[Sciatica] Different Causes = Different Treatments

By Dr. Bryen Brown

February 15, 2018

Sciatica is a term that is used loosely and sometimes incorrectly by many.

It’s usually based on the person having symptoms such as low back pain or pain going down their legs. Being a musculoskeletal specialist, there are many different causes of low back pain and pain going down your legs and sciatica is just one of them. Today in this article I will give you a couple different causes of sciatica and treatments that will target those certain causes.

In a general sense, just to clear up the definition of sciatica, I looked at the Merriam-Webster Dictionary and they define sciatica as “pain along the course of a sciatic nerve especially in the back of the thigh; broadly : pain in the lower back, buttocks, hips, or adjacent parts”. So when looking at that definition its more about what you feel. I get why many people can be confused and say they have sciatica because they have low back pain, it clearly states in the dictionary that sciatica is low back pain.

Sciatica can have different symptom presentations.

It doesn’t always have to shoot down the legs, it doesn’t always have to include numbness and tingling, and so on. I’m not here to argue with anyone about the symptoms of sciatica. There’s a ton on research on sciatica and what it is and isn’t. The one thing I know is that it affects a lot of people and the most important thing people need to know is what’s causing their lower back pain/sciatica/buttocks pain/leg pain/numbness and tingling so that they can get rid of it.

The first questions that need to be asked is “Where is the nerve being compressed and what is compressing it?” In the lumbar region (or low back) and sacral region (what most people call the tailbone) individual nerves exit out the spine and join together in the buttocks region to form the biggest nerve in the body, the sciatic nerve. You feel sciatica when there is pressure on either the individual nerves or the larger sciatic nerve. The most common problem with sciatic sufferers isn’t pressure on the larger sciatic nerve but with the smaller individual nerves exiting the spine. Depending on how that nerve is compressed outlines the direction of treatment.

The individual nerves leaving the spine get compressed two different ways: vertebral misalignment and disc bulging/herniation. Treatment options can differ depending on severity is condition.

They both can have the same symptoms but “patient A” may have a spinal misalignment and “patient B” a disc herniation. The direction of treatment should not be the same. This does not mean they will not get some of the same treatments. One way to know what is causing your sciatica is to see a musculoskeletal specialist, that is your local chiropractor. If you don’t have one, get one.

“Patient A” has a vertebral misalignment creating sciatica. The 24 vertebrae in an adult human body can be shifted out of its normal alignment and get stuck. These misaligned bones can pinch the nerves that are exiting through a hole below it. An example I like to use in this scenario is straw. When the straw is pinched the fluid does not flow or flows at a lesser rate. The straw represents a nerve being pinched that causes pain, numbness, tingling, weakness, and a few other symptoms. Vertebral misalignments pinching nerves are defined as subluxations. You remove the problem when you remove the subluxation.

You remove the subluxations with chiropractic adjustments that helps to realign the vertebrae which will help take pressure off the nerve.

Stretching exercises will help by allowing for better spinal flexibility and motion. Spinal strengthening exercise help to promote spinal stability by strengthening the muscles and ligaments that act on the spine. Together these treatments are very effective in treating sciatica caused by subluxation of the spine. It is also the most cost effective treatment. How do you find out if this is the cause of your sciatica? Find a chiropractor and schedule a visit. If you’re nearby its easy, just click here. A consultation only will be at no cost and you will get the opportunity to speak with one of our doctors and we will find out if we can help.

“Patient B” has damage to the disc causing sciatica. The spinal disc are located between the vertebrae. The outer layers of the disc are made up of ligamentous materials that form rings called the annulous fibrosus. It helps keep the inner gelatinous material in the inside the disc. A disc can be damaged is two ways, a disc bulge and a disc herniation. These two can be confusing so I’ll try to give a good explanation of both. A disc bulge is more wear and tear over time. It’s considered degenerative. Imagine your hands above and below a balloon and over time you squeeze your hands closer and closer together. The more you squeeze the more the balloon bulges out in all directions. In this example, your hands represent the vertebrae above and below the disc which is represented by the balloon that’s bulging. Disc bulge increases the risk of the nerve being pinched.

Imagine a jelly donut and has a stronger outer layer and a jelly in the middle.

Then imagine adding pressure to that donut and watching the jelly shooting out through a hole on the side of that donut. This is an example of a disc herniation. The gelatinous material is forced in one direction and can tear through the annular fibers or rings. The material herniates out usually through its weakest area of the disc, the posterior lateral sides. This can be degenerative as well but often due to a traumatic injuries or repetitive motions.

Patient B is also recommended to start with a consultation and examination with a musculoskeletal specialist. Chiropractic care with stretching and strengthening exercises will help to align the vertebrae and pelvis and take abnormal pressure from that damaged disc. This will help with pain relief and spinal stabilization. In situations when pain is off and on or acute, use ice and/or a TENS unit to help reduce inflammation. If your chiropractor feels you are not making the expected progress with care, other options include getting an MRI and consulting with another specialist such as a physiatrist.

For more information or questions, please visit our website. You can schedule your consultation, read more information on our blogs, or ask a question.

Dr. Bryen Brown

About the author

Dr. Bryen Brown is married to Dawn and has one son. He grew up in Bogalusa, LA and received his Bachelor of Science Degree in Biology from Grambling State University in 2008. He then attended and graduated from Texas Chiropractic College in 2012. Click Here To Read Full Bio

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