Sciatica or Piriformis Syndrome: Not all nerve pain is created equal!

Let me tell you that over my years as a chiropractor I have heard a lot about shooting, burning pain down the lower back and hip.  So let me ask you, “Have you ever experienced an intractable burning pain that courses from your low-back or hip running down to your leg? Sometimes all the way to your foot? Is it just as bad sitting down or standing up?” Your sciatic nerve might be talking to you!

Sciatica, as the name implies, affects the sciatic nerve and the sciatic nerve is the single longest nerve in the body. It starts bilaterally with nerve tissue on the left and right in the lower lumbar region of your spine. The nerves then pass through a left or right opening in the pelvis. Just under or through the piriformis muscle and down the hind portion of both legs and on to the respective foot. The sciatic nerve and the nerves that branch off of it are mainly responsible for the innervation of the lower extremity.

Sciatica commonly is caused from:

Herniated Disc

When one suffers from a herniated disc, there is an inflammation or bulging of the spinal disc causing it to protrude out of the annulus. The annulus is a tough ring that (when healthy) surrounds the jelly-like nucleus pulposus preventing that gel from putting pressure on the sensitive spinal cord and nerves that branch off of it. Disc herniation often exerts pressure on the nearby nerve roots causing compression on sensitive nerve tissues like the sciatic nerve.

Sciatica: Herniated Disc

Lumbar Spinal Stenosis

Lumbar spinal stenosis is similar to disc herniation in the sense that painful pressure is applied to the spinal nerves. In this case, though, canal that houses the spinal cord or the nerve root shrinks, choking the spinal cord or nerve root inside. These nerve roots are typically found in or near the spinal canal or nearby openings called as neural foramina.  These passages can become congested or narrowed, compressing the nerves and causing pain. If the blockage happens in one these passageways, they’re considered foraminal stenosis. If it occurs in the spinal canal it is canal stenosis and if it occurs in or near the opening where the sciatic nerve passes.

Sciatica: Lumbar Spinal Stenosis

Spondylolisthesis

Another cause of sciatic nerve pain can be spondylolisthesis, often know as a “slipped disc”. When the whole disc slips forward backward or to either side without necessarily rupturing it can still cause sciatica when it applies direct pressure to the spinal nerve just next to it.

Sciatica: Spondylolisthesis (slipped disk)

Trauma

Traumatic incidents like auto accidents or fall involving the lower back can cause severe damage to the spine which may result in sciatica as well. I have had many patients recount stories of accidents like auto accidents, horse riding accidents, and sports injuries that all lead to sciatic pain because of traumatic nerve compression.

Sciatica: Trauma

Piriformis Syndrome

There is something special that I always check for when a patient presents with complaints that might be due to sciatic nerve irritation.  I do a muscular evaluation of the hips and lower extremities specifically looking for how well the piriformis muscle is working.  I often find that even with true sciatic nerve problems that the piriformis muscle has developed a painful trigger point and spasms are applying either all or part of the pressure that is resulting in the sciatica.  This is known as piriformis syndrome and it occurs when the piriformis muscle spasms and compresses the sciatic nerve. In this case, the sciatic nerve running beneath or through the piriformis muscle is often irritated by any movements of that muscle as long as the trigger point or muscle spasm is present.

Sciatica: Piriformis Syndrome

Spinal Tumors

Lastly, spinal tumors are a serious cause of sciatica.  These anomalous growths on the spine whether they are benign or malignant can cause pressure to be applied to the sciatic nerve. As rare as sciatica cases being due to spinal tumors may be, once the tumor has developed in the lumbar region, the pressure it applies as it grows can easily cause nerve compression resulting in sciatica.

Sciatica: Spinal Tumors

Chiropractic and Other Treatments for Sciatica or Piriformis Syndrome

As a chiropractor I have seen and recommended many treatments for sciatica, some non-invasive and some going all the way up to surgery. While I will be the first to admit that in cases of sciatica involving bone fragments after a fracture, spinal tumors, or severe cases of slipped or herniated disc, surgery may be required in most instances, chiropractic treatment and acupuncture is often enough to relieve the pain. These therapies often entail the lumbar area being exposed to cold or heat, or different modalities to reduce inflammation and muscle spasms. Chiropractic therapy may range from ice/cold therapy, ultrasound, transcutaneous electrical nerve stimulation (TENS), soft tissue manipulation like active release technique, to spine adjustment or manipulation.

I would also like to point out that acupuncture is a form of alternative medicine that originated in China. It is based on applying pressure to certain areas of the body that can alleviate pain and other symptoms.  In acupuncture very fine needles are inserted into your skin in strategic points to help balance the body and restore health and well-being, thereby treating pain and illness. Acupuncture and acupressure have been proven effective by medical practitioners the world over. I highly recommended acupuncture or acupressure as a treatment for generic lumbar pain, even for mild sciatica, as I have seen it relieve the tension of muscle spasm and reduce the pressure on compressed nerves.

Just a few words of wisdom…

“An ounce of prevention is worth a pound of cure.”

~ Benjamin Franklin

So believe me. If you are experiencing sharp, burning pain in your low-back, hips, or lower extremities, don’t wait and suffer! Consult a chiropractor that you trust at once. Your sciatic nerve might just be talking to you! Get things checked out early before they become a mess and you will thank yourself in the long run.