Sciatica is not itself a diagnosis; it is a symptom of an underlying disorder. Your chiropractor will be evaluating four major causes of sciatica: a herniated disc or a tear in the outer fibrous rings of the disc, spinal stenosis, facet joint conditions, and nerve entrapment syndromes. In addition to these four common causes of sciatica, your chiropractor will also rule out other much rarer, but more serious, causes of sciatica, such as tumor, infection, or metabolic disease.
Disc Herniation and Tearing: It’s important to rule out a herniated disc or tears in the disc as the cause of sciatic pain, a condition known as sciatic neuritis. If your chiropractor finds that your leg pain is disc-related sciatica, then the evaluation and treatment program is for a disc injury
Spinal Stenosis: Another common cause of sciatica is spinal stenosis, a chronic narrowing of the bony canal or the spinal column, both of which can trigger nerve inflammation. A diagnosis of spinal stenosis as the cause of your leg pain will mean you are a candidate for chiropractic care suited especially to this condition.
Lumbar Facet Syndrome: Facet joints can degenerate and go through arthritic changes. Degeneration of the facet joints can significantly contribute to sciatic nerve inflammation. A diagnosis of facet syndrome as the cause of sciatica will determine a treatment program of gentle chiropractic manipulation, sometimes including flexion-distraction protocol, and manual therapies especially suited for facet sprain.
Nerve Entrapment Syndromes: Mechanical imbalances in the spine and pelvis, disc degeneration without herniation, and spinal joint restrictions can lead to muscular tightness (hypertonicity) that can cause “entrapment” (or trapping) of the sciatic nerve. Specific muscle techniques that address the piriformis muscle are used in chiropractic practice to treat sciatic nerve entrapment. Chiropractors utilise manual and muscle therapies, spinal manipulation, pelvic blocking, and other approaches to correct mechanical imbalances that contribute to entrapment.
Chiropractic Care and Sciatica
Chiropractors specialise in the care of non-surgical conditions of the low back with gentle, timesaving approaches that address the mechanical and neurological causes of sciatica.
Chiropractors are rigorously trained to diagnose the different causes of leg pain associated with sciatica. Your chiropractor will take an extensive history and provide a comprehensive examination to determine whether you have disc-related sciatica or whether stenosis, mechanical spinal conditions and spinal joint restriction, or nerve entrapment are contributing to your leg pain.
The goal of chiropractic care in treating sciatica is to optimise motion in the spine, treat the spinal discs, reduce muscle spasm, and improve muscular strength.
Possible Chiropractic Treatment Approaches for sciatica
Specific Spinal manipulation: Sometimes called spinal adjusting, spinal manipulation is an active, hands-on care that returns motion to the spine. With a return of normal spinal mechanics, muscles relax and pain is resolved. In specific spinal manipulation, the chiropractor identifies the joints that are restricted or show abnormal motion. He or she then returns motion to the joint with a gentle thrusting technique.
Flexion Distraction technique: This is a gentle, non-thrusting type of spinal manipulation. This treatment is still hands-on, utilizing a specialized table to assist the chiropractor. It’s especially useful in treating bulging discs and ruptured (herniated) discs.
Instrument-assisted manipulation: This is another non-thrusting technique. Using a hand-held instrument, the chiropractor can apply force without thrusting into the spine. This is especially appropriate in older patients with degenerative joint syndrome.
To treat your back pain, the chiropractor may also use various manual therapies. These are used to treat soft tissue (ligaments and muscles, for example) injuries. Some possible manual therapies are:
Trigger point therapy: The chiropractor identifies specific hypertonic (tight), painful points on a muscle. Then applies direct pressure (using the fingers) on these points to relieve the tension.
Dry Needling (western Acupuncture): Myofascial trigger point dry needling is a treatment to restore proper function to abnormally behaving muscles. These muscles become painful with nodules also called knots and tight bands of muscle that can be painful locally or send pain signals to other locations. The muscles, which contain these abnormal areas are “locked” and cannot function normally, which causes restriction of movement and chronic pain. This treatment allows the muscle contracture to release to its normal length and the circulation to improve.
Manual joint stretching and resistance techniques
Therapeutic massage: To reinforce the improved joint mechanics (return of normal spinal motion), your chiropractor will prescribe therapeutic exercises.