Quinci Herll, Chiropractic Intern
Have you ever experienced pain and numbness in your glutes and down the back of your leg? If you answered yes, you may have experienced sciatica which occurs when the sciatic nerve is compressed. The sciatic nerve is the largest nerve in the human body originating from nerve roots in the lumbar spine and sacrum, then travels down the back of the legs. Since the sciatic nerve is so large, there are many places the nerve can be compressed. Sciatica is not a diagnosis, rather it is a symptom of an underlying issue. The most important step in treating your sciatic pain, it determining the cause of it. Let's dig into what causes sciatica.
Numbness and tingling of the legs can also be due to lumbar radiculopathy, which is compression of a spinal nerve rather than the sciatic nerve. A commonly used term for radiculopathy is “pinched nerve”. So how do you know where the compression is occurring? Schedule an appointment with a chiropractor who will perform a thorough exam to find the root cause of the issue and get you back to feeling your best!
A rare, but commonly diagnosed (a misdiagnosed) culprit of sciatic nerve impingement is the piriformis muscle. The piriformis is part of a group of 8 glute muscles. When this muscle becomes irritated or spasms, the sciatic nerve does not have adequate room to glide properly. In most people, the sciatic nerve exits below the piriformis muscle, but there are other normal anatomical variations that can increase the likelihood of sciatic nerve compression. Some causes of piriformis irritation include running, sitting for long periods of time, trauma such as a car accident or fall, and repetitive movements. Most of the time, patients with sciatica due to piriformis syndrome will experience burning pain in the glute and make have some pain into the hamstring but will not have lower back pain.
So, what should you do if you think your piriformis is the culprit? Book an appointment with a massage therapist who can perform trigger point therapy to reduce muscle tension. Acupuncturists can also help reduce pain and inflammation of the piriformis. If you work at a desk job, try to vary your position or go for short walks throughout the day. Make sure to properly warm up before and cool down after your workouts. Figure 4 stretches are also beneficial for people with a tight piriformis.
Why is piriformis syndrome misdiagnosed so frequently? Because symptoms flare up or get worse when sitting on the glutes or when palpating (touching) the glute muscles. However, it is common to have a flare up in sciatic symptoms when touching the sciatic nerve in this area when other causes are a factor. Let's look into more common causes of sciatica.
Sacroiliac Joint Pain
Despite their similar names, sacroiliac joint (or SI joint) pain is not the same as sciatica. The SI are the dimples on the low back where the sacrum and ilium bones meet (see photo). That said, SI joint dysfunction can be a cause of sciatica. SI joint pain is typically located on and around the SI joint with very little referral into other areas. SI joint pain occurs due to an imbalance between the sacrum and ilium. This joint does not have a lot of motion, which allows the joint to provide stability and absorb impact. Since the joint has such little motion, even a small misalignment can cause a number of issues. Since the sciatic nerve runs near this joint, a pelvic imbalance can irritate this largest nerve in the body.
The good news is SI joint dysfunction is the easiest of all causes of sciatica to treat and resolve. If the pelvis is misaligned, chiropractors can assess and adjust accordingly. Pelvic misalignment can cause one leg to be shorter than the other, altering gait and causing other problems in the lower extremities and low back.
Side note about SI joint pain, often times patients come into a chiropractic office saying, “my hips feel off”, but the issue is often in the pelvis or SI joint, not the hips. Make sure you are able to explain exactly where you are having pain or symptoms to your chiropractor - this will aid in a more accurate diagnosis and treatment plan, ultimately solving your pain faster!
One of the most common causes of sciatica is a disc herniation. A disc herniation occurs when there is a tear in the fibrocartilaginous material surrounding the intervertebral discs. Patients will often times know the exact time and movement that caused the injury. It may have followed heavy lifting, twisting, or repetitive movements. When the outer portion of a disc tears, the inner jelly-like portion escapes and can cause nerve impingement. Disc herniations of the lumbar spine can irritate the spinal or sciatic nerves. If a spinal nerve is irritated, chiropractors can assess which level the compression is occurring at by testing muscle strength, reflexes, and sensory of the lower extremity. Sneezing, coughing, and bearing down increases pain and radiating symptoms of a disc herniation.
In most cases, disc herniations will resolve spontaneously with conservative treatment. Disc herniations respond extremely well to chiropractic care. Chiropractors can also Spinal decompression to decrease pressure on discs and reverse the effects of gravity by pulling apart the vertebra. Chiropractors can also offer patients rehab exercises. Many patients with a lumbar disc herniation can also experience relief with lumbar extension exercises.
Degenerative changes of the lumbar spine also cause compression of nerves. Often times patients that experience numbness down the legs automatically assume it is sciatica, but the compression may actually be in the spinal nerves. As we age, the discs in our spine become thinner, putting more pressure on the joints in the spine. Degenerative changes can also occur after trauma, both major and minor. When we hear the word trauma, we often think car accident or big fall. However, repetitive motions like running or lifting can cause micro traumas that overtime lead to degenerative changes. When these degenerative changes happen, the joints feel unstable, so the body compensates by making osteophytes, or bone spurs, to make the joints more stable. Unfortunately, these bone spurs can put pressure on the nerves in and around the spine, causing numbness down the legs.
Chiropractors will perform a number of orthopedic and neurological exams to determine whether the compression is happening to spinal nerves or the sciatic nerve and come up with a treatment plan based on their findings. Similar to a lumbar disc herniation, spinal decompression can also help alleviate pain from degenerative changes.
Lastly, a condition called spondylolisthesis can also put pressure on the sciatic nerve. Spondylolisthesis occurs when a vertebra of the spine shifts forward on the segment immediately below it. This forward shift can be caused from micro traumas causing a stress fracture, degenerative changes, major trauma, and some people are unfortunately just born with it. If a spondylolisthesis is expected, your healthcare provider will order x-rays to diagnose and grade the forward position. Similar to degenerative changes, the forward position of a vertebra can cause both compression of spinal nerves and the sciatic nerve, especially when it occurs at the bottom of the spine near the sacrum.
If a spondylolisthesis is diagnosed, chiropractors will focus their adjustments on the segments above and below the forward vertabrae. Make sure you let your chiropractor know what adjustments feel good for you and they will treat you accordingly! Spinal decompression can also be beneficial for people with a spondylolisthesis.
Sciatica is a symptom!
Much like headaches, there is not one single cause of Sciatica. It is important to rememver that sciatica is a symptom of numbness and tingling down the legs. It is important to get to the root cause of the compression to the sciatic nerve. In most cases, the cause of sciatica can be treated with conservative care such as chiropractic, massage, and acupuncture. Since there is not one single cause of compression, there is also not one single treatment plan for everyone. If you are experiencing radiating symptoms down the legs, schedule an appointment now to get back to doing the things you love with no discomfort!
Quinci Herll is a chiropractic student from Northwestern Health Sciences University in Bloomington, Minnesota, completing her internship at Washington Park Chiropractic. She is passionate about athletes, pediatrics and perinatal care. She enjoys educating patients on the power of chiropractic and helping others achieve their health and fitness goals.