An Overview of Sciatica

Sciatica is a term that usually describes pain that originates or travels down the sciatic nerve.  Sciatica is a symptom, not a disorder, and is the result of an issue in the lumbar spine.  The sciatic nerve is also very big; its about the size of the human finger!

Sciatic nerve fibers originate on the fourth and fifth lumber vertebra and the sacrum.  The fibers then create the sciatic nerve, which travels down through the sciatic foramen below the Piriformis muscle, which then runs down the hip and posterior thigh.  It continues to run down the leg and branches when it reaches the calf, before it runs down to the feet.

The symptoms of sciatica vary, but sciatica usually dominates one side of the body.  The way the pain is experienced in several ways: dullness, shocking, burning or shooting pain down the buttocks and thigh.  Sciatica can also extend down the leg and symptoms can even be felt in the feet.  These symptoms can make sitting for long periods of time and standing difficult, and coughing and sneezing can exaggerate these symptoms.

The root of this problem is the impingement on the lumbar nerves that give rise to the sciatic nerve.  This nerve damage is very rarely permanent and paralysis isn’t an issue as it will not affect the spinal cord; However, Cauda Equine syndrome, characterized by bladder or bowl incontinence, trunk or leg weakness and severe pain is a disorder which can require emergency treatment.

Some lumbar spine injuries that can cause sciatica include herniated discs, and degenerative disk disease, a biological process caused by aging, which causes disc weakness.  Lumbar spinal stenosis can also cause sciatica as it narrows neural pathways through disc degeneration or arthritis of the facet joints, which can pinch the sciatic nerve.  Isthmic Spondylosis, similarly, can cause sciatica as the 5th lumbar vertebra slips towards the first sacral vertebra.  This slippage may cause the the L5 nerve root to be impinged, causing sciatica.  Lastly, spinal tumors and other infections can manifest sciatica as the compress the sciatic nerve, although these are rare.

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To diagnose sciatica, your chiropractor will perform an exam which will include a review of your medical history and current medications, a physical and neurological test and, most likely, x-rays.  The diagnosis will be complete by analyzing the patient’s pain levels using pain indicators.  The chiropractor may ask how the pain developed, how you would rate your pain on a 1-10 scale, if the pain gets worse walking up hill or down hill, how the pain affects you daily and what types of treatments you’ve tried before.  Range of motion will be tested along with muscle reflex and strength.  Lastly, the chiropractor will locate the source of your pain..

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