The Sciatica Story

Learning the cause of any type of pain is a critical step in the healing process. This is especially true for the tricky yet oh so painful sciatica. But what is Sciatica? How is it diagnosed? Can it be healed?

What is Sciatica?
Many folks confuse sciatica to be a diagnosis. It's not. It's a symptom of a different problem. But finding the problem can be…well, a problem. Think of it this way: You pull out a string of Christmas lights to put on your tree. You plug it in to be sure they work…but they don't. So you check the fuse. It's good. Now what? You systematically start looking at each bulb to find the one that is missing or burned out. It's a painstaking process of hit and miss. That's the same kind of problem doctors are facing—albeit much more intricate and critical—when they are trying to pinpoint the cause of sciatica.

Finding the source of sciatica can be difficult at best because it can be caused by a number of different conditions anywhere along the roots of the five sciatic nerves. The roots stem from the lumbar and sacral nerve lines which string down the spine in the L4 to the S3 vertebrae regions. Just about anything can go wrong in that area and cause sciatica to manifest itself in your buttocks, leg, knee or foot. You'll know it when it occurs because it hurts! But moderate to severe pain is not the only challenge. Numbness, tingling, pins and needles and muscle weakness are signs of sciatica as well.

The most common culprit behind sciatica is nerve pinching. Nerves can get pinched in a variety of ways ranging from lumbar misalignment, a sacroiliac joint misalignment, Piriformis syndrome, greater Trochanteric Bursitis and most commonly, disc herniation.

How is Sciatica Diagnosed?
The standard protocol no matter what kind of doctor is consulted is for an examination to be performed first. If the sciatica does not extend below the knee, it is less likely that it is due to a disc problem, and it's more likely that it's due to a lumbar misalignment, a sacroiliac joint misalignment, Piriformis syndrome or Greater Trochanteric Bursitis. However, it is more likely due to a disc lesion if the sciatica extends below the knee.

Once the examination is performed the next steps differ depending on what type of doctor is doing the examining. If it's a chiropractor, it is most likely that after the examination he will take an x-ray to rule out any kind of pathological process (such as bone cancer), and then treat the patient with chiropractic adjustments and physiotherapy. If the patient does not respond favorably within a week or two to this conservative approach, then the doctor will request pre-authorization from the insurance company for an MRI. It is unlikely that an insurance company will approve an MRI until after conservative treatment has been tried first and failed.

If however the patient is complaining of neurological symptoms such as numbness in the leg or weakness of any of the muscles of the leg, particularly the inability to walk on their heels (a condition called foot-drop), or loss of control of bowel or bladder function, then those neurological signs justify immediate approval and performance of an MRI. To not do an MRI in such a case could constitute negligence and could jeopardize the patient's life, if not their ability to walk normally for the rest of their life.

An MD will approach things a little differently than a chiropractor. An MD will likely first prescribe some pain killers and anti-inflammatory medicine. If that doesn't work then they'll prescribe physical therapy. An MRI will be ordered if the therapy fails to relieve the pain. Unless of course the patient demonstrates neurological signs and symptoms in which case the same urgency exists as in the above paragraph.

It is important to note that X-rays do not show whether or not a disc is bulging or ruptured. They only show the disc space, showing if it's normal-sized, or thin. If it's thin it may or may not show signs of arthritis. Occasionally an inflamed disc can show up on an x-ray as somewhat thicker than usual.

MRI's and CT's both show discs and will differentiate a normal healthy disc from an unhealthy one. They will also show if a disc is bulged or herniated and will show how well hydrated it is. Generally speaking, CT's are best to show hard tissues such as bone, and MRI's are best to show soft tissues like discs and nerves. So if arthritis or fractures are suspected by the ordering physician, a CT is ordered. If a disc bulge or herniation is suspected, then an MRI is ordered. Other diseases can also show up on CT's and MRI's such as spinal cord tumors, bone cancer, bone abscesses, meningeoceles, etc.

Can Sciatica be cured?
The more correct question is, "Can sciatica be relieved?" Remember sciatica is a symptom not a diagnosis. So whether or not sciatica can be relieved depends on whether or not the cause of the sciatica can be fixed.

The good news is that since the most common cause of sciatica is an impinged nerve usually resulting from a herniated or bulging disc, the answer is yes: Sciatica can be relieved with a fairly high success rate depending on how the problem is addressed. Many successful tactics can be implemented by your chiropractor or MD. They range from spinal decompression to surgery on the extreme end to core muscle strengthening, stretches, yoga and acupuncture on the more conservative end.

If the diagnosis is something other than a disc problem, the treatments can vary quite a bit…more than can be covered in this article.

Conclusion
The cause of sciatica can be very hard to diagnose. Seek help today if you or someone you know is suffering. Visit your chiropractor or MD, based on your preference. To do nothing may cause irreversible damage that may affect your ability to walk. Rest assured, help is out there. Relief is within reach.