Is sciatica a spinal disorder or a symptom of a spinal disorder? The term sciatica is commonly used to describe pain traveling in the distribution of the sciatic nerve, therefore it is more accurate to state that it is a symptom of a spinal disorder not a spinal disease itself.
Frequent symptoms of sciatica are listed below.
- Sciatica usually affects one side of the human body, although it may affect both.
- Pain from sciatic nerve pain may feel dull, sharp, burning, or accompanied by irregular shocks of shooting pain starting in the buttock and traveling downward into the thigh and/or leg.
- Sciatica may also extend below the knee and might be felt at the feet.
- Occasionally, symptoms of sciatic nerve pain include tingling sensations and numbness.
- Sitting and attempting to stand up could be painful and challenging.
- Coughing and sneezing can intensify the pain.
Where is the Sciatic Nerve?
Sciatic nerve fibers start at the 4th and 5th lumbar vertebra (L4, L5) and the first few segments of the sacrum. The nerve passes through the sciatic foramen, a nerve passageway just beneath the piriformis muscle which rotates the thigh laterally, towards the rear of the extension of the hip and into the lower part of the gluteus maximus, or the muscle in the buttocks, that helps with thigh extension. The sciatic nerve then runs vertically down to the rear of the thigh, behind the knee and branches out into the hamstring muscles, or the calf, and farther downward into the feet.
Sciatica Caused by Nerve Compression
Compression of the sciatic nerve may cause any of the above-cited symptoms. Rarely is neurological damage permanent and paralysis is rarely a threat due to sciatica since the spinal cord ends before the first vertebra of the lumbar spine.
When to seek immediate medical attention for sciatica: Increasing back or leg weakness and/or bladder or bowel incontinence is a sign of cauda equina syndrome, a severe illness requiring emergency treatment. If you are experiencing these symptoms at the moment, please seek immediate medical attention from a qualified and experienced back pain specialist.
Certain lumbar spinal diseases can cause or lead to sciatica symptoms, including:
- Herniated discs are the usual cause of sciatica in the lumbar spine.
- Degenerative disc disease, a natural biological process related to aging, is known to cause disc weakness that may be a precursor to disc herniation.
- Lumbar spinal stenosis is a narrowing of one or more neural passageways due to disc degeneration and/or facet arthritis. The sciatic nerve may become impinged as a consequence of these changes.
- Isthmic spondylolisthesis results from a stress fracture frequently at the 5th lumbar vertebra (L5). The fracture together with disc space collapse may enable the vertebra to slide forward on the first sacral segment (S1). The slippage might cause the L5 nerve root to become pinched as it leaves the spine, developing into symptoms of sciatica.
- Spinal tumors and illnesses are other ailments that may compress the sciatic nerve, but this is rare.
How Your Doctor Diagnoses Sciatica
A healthcare professional's diagnosis of your pain and other symptoms may include discussing your medical history, recent accidents or injuries (eg, falls) as well as also a review of your current medicines (both over-the-counter and prescription drugs). Your doctor may additionally perform a physical evaluation using one or more movement evaluations to help determine the origin or causes of your pain. During the neurological portion of the evaluation, your reflexes and muscle strength are tested. If needed, they may order imaging studies, like an x-ray, CT scan, or even an MRI. The imaging tests can help confirm their diagnosis.
Furthermore, a healthcare professional may ask you a few questions, such as:
- "How did the pain develop?"
- "On a scale from 1 to 10, with 10 being the worst pain possible, rate your pain."
- "Is the pain caused by walking uphill or downhill?"
- "How does the pain affect activities of daily living?"
- "What kind of treatment was attempted and what was effective?"
Not all buttock and leg pain is sciatica as there are a number of different structures in the spine that can cause these kinds of pain. For example, the sacroiliac joint, or the joint between the pelvis and sacrum, the smallest segment of the spine, may cause or refer pain to the buttock as well as a sprain of the facet joints, which would be the connecting joints at the rear part of the spine. A bulging or herniated disc can also refer pain down into the leg. If buttock and leg pain symptoms are correlated with any neurologic signs of numbness or weakness, it is "true sciatica" and has to be evaluated by a spine care expert, such as a chiropractor. If severe neurologic symptoms occur along with bowel and/or bladder control problems, it needs to be evaluated as soon as possible.
Chiropractic Diagnosis
In the assessment of lower back pain and sciatica, differential diagnosis using a "triage" concept of classifying back injuries and/or conditions to one of three categories helps guide the chiropractor when determining the source of the patient's symptoms. These categories of chiropractic diagnosis include:
- Potentially severe: tumor, infection, fracture, major neurological issues, such as cauda equina, local open wound or burn, prolonged bleeding (hemophilia), artificial joint enlargement, pacemaker problems and joint infection
- Nerve issues: whenever the nerve roots from the lower back are pinched or compressed, they may cause radiculopathy or sciatica. Typical causes of nerve root pinching and irritation include aherniated disc, spondylolisthesis and spinal stenosis
- Non-specific: mechanical back pain in the lumbar spinal column. This type of lower back pain is the most frequent presentation, also contains pain for that there is not any identifiable cause.
Once the chiropractor has categorized the patient's source of their sciatica, they may begin with the proper treatment. With chiropractic diagnosis of potentially serious injuries and/or conditions, the chiropractor will generally refer the patient to a relevant medical specialist, and as appropriate, the chiropractor might co-manage the patient's care along with other back pain healthcare professionals. With this classification, chiropractic care may be used accordingly to avoid further spinal health issues.
In addition, with chiropractic diagnosis of a nerve root problem causing sciatica and/or non-specific causes of low back pain, chiropractors normally describe the symptoms experienced on the following scale:
- Acute (symptoms lasting less than 6 months)
- Subacute (symptoms lasting between 6 and 12 months)
- Persistent (symptoms lasting for 12 months or more)
- Recurrent/flare up (symptoms are similar to original symptoms and return sporadically or due to exacerbating circumstances).
Dr. Alex Jimenez's Insight
Through the use of several physical evaluations and neurological assessments, a doctor of chiropractic is able to properly diagnose the source of a patient's sciatica symptoms. Once a diagnosis has been established, a chiropractor will follow-up with the best, most recommended treatment for the individual's specific needs and requirements. A spinal misalignment, or subluxation, is the most prevalent cause of sciatica. Spinal adjustments and manual manipulations are the most common treatment methods used to help carefully restore the natural alignment of the spine. A variety of other treatment methods can also be used by a doctor of chiropractic, to help speed up the patient's recovery process. If the diagnosis of a patient's sciatica symptoms determines that the source of their sciatic nerve pain is severe, a chiropractor may also refer the patient to the most appropriate healthcare professional to continue treatment.
These back pain or sciatica symptoms might be further broken down as mild, moderate or severe in pain. Once a chiropractor has properly diagnosed your sciatica symptoms, they may utilize a series of treatment modalities, including spinal adjustments and manual manipulations, among other well-known alternative treatment options, to help improve sciatic nerve pain. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Sciatica
Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.
