A PAIN IN THE REAR: UNDERSTANDING AND TREATING SCIATICA
What are the three most common things that you hear people say they were treated for at the chiropractor? In the general population, most people would say low back/neck pain, headaches and sciatica. In this week’s blog, we will focus on the sciatic nerve as most people will experience sciatica at least once in their lifetime. We will discuss the anatomy & physiology of the sciatic nerve, its function, how people get sciatica and how it can be treated.
What is the Sciatic Nerve?
The sciatic nerve is the largest nerve in the entire body that starts at the L4 nerve root in the lumbosacral region and extends down to the S3 nerve root in the feet. To be more specific, the sciatic nerve actually stops behind the knee joint in a region called the popliteal fossa and splits into two main branches
- Tibial Nerve-runs down the back of the calf, extending to the heel and the sole of the feet.
- Common Fibular (Peroneal) Nerve-runs from the outer part of the knee to the outer part of the foot.
Along its course, the sciatic nerve branches off into smaller branches, called collaterals, including:
- Muscle branches of the sciatic nerve that supply the muscles in the thigh–including the hamstring group at the back of the thigh, and the adductor magnus muscles along the inner thigh. Other small branches supply the leg and foot muscles.
- Articular branches of the sciatic nerve that supply the back of the hip joint and the back and side of the knee joint.
Sciatic Nerve Function
The sciatic nerve is like any other nerve in the body. Its function includes motor movement and sensation to the majority of the lower extremity, including the back of the thigh, back/front of leg, feet and toes. Sciatica patients experience the same symptoms as any other nerve impingement: pain, muscle weakness, loss of sensation, and/or organ malfunction.
Why is Sciatica so Common?
That’s a great question. The sciatic nerve is prone to causing issues because of its large size and thickness. No other nerve compares in size to the sciatic nerve. There are many different reasons why people get sciatica, but the most common causes are vertebral subluxations, degenerative disc disease, spinal stenosis, facet syndrome, disc bulges/herniation, trauma, tight piriformis muscle and wallet neuralgia.
The first handful are concerns that we have already discussed in great detail, but let’s briefly discuss the last two. The piriformis is a flat, pyramidally-shaped muscle in the gluteal region that acts either as an external rotator of the thigh or as an abductor of the thigh depending on the position of the thigh. The piriformis sits directly on top of the sciatic nerve, so whenever the piriformis is contracted, the muscle shortens, becomes tighter and applies pressure to the sciatic nerve. There is a condition called “piriformis syndrome” but it is extremely difficult to differentiate between piriformis syndrome and sciatica because symptoms are completely identical. In addition, the sciatic nerve is also affected in piriformis syndrome, so it has been said that either diagnosis is appropriate.
Wallet neuralgia sounds like money is involved and that’s because it is. A wallet that is used to hold money and cards is exactly what is causing the issue. Wallet neuralgia is when wallets are placed in the back pocket and are sat on for long periods of time. Prolonged sitting on a wallet will cause symptoms of sciatica as it’s creating unwanted pressure on the piriformis muscle and the sciatic nerve. So if you have ever heard a chiropractor say not to put a wallet in the back pocket, that is why.
How is Sciatica Treated?
You may have caught on by now that we sit on our sciatic nerve. Have you ever noticed that if you sit for too long that you start to feel numbness or tingling in the glutes or legs? That is the sciatic nerve saying stand up and stretch a little. Prolonged sitting can be the main issue and all that is needed to resolve the issue is to stand up and walk around every few minutes. Sciatica is treated based on the severity of the case and duration of sensations. Mild cases caused by piriformis syndrome or wallet neuralgia are simple fixes. Stretching the piriformis will help relax the muscle and ease pressure on the sciatic nerve. Stretching the entire lower extremity, especially the hamstrings, can help reduce sciatica symptoms as it can all be muscle related.
In more severe cases such as vertebral subluxations, degenerative disc disease, spinal stenosis, facet syndrome or disc bulges/herniation, more involved intervention such as chiropractic or non-surgical spinal decompression may be necessary. To learn more about our spinal decompression service, look back to our blog page on decompression as we go into greater detail on the topic. No matter the case, everyone should be seeing a chiropractor for spinal manipulation. Again, we stress on almost every blog that doing a thorough case history and examination is key to finding the root problem and to creating an appropriate treatment plan that will best fit patients’ needs.
Sciatica is something that should not be ignored. In fact, sciatica is an early sign saying that something is wrong with the body and should be dealt with immediately to avoid exacerbation. We can’t begin to discuss how many patients walk into our facility and say they have had sciatica issues for years and have done nothing about it. What starts as a mild condition can turn into a severe case quickly because of delayed treatment. Don’t let that happen. If you or someone you know is dealing with sciatica no matter the severity, please call our office at (724) 547-3377 so we can help and checkout our website at www.drlarrywilkinsspinalcare.com for more information on sciatica and treatment options.
Yours in Health,
Larry E. Wilkins, DC
Brian M. Steinert, DC