5 Causes of Sciatica

First, let us define what sciatica actually is and is not. Sciatica is, very specifically, pain along the sciatic nerve stemming from irritation of that nerve. The sciatic nerve is formed from a conglomeration of spinal nerves in the low back which binds together into one sheath. This nerve runs under the piriformis muscle in the pelvic area, then runs in between the two parts of the biceps femoris, also known as the hamstrings. It has become common to call any pain in the leg which is suspected to come from the back, sciatica. However, sciatica is a nerve pain which is the same feeling you get when you hit your “funny bone.” Most leg pain, and consequently what most people call sciatica, is actually referred pain. That is a different post. To be a true diagnosis of sciatica, it must be nerve pain that stems from the lumbar spine and runs into the buttock and/or down the backside and middle of the thigh. Now that we have that out of the way, let’s talk about what causes it!

  1. Disc Injury. Disc injuries are the most common back ailment. When a disc bulges or herniates, it can occupy the space where the spinal nerves exit from the vertebral column. If a disc bulges too far it can push against the nerve root causing pain to travel down the sciatic nerve and beyond. Sometimes, the bulge will hit the nerve and then pull back enough so that the sciatic pain is not constant. If the disc is in constant contact with the nerve, one can experience pain, numbness and tingling, weakness, and other symptoms. Chiropractic can help, but these can take a long time to heal and consistency makes the difference. Traction, rehabilitation exercises, physical therapy, and stretching can also help if done properly. If it comes to it, cortisone injections and surgery may be last resort options.
  2. Inflammation. With injury comes inflammation. Though the disc is the most common injury, there are several other structures in the area of the nerves that make the sciatic nerve that can be injured. Inflammation is toxic and can cause its own set of issues. Nerves are especially sensitive to inflammation. Icing, NSAIDs like ibuprofen, Chiropractic, and steroids can all help reduce inflammation. When the inflammation is in check, the back and sciatic pain will diminish. When the area with the sciatic nerve or nerve root is inflamed. The symptoms will remain constant.
  3. Sacro-Iliac (SI) Joint Dysfunction. The sciatic nerve crosses the SI Joint just after it forms the large nerve. If the pelvis shifts or is not working properly, it can irritate the Sciatic Nerve through direct pressure, inflammation, or by causing muscle tightness or spasms from the imbalance. Adjusting the SI joint will help reduce inflammation and muscle guarding, as well as move it away from contact with the nerve if that is the case. Chiropractic is by far the best thing for this case but a clever physical therapist can help, too. Exercise, stretching, and icing may help but can irritate it, as well.
  4. Piriformis Syndrome. This diagnosis has become pretty popular. I find that it is misdiagnosed more often than not. The piriformis is a little pear-shaped muscle (hence the name, piri means pear), that spans the SI joint. The Sciatic Nerve runs underneath it in most individuals. If this muscle tightens, it can compress the sciatic nerve and cause sciatica. The piriformis can tighten for various reasons including any of the above-mentioned maladies. Usually, I find the piriformis is a secondary issue. Sometimes, however, it can take on a life of its own after the other condition has resolved. If it is, truly, piriformis syndrome, the best thing to do is have a specialist perform a muscle release on it. Active release, myofascial release, Bowen, Rolfing, massage, etc. can all help if done right. Be aware that if it only helps for a little while, then there is probably another issue that is still causing the muscle to tighten or guard.
  5. Direct Contact. Because the Sciatic Nerve runs through the buttock and down the back of the leg, the way one sits can cause sciatica. The most common cause is a wallet in the back pocket. Additionally, a seat that curves upward along its lip can put pressure on the legs and irritate the nerve. Unfortunately, I have seen this most often in vehicles.  The solution for these is obvious. The trick is to figure it out before it causes problems more difficult to remedy.

There you have it. Probably not a comprehensive list but definitely the most common causes. Sciatica is actually rarer than it seems. When you have it, however, it is very painful and can be difficult to treat. If you are experiencing sciatica or any type of pain or other symptoms down the leg, chiropractic can help. And, like all conditions, being prompt and consistent makes for better and quicker healing.

Chiropractic and the Healing Process

In this world of instant gratification, realistic expectations are often scarce. We have instant coffee, fast food, automatic deposit, etc. We demand results quickly and for most things we get them. Unfortunately, healing is not an instantaneous event. It takes time. Don’t get me wrong. I am as impatient as anyone. I like to see or experience improvement quickly. However, when it comes to healing, there is still a process.

This article was written to help you understand the healing process and what to expect on your road to recovery.

The healing process has several stages. They can be broken down into three major steps:

1. Inflammation: Whenever an injury occurs there is damage to tissue. Tissue damage causes a reaction in the body that brings chemicals to take care of the damage. It causes swelling which keeps the affected area from moving too much. The reaction also generates heat, hence the term. I like to compare inflammation to firefighters putting out a fire. They arrive quickly and start shooting water onto the fire. Though necessary, often times the damage from the water is just as bad as the damage from the fire itself. This is even more true of inflammation. If not taken care of quickly, inflammation will begin to destroy the good tissue and cause a host of other problems. For this reason, ice is a powerful tool. Controlling the swelling with compression and an anti-inflammatory diet can also be very valuable.

2. Scar Tissue Repair: After a 2-6 days of inflammation, the body starts to lay down scar tissue. Scar tissue is weak and it complicated by the fact that it is laid down quickly and haphazardly. To further the analogy of a home damaged by fire, imagine a crew going in after the water has mostly dried and quickly supporting the overall structure with whatever wood they can find. They make it more stable than it was but it is not as functional and it is certainly not as stable. Scar tissue is supposed to be a temporary process that takes 6 weeks to 6 months depending on the damage. Unfortunately, many people do not do what it takes to get beyond this stage. As a result, they easily tear the scar tissue and the process starts again. This is the cause of chronic injury.

3. Remodeling of Tissue: When scar tissue starts to act like the original tissue, the remodeling process has begun. It is critical to get to this stage if true healing is to occur. This stage can last for a long time. For some tissues, like the nervous system, the process can be so slow it is almost imperceptible. For such tissues, support therapies like hyperbaric can help. In joint,  muscle, bone, ligament, tendon, etc., proper motion and function dictate this process. You have to train the scar tissue to line up all in the same direction and act like and be in sync with the surrounding tissue. Only at this point will true healing occur.

Unrelated topic: when you make a comment on this blog, you will automatically be entered into a drawing to win free chiropractic care for April.

Bursitis? Isn’t That What My Grandma Has?

By request, I am going to blog about bursitis. Most people have no clue what I mean when I tell them they have bursitis, even though they may have heard of it. I like to explain it like this: Suppose you have a rope hanging over the edge of a cliff. If the rope swings or moves it will start to wear out at the point where it makes contact with the rock, right? So, to avoid the wear and tear, you place the bag that you used to carry the rope up to the top of the cliff (rock climbers and repellers will relate) under the rope. This will help reduce friction and keep the rope from fraying.

In this analogy, the rope is like a tendon which is the continuation of a muscle that inserts it into a bone. Tendons often stretch over a bony edge, the cliff. The bursa, then, is the bag y
ou put under the rope or tendon to reduce friction. It is, indeed, a sack that is flat and fluid filled. Because it is fluid filled, the outer edges glide back and forward on each other underneath the tendon thus limiting friction of the tendon.

Anytime you see or hear the suffix “itis” it just means inflammation. So, bursitis is inflammation of the bursa. How does it happen? There a few ways you can develop bursitis. The most common happens when you put too much tension on the tendon and therefore too much pressure on the bursa. Imagine the rope wearing out the bag. This can happen with poor muscle mechanics or just too much load. In a shoulder bursitis what comes to mind is someone with bad posture whose shoulders are slumping forward who starts to lift weights at the gym but doesn’t want to look like a sissy so they lift too much. This scenario neatly covers most of the common risk factors. (There can also be metabolic conditions that cause bursitis, like calcium deposits in the bursa and things like that but they are not as common and frankly would bore you, probably even more than this).

The way to determine if you have bursitis is through a process of resistance and elimination. The first thing you have to rule out is a tendinitis, (which you have cleverly deduced based upon earlier information is inflammation of a tendon). The tricky part is that a tendinitis feels the same as a bursitis. Usually, bursae (the plural of bursae) have more that one tendon running over them so the only way to distinguish the two is to test all of the tendons by checking resistance of all of the muscles attached to the tendons. If stress on every tendon is painful it is more likely you have a bursitis instead of tendinitis of all of the tendons. In simplicity, if it hurts when you use your arm in every motion it is most likely the bursa.
Healing bursitis can be difficult. Motion causes the bursa to work, so any motion is potential for more inflammation and pain. The key is to reduce the inflammation. You can do that through icing (15-20 minutes at a time) and rest. For diet, it may sound crazy but a half a fresh pineapple a day for 6 six days reduces inflammation like a champ. Also, Omega 3 supplements really help.
The other thing you have to address is why you developed the bursitis. If a joint is subluxated or you have bad posture you need to be adjusted to reduce the amount of pressure on the bursa. Likewise, changing how your mechanics or the amount of resistance can make a big difference.