Hi. Dr. Tim Steflik here, with Coastal Integrative Healthcare and I’d like to talk to you about sciatica, what causes it, and what you can do about it.
There are several causes of sciatica. Your sciatic nerve is about as big as your pinky and runs all the way from your lower back, down your leg, to your toe.
When this nerve is pinched or being impeded in some way, the pain it causes is called sciatica. The sciatic nerve can be pinched or impeded in several different areas along that route to your foot. The first area where it can be pinched is the lower back. This can happen because of degeneration in the spine where the discs – they’re like shock absorbers in your spine – start to wear out. As they get thinner and thinner, there’s less space for the nerves to come out. If they run out of space, those nerves can be pinched and you can have pain running down both legs, not just one or the other.
Also, if the vertebrae in the area are misaligned – or if there’s an accident that caused a lot of inflammation – that can also cause pain that runs down the leg.
So, sciatica can come from degeneration in the spine or disc herniation, which is similar to a rupture.
The other area sciatica can come from is your piriformis muscle. Some of you may have heard of this muscle – it goes from your hip to your tailbone, and connects those two bones. It also helps with turning your foot in and out.
The piriformis muscle can go into spasm for various reasons. Sometimes it starts to spasm because it’s trying to compensate for weak muscles surrounding it. If the muscles have become weakened due to lack of use in the butt area, the piriformis muscle starts to tighten up. The sciatic nerve passes either directly below or sometimes directly through the piriformis muscle. So when the piriformis muscle tightens up and goes into spasm, it can pinch the sciatic nerve right in that spot and cause pain all the way down the leg.
Sciatic nerve pain can be completely debilitating to the point where somebody can’t walk, can’t think, can’t concentrate. It can be very, very painful and stop a person from doing all their activities at work, at home, at school – wherever they might be. When someone comes to us with sciatica, we do a very thorough exam and diagnostic tests to find out what’s causing it. We can’t treat someone or tell them we can fix their problem until we know where the pain is coming from.
Once we know what’s causing it, we can offer appropriate recommendations. Our recommendations might include physical therapy to stretch that muscle and strengthen the ones around it. They might also include a trigger point injection right into that muscle to get it to relax. That provides some immediate relief. And we might recommend decompression for the spine – as we separate those discs and vertebrae and open up that area, it’s going to take pressure off the nerve and the patient will feel a lot better. And it’s going to hydrate those disks.
We’re also probably going to recommend chiropractic adjustments to make sure those bones and joints are moving properly and freely like they should. There are a lot of other treatments we can do – cold laser, Graston, ultrasound, muscle therapies, massage, and other types of injections. But we don’t know what’s going to be best for a patient until we’re able to properly evaluate them.
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