor or medical doctor competent in treating conditions associated with pain in the lower back or running down the back of the leg.
That being said there are three main causes of Sciatica.
Misalignment of Vertebra
Herniated / Bulging Disc
Misalignment of Vertebra
If you’ve ever experienced a fall, odd step off a sidewalk or curb, car accident, or any other type of physical force to your body you may have a misaligned vertebra. If the lower lumbar (lower back) vertebra are misaligned they can create any number of problems in the lower back or legs. When vertebra are misaligned four things will happen everytime. First, the misaligned vertebra will cause a restriction of motion. This may be noticeable to the patient but sometimes is not. It can always be demonstrated in an examination if it exists. Second, the misaligned vertebra will cause an imbalance in the skeletal structure which is identified simply by observing the way a person moves or looking at their imbalanced posture. Is one hip higher than the other when you look in the mirror? Or is one leg shorter than the other when lying down? Thirdly, misaligned vertebra will cause inflammation or swelling in the area. This is difficult to detect in the lower back because of the thickness of the muscles. One way to tell is to hold the hand over the back and feel if there is any increase in heat. A chiropractor trained in detection of misaligned vertebra can usually feel the swelling or has an instrument to measure if there is any abnormal heat patterns. Lastly, misaligned vertebra will cause muscle spasms. When a person has muscle spasms they usually know it. The back is feels tight and pain is increased when they use the muscle (move a certain way). The problem with this is many doctors will diagnose the patient with myalgia (muscle pain) myospasm (muscle spasm) or a strain or sprain of the muscle. While the doctor is correct that this condition exists it is not the correct and full diagnosis. The doctor should check to see if it’s being caused by a misaligned vertebra. The treatment for a misaligned vertebra is far different than just treating the muscle spasm.
Herniated / Bulging Disc
If the sciatica is being caused by a herniated and/or bulging disc then the problem is more serious. The disc in our backs are made of a very tough ligamentous type structure which is not easily damaged. In the middle of that disc structure is a gel like substance that forms the nucleus (center) of the disc. When a person has a bulging disc it means the gel substance is being pushed or pressured from the center outward and is bulging out. When the disc has bulged out and actually broken through the ligamentous barrier it is then said to be herniated. This ligamentous barrier is supposed to hold the gel in the middle. It will do so unless it is somehow damaged. Usually, it suffers a trauma to it and is injured and then slowly over time it deteriorates. Usually, with some thought or correct questions from the doctor and sometimes looking at an x-ray the original date and cause of the weakened disc can be found. Because the disc is a “soft tissue” of the body (meaning it’s not bone) it is only able to be properly diagnosed with an MRI.
Stenosis means an abnormal shrinking of a hole. It could be the hole formed by the vertebra called the spinal canal, which is where the spinal cord is. Or it could be the hole where the vertebra fit together and for the neural foramen. There is one neural foramen on the left and one on the right between each vertebra. This hole, or neural foramen is where the nerve root exits from the spinal cord and travels out through the hole and away from the spine to go to a part of your body. For our discussion here the L3, L4, L5 nerve roots exit out between L3/L4 neural foramen, L4/L5 neural foramen, and L5/S1 neural foramen. These then join back together to form the sciatic nerve. When a person is given the diagnosis of stenosis it can either be canal stenosis or neural foramen stenosis (left or right) or a combination of these. So, what causes the hole to shrink? As with sciatica having many causes, there can also be many causes to the shrinking of a canal or foramen. And, as with sciatica, stenosis has three causes that occur most often. First is a herniated or bulging disc that is extending out into the foramen or canal and thereby pressing into the “hole”. This didn’t actually make the hole smaller but did press into it and is applying pressure to the contents of the “hole”. Second, is Ligamentum Flavum Hypertrophy. What? Sorry, but no other way to put it. The Ligamentum Flavum is a ligament that runs in between those bumps you see or feel on your back. If there is strain on this ligament over time it will respond by gaining size. Might be cool if it were your bicep. But when this ligament gets bigger it grows or extends into the spinal canal and can compress the contents thereby “shrinking” the canal. Lastly is the only one that actually shrinks the hole. This is most commonly referred to as arthritis. Arthritis is not really a good diagnosis. It might be what a doctor tells a patient is the diagnosis but it is rarely used to tell another doctor what the diagnosis is. The better description of this “arthritis” is facet hypertrophy or osteophyte complex. Both of these are the same thing just different locations. They are the result of increased stress on the bone and therefore the bone responds by increasing in strength and size and grows. The problem is it grows in the form of a bone spur and grows into the canal or foramen and actually shrinks the opening. This is true stenosis.
What Should You Do About Your Sciatica?
Home Care for Sciatica?
At home it is best if you think you have sciatica to apply ice. Don’t freeze it to being uncomfortable but cool it down. Apply the ice pak for approximately 15 minutes. Also, rest and avoid any twisting at all as this tends to aggravate sciatica. Even if this helps and the pain subsides or goes away it is still best to find out what caused the issue to see if it might return. Call our office at 386-672-3305 and we can do a no cost consultation to evaluate for the three most common causes of sciatica and also rule out any other rare causes.