Sciatica, what is it?


What is this ache shooting down my leg?

It’s not uncommon for a patient to seek out a Doctor of Chiropractic for sciatica, and many times with the use of the internet people are coming in self-diagnosed, saying they have sciatica, but few actually understand what it is.  For every 10 people coming in with it, less than one actually has it.  Correct diagnosis is important because that determines treatment, and if you’re not getting the correct treatment you won’t see any results. 

Sciatic Nerve

Sciatica is inflammation/irritation/damage to the sciatic nerve and the resulting symptoms (usually pain) and is almost always one sided.  Pain is normally the first symptom you will experience, after time tingling and numbness may develop, in advanced/extreme cases muscle weakness or paralysis of affected muscles may occur (typically from significant trauma).  This nerve starts in the pelvis after the L4, L5, and S1 nerve roots join up.  It travels out to the gluteal crease of the butt under the piriformis muscle, down the back of the thigh and behind the knee.  After the knee it branches out primarily into 4 other nerves.  This primary nerve controls the muscles of the lower legs, ankles, feet, and toes.  The image below is the sensory pattern of the nerve, meaning where the nerve conveys pain and other information from the body to the spinal cord.  

Sciatic pain

If your pain pattern does not match the colored areas to the left, you don’t have sciatica.  When a nerve is injured, if it carries pain signals, all areas away from the spine that that nerve communicates with will have symptoms.  It is possible to have pain in the sciatic nerve without the nerve itself being injured, this usually involves an injury occurring to the spine or near the spine, Chiropractors are trained to differentiate these types of issues, to read the nervous system like a road map.  Typically injuries near the nerve roots will affect only part of the sciatic nerve distribution above. 

How did I get sciatica and how do I treat it?

The sciatic nerve can become entrapped in 2 common locations.     The piriformis muscle running along the gluteal crease to the hip is the most common, and usually referred to as Piriformis Syndrome; this will result in pain starting at the butt and going down the leg into the regions above.  Another possible entrapment point is deep within the pelvis or lower back, again pain will start at the point of injury.  It isn’t uncommon to see injury to this nerve with trauma to the back of the thigh or knee, again pain will start at the point of injury and go into the lower leg.  Patients with sciatica will typically have difficulty sitting due to pain as well.  Most common conditions we see that get confused with sciatica are IT-band syndrome (Pain down the side of the thigh to the knee), gluteal spasms (pain from the pelvis to the hip), and pelvic joint injuries (localized pain from the lower back into the gluteal crease and hip).

Treatment in the office involves identifying the site of injury first and applying the appropriate treatment.  Chiropractic treatment is very effective in correcting bad mechanics in the legs, pelvis and lower back that result in irritation to the sciatic nerve.  Stretching ,exercise, rehab can be used to treat muscular issues that result in irritation to the sciatic nerve.  In the case of injury to the nerve; Ultrasound, EMS, and Acupuncture can be utilized.    

Scott Kiemle