Chiropractic Care for Sciatica

Chiropractors routinely diagnose and successfully treat leg pain associated with inflammation of the sciatic nerve, commonly called sciatica. The sciatic nerve is the largest nerve in the body and it can be the source of significant pain and discomfort. Your chiropractor will carefully examine the source of your leg pain to differentiate the cause of sciatica.

Understanding Sciatica
Sciatica is not itself a diagnosis; it is a symptom of an underlying disorder. Your chiropractor will be evaluating four major causes of sciatica: a herniated disc or a tear in the outer fibrous rings of the disc, spinal stenosis, facet joint conditions, and nerve entrapment syndromes. In addition to these four common causes of sciatica, your chiropractor will also rule out other much rarer, but more serious, causes of sciatica, such as tumor, infection, or metabolic disease.

• Disc Herniation and Tearing: It's important to rule out a herniated disc or tears in the disc as the cause of sciatic pain, a condition known as sciatic neuritis. If your chiropractor finds that your leg pain is disc-related sciatica, then the evaluation and treatment program is for a disc injury.
• Spinal Stenosis: Another common cause of sciatica is spinal stenosis, a chronic narrowing of the bony canal or the spinal column, both of which can trigger nerve inflammation. A diagnosis of spinal stenosis as the cause of your leg pain will mean you are a candidate for chiropractic care suited especially to this condition.
• Lumbar Facet Syndrome: Facet joints can degenerate and go through arthritic changes. Degeneration of the facet joints can significantly contribute to sciatic nerve inflammation. A diagnosis of facet syndrome as the cause of sciatica will determine a treatment program of gentle chiropractic manipulation, sometimes including flexion-distraction protocol, and manual therapies especially suited for facet sprain.
• Nerve Entrapment Syndromes: Mechanical imbalances in the spine and pelvis, disc degeneration without herniation, and spinal joint restrictions (subluxations) can lead to muscular tightness (hypertonicity) that can cause "entrapment" (or trapping) of the sciatic nerve. Specific muscle techniques that address the piriformis muscle are used in chiropractic practice to treat sciatic nerve entrapment. Chiropractors utilize manual and muscle therapies, spinal manipulation, pelvic blocking, and other approaches to correct mechanical imbalances that contribute to entrapment.

Chiropractic Care and Sciatica
Chiropractors are doctors who specialize in the care of non-surgical conditions of the low back with gentle, time-saving approaches that address the mechanical and neurological causes of sciatica.

Chiropractors are rigorously trained to diagnose the different causes of leg pain associated with sciatica. Your chiropractor will take an extensive history and provide a comprehensive examination to determine whether you have disc-related sciatica or whether stenosis, mechanical spinal conditions and spinal joint restriction, or nerve entrapment are contributing to your leg pain.

The goal of chiropractic care in treating sciatica is to optimize motion in the spine, treat the spinal discs, reduce muscle spasm, and improve muscular strength.

Chiropractors are specialists in spinal manipulation—an active, hands-on care that returns motion to the spine. Depending on the cause of your leg pain, your chiropractor will choose a treatment plan that addresses the cause of your sciatic nerve inflammation.

How a Chiropractor Diagnoses Sciatica
Even if you go to the chiropractor complaining leg pain and low back pain, he or she will evaluate your spine as a whole. The chiropractor will check your neck (cervical spine), mid-back (thoracic spine), and low back (lumbar spine). It's important to examine the entire spine because even though it's just your low back that hurts, other regions of the spine may be affected.

Your chiropractor will determine areas of restricted joint motion, disc injury, muscle spasm, and ligament injury. One way the chiropractor does that is through motion and static palpation. Motion and static palpation is an examination by means of touch. The chiropractor will feel for tenderness, tightness, and how well each spinal joint moves.

The chiropractor will also analyze how you walk and look at your overall posture and spinal alignment. Those details will help your chiropractor understand your body mechanics and how well your spine is working and moving. You will be examined using standard neurological and orthopedic tests to rule out a herniated disc, a vascular problem or another organic cause for the leg pain.

You'll also go through your past medical history with the chiropractor. Your chiropractor will have x-rays of your spine taken, or an MRI if it is indicated, to evaluate possible degenerative changes.

After the examination, the chiropractor will be better able to create an effective treatment plan for your leg pain.

Possible Chiropractic Treatment Approaches for Sciatica
The exact treatment plan depends on your diagnosis. Your chiropractor may use a type of spinal manipulation, or spinal adjustment, to improve joint motion and soft tissue health. Some spinal manipulation techniques are:

• Specific spinal manipulation: The chiropractor identifies the joints that are restricted or show abnormal motion, also called subluxations, and returns motion to the joint with a gentle thrusting technique. This gentle thrusting rapidly stretches soft tissue and stimulates the nervous system to return normal motion to the spine.
• Flexion-distraction technique: This is a gentle, non-thrusting type of manipulation used to treat bulging or herniated discs. This treatment is still hands-on, utilizing a specialized table to assist the chiropractor, but uses a slow pumping action on the disc instead of direct force.
• Instrument-assisted manipulation: This is another non-thrusting technique. Using a hand-held instrument, the chiropractor can apply force without thrusting into the spine. This is especially appropriate in older patients with degenerative joint syndrome.

The chiropractor may also use manual therapy to treat injured soft tissues such as ligaments and muscles. Some examples are:

• Trigger point therapy: The chiropractor identifies specific hypertonic (tight), painful points on a muscle. He or she puts direct pressure (using the fingers) on these points to relieve the tension.
• Manual joint stretching and resistance techniques: Muscle energy therapy, an osteopathic technique, is an example of a resistance manual joint therapy.
• Instrument-assisted soft tissue therapy: The chiropractor may use Graston technique, an instrument-assisted therapy to treat the injured soft tissue. Your chiropractor will perform gentle repeated strokes of the instrument over the area of muscle injury.

In addition to spinal manipulation and manual techniques, the chiropractor may use various therapy modalities to help reduce the inflammation that can cause sciatica. Some examples are:

• Interferential electrical stimulation: This uses a low frequency electrical current to stimulate your muscles in order to reduce inflammation.
• Ultrasound: By increasing blood circulation, ultrasound helps reduce muscle spasms, stiffness, and pain. It does this by sending sound waves deep into your muscle tissues, creating a gentle heat that enhances circulation and heating.

To reinforce the improved joint mechanics (return of normal spinal motion), your chiropractor will prescribe therapeutic exercises.

Chiropractors are "whole person" doctors who view back pain as unique to each patient. Therefore, they don't focus on just your low back and leg pain. Chiropractic care includes nutrition, stress management, and lifestyle goals (because all of those can add to back and leg pain, so you need to address them if you really want to relieve your pain).

Chiropractors emphasize prevention as the key to long-term health—another example of chiropractors looking at the whole person, not just the painful problem. Keeping the low back healthy is vital to the chiropractic approach to care.

How Chiropractic Helps Patients with Sciatica
A chiropractor will help you return to your normal activities quickly so that you can enjoy your daily life without pain. He or she will work to address the underlying mechanical (how the spine moves) or neurological (nerve-related) causes of your sciatica.