Are you looking for ways to prevent sciatica or manage it with conservative therapies? SpineUniverse reached out to William J. Lauretti, DC, FICC, FACC, associate professor at New York Chiropractic College in Seneca Falls, NY, and spokesperson for the American Chiropractic Association (ACA), for his thoughts on how to avoid and reduce this debilitating low back and leg pain.
Q: What is the role of chiropractic care in managing sciatica and its potential recurrence?
There’s clear evidence that the manual treatments chiropractors provide do help patients gain and maintain more motion and flexibility in their spines—we call it less stiffness. You don’t want your spine to be stiff. The theory is that stiffness can get worse with time and spread throughout the spine. Stiffness leads to numerous spinal problems: It throws off the balance of the spine, can lead to herniated discs, and can eventually cause sciatica. Sciatica isn’t just related to disc injury—it can also be caused by tight muscles (nerves can get entrapped in the deep muscles of the buttocks).
The best way to avoid spine problems, in general, is to stay flexible and avoid spinal stiffness. As chiropractors, one of the things we do best is help keep patients from getting stiffer. In my personal experience, I’ve helped patients recover from a bout of sciatica, and then I’ve treated them on a long-term, less frequent basis to keep flexibility in their spine to prevent a recurrence. I’ve also had several patients who’ve had lumbar surgeries and come to me to help manage continuing pain.
Sciatica is usually considered a condition of middle age. I found one study that said peak incidence is between ages 40 and 49. On either side of that range, you have an upward curve as people reach their 30s, and the risk goes down when they reach their 50s.
Q: What activities best prevent sciatica?
Maintaining a healthy weight reduces your risk for sciatica, so engaging in activity is an important preventive measure. Low-impact exercises are especially good, and stretching is excellent for sciatica prevention—particularly stretches that work out the low back and gluteal muscles.
Q: While staying fit and at a healthy weight are important, are there exercises that people with sciatica should avoid?
Studies have shown that people in occupations that require them to twist from the trunk, or work while bending or squatting tend to have higher sciatica risk. Based on that, sports that involve those activities, such as certain types of weight lifting, probably do carry a higher risk of causing sciatica. If you enjoy weight lifting, work with a personal trainer, physical therapist, chiropractor to ensure you’re lifting correctly.
Q: Can an anti-inflammatory diet help reduce or prevent a sciatic episode?
In theory, yes. But as far as I know, there hasn’t been a study to confirm it. However, studies have looked at the effect of anti-inflammatory drugs on sciatica—and anti-inflammatory drugs are more powerful than an anti-inflammatory diet, at least in the short term. Specific to sciatica, studies show anti-inflammatory drugs are only marginally better than a placebo.
Based on that, if you follow an anti-inflammatory diet or taking anti-inflammatory herbs like ginger and turmeric, it likely isn’t going to have a major effect on sciatica. Instead of a specific type of diet, I recommend people focus on eating a healthy, balanced diet rich in fruits and vegetables.
Q: What advice do chiropractic physicians give their patients to manage and prevent sciatica?
The best advice is to try to remain as active as you reasonably can. Certainly, you want to avoid activities that you know are worsening your pain, but being active is good for your overall spine health. Also, smoking is a major risk factor for sciatica and back problems in general.
I also make sure my patients understand the possible red flags. What you need to look for is a true, lasting loss of sensation in the legs or feet, or true weakness (you can’t stand on your toes, or you drag your feet while walking). The biggest red flag related to sciatica is loss of bowel or bladder control. If my patients experience any of these red flags, I refer them for an urgent surgical consultation.
Overall, chiropractic focuses on keeping people active and doing exercises. A lot of people fear chiropractors because we have a reputation of doing high-velocity spinal adjustments and motions. However, the latest evidence shows there is no greater risk of a disc injury from a chiropractic appointment than if a patient went to their primary care doctor.
Q: What else do you want people with sciatica to understand about managing their pain and preventing future episodes?
I think the worst message people can be left with is what we call catastrophizing the pain—leaving the patient with the idea that one false move will cause permanent damage. For example, a doctor might tell you if you bend the wrong way, your spine is so fragile that you could injure yourself.
Labels are powerful things. If you label a patient as disabled, that’s a powerful message that sometimes creates more disability than it fixes. In treating back problems, the tendency is to over-diagnose and do a lot of unnecessary testing—and doctors will inevitably find something that probably has little or nothing to do with the patient’s problems. That is a dangerous thing for the overall health and well-being of that person. Certainly, you don’t want to ignore significant findings, but the tendency in treating back pain over the past 50 years has been to over-emphasize imaging findings that aren’t clinically significant.
It’s much more beneficial to focus on the positive. And, in the majority of cases, people with sciatica do get better. The positive message is important. The most valuable thing we as chiropractors can do is give people positive advice and a positive message that things do get better.