Pressure on the sciatic nerve causes sciatica which is the pain people feel from the inflammation of the sciatic nerve. Chiropractors can identify the source of the nerve pressure in the spine and use chiropractic treatments to relieve the pain.
Can you start by telling us what sciatica is and the significance of the sciatic nerve?
Dr. Gregg Rubinstein: Absolutely. Well, sciatica is literally the Latin term for, anything that has that -tica on the end of it is just inflammation, and that’s inflammation of the sciatic nerve, technically. So really, that diagnosis is just the symptom described in Latin.
But the significance of the sciatic nerve is it happens to be the largest nerve in the body, and it’s made up of several nerve roots that join together that come out from the lumbar spine. What’s significant about that area of the spine is that very often, that’s where you’re going to see herniated discs or misaligned vertebrae, which can pinch and irritate those nerve roots.
When those nerves are pinched or irritated, then they conjoin and they come down. People will get pain in the lower back and then symptoms down the leg, which can be painful but it also could be numbness or tingling down the leg. So, it can be quite uncomfortable. They can get numbness, weakness, tingling, all of those different things shooting down the leg.
Another thing that’s interesting about the sciatic nerve is that it actually goes through the piriformis muscle in a certain amount of people. If the piriformis muscle spasms, it squeezes that nerve, and that will create sciatic pain or pain radiating down the leg.
It could be very different presentation in different people, but anything that pinches or irritates the branches that contribute to the sciatic nerve or the sciatic nerve itself will cause sciatica. That typically can be from misaligned vertebrae, herniated discs, and these are all things that chiropractors can handle.
Some sciatica sufferers complain about excruciating and debilitating pain. How would you describe the symptoms and side effects people experience if they suffer from sciatica?
Dr. Gregg Rubinstein: Well, typically, these people are going to present how I described. They’re going to usually come in. They’re going to have some lower back pain, usually at the base of the spine. It may be left or right. Sometimes it’s down the center. Typically, they’re going to get pain, which radiates from that lower back through the glutes or the buttocks area and go down the leg. Some people will have pain all the way down to the big toe. Some people have pain proximal or close to the spine. Others will have numbness or tingling radiating all the way down. Some people have so much numbness that the foot drops. You don’t get full motor control. If there’s long-standing pressure, you can see muscles starting to waste away. The reflexes can be slowed down. Sometimes they’ll have different sensations where they will feel altered sensation where you touch the leg and they can’t feel it or it becomes hypersensitive.
Anything that irritates the nerve will change the way the nerve functions and perceives and sends information up to the brain. So, there can be a host of different symptoms, but the most typical are usually just the lower back pain with radiation down the leg.
How would a chiropractor treat a new patient who is suffering from sciatica?
Dr. Gregg Rubinstein: We treat new patients and old patients pretty much the same. We’re going to be looking at the spine. When they come in, we do a complete examination. We want to determine what structures are involved. Is there a herniated disc, or is it just some misalignment, or is coming from the piriformis syndrome? So, you need to do your differential diagnosis and figure that out.
In many cases, we’ll take x-rays to take a look at the spine and see how healthy it is. If we see anything suspicious there, then we might even take an MRI and take a closer look at the discs. We need to figure out if it’s a bulging disc, a herniated disc, if there’s disc material that’s displaced pinching the nerve. There can be canal stenosis where the spinal cord canal, which is inside the vertebrae, can be compromised and become smaller. That can put irritation to the cord, and then you can get radiating symptoms down into the sciatic nerve as well. So, there’s many different causes of sciatica, and determining which is the proper cause will really pretty much point you in the direction of how you treat it.
Where the person has a sore neck, a sore back, or a sciatica, they’re treated similarly. We’re going to assess their posture, look at how their weight is balanced, do a complete chiropractic analysis along with our regular orthopedic and neurological testing to rule out any other neurological problems. Once we’ve determined the problem is related to the lower lumbar or a disc, we start a series of adjustments to realign the vertebrae, get the pressure off the nerves, and typically just sit back and watch the body heal.
Most of the time, these sciatic sufferers will have symptoms that are on and off. But when you really understand it very simply, the anatomy, when you look at it, the nerves exit from a notch in the vertebrae above and a notch in the vertebrae below. If those two bones are not lined up perfectly, that little notch where the nerve comes out can be made smaller, which will pinch and irritate the nerves, and that will cause the pain to radiate down the nerve paths towards the feet and where they terminate in the toes.
So that’s pretty much how it would look when someone comes into the office. We do the complete examination and start a course of treatment. We do re-exams on visit 10 to make sure that they’re progressing, and if they’re not, sometimes we have to refer those cases out.
Is sciatica commonly a recurring problem, or is it something that be corrected with chiropractic care?
Dr. Gregg Rubinstein: That’s a really good question. As we touched on in the last question, it really depends on the cause. If it’s just general misalignment putting pressure on it, then usually we can correct that pretty well and have good long-term results.
Sometimes when it’s more related to a disc, the disc material tends to get more swollen at certain times. If there’s a lot of compression on the spine, it creates irritation and inflammation, and then the disc will swell up and occupy more space, and then it’ll start to hit the nerves. Those are the people who will have maybe one or two or sometimes three episodes a year where that disc gets pretty inflamed and starts hitting the nerve.
We can do some palliative care, get everything calmed down, line everything back up, and the better alignment in the lower spine, the less inflammation there will be to the disc because the disc will be balanced and the spine is lined up right so it more evenly disperses the forces that the spine encounters, because that’s really what a disc does. It’s a shock absorber.
When the disc is involved, then sometimes it can be a recurring problem where we’ll see a couple of episodes. But typically, if people are under chiropractic care consistently doing prevention and maintenance, those episodes usually come less frequently, and when they do come, they hit at a less intense level and usually don’t last as long.
Can chiropractors recommend stretching or exercises to help patients deal with sciatica or even help prevent it from recurring?
Dr. Gregg Rubinstein: Absolutely. A lot of chiropractors will spend a lot of time with patients working on rehabilitative exercises and pointing them in the right direction. The types of exercises people do, again, will be determined by what the cause is. Again, if it’s a disc, then usually we’ll focus more on flexion exercises. Having additional information like MRIs can be very helpful in determining the type of treatment that you would provide with someone who has sciatica.
But stretching is important in the correction of alignment as well because when the muscles are tight, they’ll continue to pull the bones out of alignment, and when things are lined up better, it creates more even distribution of the weight over the discs so they’re less likely to get inflamed and swell up and then put pressure on the delicate spinal nerves.
Chiropractic adjustments can help prevent reoccurrences, actually correct the alignment, and make these episodes shorter-lived and less intense, and a spine that’s well-adjusted and fully corrected and aligned is less likely to have pressure and pain building up in it. That’s really the best way.
It’s all about prevention. Once you know that you have sciatica, prevention and maintenance is the key, but for many people, we just focus on the crisis. If we feel good, sometimes we don’t want to take care of anything. They always say, “Well, if it ain’t broke, don’t fix it,” but we don’t really do that with our teeth. We brush and floss whether our teeth hurt or not. We don’t wake up in the morning and say, “My teeth don’t hurt. I’m not going to brush them.” You still do the maintenance required to keep your teeth healthy. People just need to engage a little bit more in a little bit about the spinal health.
To speak with Dr. Gregg Rubinstein, visit www.ChiropractorMidtown.com or call 917-534-6484 to schedule an appointment