The sciatic nerve is a large nerve that begins at the low back and travels down the back of the leg. “Sciatica” is the word that is used when this nerve is inflamed. The pain of sciatica can be severe and constant, or it may come and go depending on activity or weather changes.
The pain of sciatica is confusing because it is felt in the leg, but it is caused by the spine. Many patients with sciatica have little or no back pain, but a brief exam of the spine can quickly reveal the problem.
The usual treatment for sciatica has always been bed rest and painkillers, and in severe cases, surgery. Research has shown this is not an effective course of treatment, and surgery is now discouraged. Even the bed rest part of the treatment has been shown to worsen the problem if done for more than two or three days. Studies have shown that the most effective treatment is chiropractic adjustments along with a gentle exercise program.
Usually, the reason the spine is causing the nerve to be painful is because it has a subluxation. This word literally means “less than a dislocation” but it is used by chiropractors to describe a joint that does not move properly. If the joint does not work properly, it is irritating to all the other parts in the area- including the muscles, discs, and nerves. With most patients, the muscle pain is the worst, and they have a “common backache”. With others, the joints themselves are stressed, and wear out prematurely, causing symptoms of arthritis. For some reason, those with sciatica have more nerve irritation than joint or muscle pain, and their pain is in the leg.
The symptoms that a person feels will depend on how badly the nerve is irritated. If the nerve is slightly irritated, the first symptom can be a “pins and needles” feeling that comes and goes. As the irritation worsens, the feeling becomes constant. Pain- often a burning pain- is a sign of more irritation, and weakness is the next. When the irritation is so bad that there is a loss of reflex, strength, and true numbness, the irritation is severe. In some cases of sciatica, the discs that rest between the bones of the back rupture, and a part of the disc actually hits the nerve. This is the most severe (and least common) type of sciatica. Sometimes the disc slowly gets reabsorbed, but in a few cases surgery is needed to remove the part of the disc that is hitting the nerve. It used to be routine that these cases went to surgery, but several studies have shown that chiropractic can relieve the pain without surgery.
One study showed a reduction in the need for surgery in these cases by a factor of twenty- meaning twenty times fewer people needed the surgery after manipulation (the treatment chiropractors specialize in). In another study, twelve people who were scheduled for surgery were sent to a chiropractor, and after treatment, none of them needed the surgery.
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