A common complaint that one might seek help from a physician is low back pain. In fact the annual prevalence of back pain is around 30% and in the United States back pain is the most common cause of limitations in activity in those 45 years of age or younger. Back pain is the second most common physician visit and third most common reason for surgery. These and other statistics show the importance of properly diagnosing and treating back pain. There are many common causes of low back pain, with the most common (in no particular order) being sprain or strain of ligamentous or muscle soft tissue surrounding the spine, spinal stenosis, spinal osteoarthritis, disc budging or injury and sciatica. Sciatica is a common complaint and a diagnosis that many wonder if this is indeed what they have when they have low back pain coupled with syptoms that extend into the buttocks or down one of their legs. There are many different causes of the above described symptoms so it is important to distinguish these from true sciatica. The sciatic nerve itself is a group of nerves which originate from the lower spinal levels of the spinal cord, specifically the levels of L4, L5, S1, S2 and S3. The sciatic nerve is made up of the common peroneal and the tibial nerves which branch off themselves further down the leg, supplying muscles, joints and other soft tissues.
The term sciatica is a descriptor of any combination of pain, weakness, numbness or tingling in a person’s leg. Usually this pain extends from the low back or buttocks down the leg, not the other way around. Sciatica is not a diagnosis itself and can be cause from several different conditions. For example, a disc that is bulging and pressing out onto the exiting nerve roots right near the spine may cause sciatica. There may be a muscular tightness in the piriformis muscle which essentially has connections deep in the gluteal region right above and around the sciatic nerve, which is called piriformis syndrome. Tumors, infections or other space occupying lesions may also cause the sciatic nerve to be irritated causing the same symptoms described above. A chiropractic physician will commonly encounter a patient with such symptoms and need to properly investigate the cause to determine proper care. If a patient is having sciatica with the cause being a tumor or extensive degeneration to the discs in their lower back or the cause is from an infection process, to list a few examples, the chiropractor will need to refer such a patient out to the proper medical physician for further care. If the cause of sciatica is a simple tightness in their muscular region or an uncomplicated disc bulge, they may properly treat such pain with conservative physical modalities such as electric muscle stimulation, heat or ice, soft tissue techniques to relax spasm and reduce pain, mobilization and manipulation to the lumbar spinal segments to improve mobility and will recommend stretching and strengthening to prevent further problems in the future.
References Cited in this Article
Epidemiological features of chronic low-back pain. http://www.societyns.org/runn/2008/andersson_pain.pdf
Getting Sciatica Relief http://www.chiropractors.org/resources/back-pain/getting-sciatica-relief.htm
Low back pain fact sheet http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm
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