"Do I Have Sciatica?"

This question is heard at least once per day here at Schafer Chiropractic. Which tells me it is a good topic for a blog. I will try to limit the use of fancy medical terminology. I often find that big words are used by people who don't fully understand the subject anyway. Sciatica is merely an irritation of the sciatic nerve that creates pain down the path of the sciatic nerve. This nerve runs down the back side of your leg. Not the front side of the leg. Not the outside of the leg. The BACK of the leg. Sometimes the pain goes to the back of the knee. Sometimes it goes to the back of the calf and the foot. See picture below.

The L4, L5 and sacral nerve roots are often compromised before they combine to make the very large sciatic nerve. Then the nerve exits the gluteal region from underneath the piriformis muscle. You may have heard of something called piriformis syndrome. This would be a swelling of the piriformis muscle to the point where it compresses the sciatic nerve. This is an unlikely cause. I say that because I have encountered very few cases in my 20 years of experience. In a very small percentage of people, the sciatic nerve actually runs THROUGH the piriformis muscle. In this small percentage of patients, it is much more likely to irritate the nerve.

Sciatica may be associated with pain in the low back. Usually this pain is unilateral (one-sided). Pain going down the back of both legs is usually due to other problems. Nerve pain can feel like a general ache, sharp jolt, burning, or tingling. How far the pain goes down the leg also can vary. More severe cases involve pain going into the foot. It is my humble opinion that most cases of real sciatica are due to a swelling or bulging of an intervertebral disc. This irritation occurs well before the piriformis muscle. Damage to the discs may be from direct trauma (fall onto your butt), or from poor posture and improper lifting techniques. Excessive sitting usually plays a significant role as well. This swelling or bulging can sometimes put pressure on, compress, tug, or pinch one of the nerves where it exits the spine. In this type of sciatica, the pain will usually be worse if you sit for too long, and when you first awake in the morning. If this sounds like you, we can help. DO NOT ASSUME that you need to be prepped for surgery.

Another possible cause for sciatica is spinal stenosis. "Stenosis" means closing. So spinal stenosis is a closing of the spinal canal. The canal is where the entire spinal cord runs through. This is often due to advanced arthritis, so if you are young, this is a very unlikely cause.

As stated above, sciatica is pain down the back of the leg. I have encountered many patients with pain down the SIDE of their leg, which they call "sciatica". Obviously this cannot be, as per the very definition of the word. Yet some of these people have been diagnosed by other medical doctors, chiropractors, and/or physical therapists. It is sloppy diagnosing. This pain often starts in the low back like sciatica, but quickly passes to the outside of the hips and stays lateral down the leg. This scenario is VERY COMMON.

This is called iliotibial band syndrome, or IT band for short. The low back muscles combine with the gluteal muscles and feeds into the iliotibial band (IT band). This band runs down the outside of the leg and connects to the outside of the knee. I often find that the patient has had knee problems of the painful side for many years prior to the "pseudo sciatica". The outside muscle of the lower leg can also be affected. These are called the peroneal muscles. It is well understood that muscles work together in systems. This is one of those systems. No muscle works in isolation. It is therefore unwise to point to one muscle and say "There's your problem!". In IT band syndrome, the IT band is not the real problem. The problem is usually weak gluteal muscles, combined with an unlevel pelvis. The pelvis may be unlevel due to poor posture, previous foot, ankle or knee injuries, or awkward sleeping positions. Successful treatment of the condition must include careful examination of all of these possibilities. If this sounds like you, we can help.

In all of the above scenarios, the condition is complex. The causes are many. A thorough history and exam are needed to properly diagnose the problem. MRI's can be helpful, but should not be the first course of action. Most insurance companies won't even cover them unless you have tried some sort of therapy first. As much as I would like to, I can't say that one adjustment, one stretch, or one massage will resolve the pain. Pain is a signal from your body. It is a cry for help. Most people just don't speak the language. We do.