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Sciatica is defined by webster’s dictionary as “pain along the course of a sciatic nerve especially in the back of the thigh.”
Sciatica or sciatic nerve pain is therefore a rather broad term describing pain in the leg or legs. It is important to know that sciatica can result from many different sources including disc herniations, muscle problems(trigger points), vertebrae misalignments, bone spurs, and pelvic biomechanical problems. We will discuss each cause to help you gain some understanding why your treatments for this often stubborn condition may have failed.
Sciatica From Disc Herniations
The first cause and what I consider to be the most common results from a disc herniation that literally pinches the nerve. A pinched nerve causes radiating pain down the leg or arm (if happening in the neck). A pinched nerve in the back is a very common cause of sciatica that we treat using the DRX9000. If the disc can heal, it will relieve pressure on the nerve and you will have relief.
Sciatica Due to Foraminal Stenosis & Misalignments
Another cause of sciatica can be due to foraminal stenosis. This can be due to a vertabra misalignment called a spondylolisthesis as well as other factors causing the hole where the nerve exits to decrease in size including disc herniation as well as bone spurs. It depends on the presence of these other factors whether or not you can improve with quality conservative treatment.
Sciatica Due To Muscle Problems & Trigger Points
We often see patients suffering from sciatica due to muscle problems. These can include active trigger points causing pain down the legs or a condition called piriformis syndrome. Piriformis syndrome is a particular condition where a muscle irritates the sciatic nerve as the nerve exits just below the piriformis muscle. Doctors who are accustomed to evaluating and treating myofascial or muscle pains are able to determine which issue is causing your sciatica. Pelvic misalignment problems can also contribute to chronic muscle strain and cause sciatic symptoms. Even though this is a misalignment problem, I included it in the muscle section. The reason is because the misalignments in the pelvis can irritate the muscles and cause pain. These are sometimes called trigger points and the picture to the right with the red coloring indicates where the pain travels when you have a gluteus minimus trigger point.
It is not uncommon at all for a patient to present with several of these factors all at one time. Many of the medical treatments for sciatica are very singular or one dimensional. If you suffer from more than one causative factor for your sciatica, then injections, medications, therapy or even surgery may not be enough to rid all of your symptoms.
For example. if you are diagnosed with a herniated disc you may elect to try injections first. If that fails and other indications are present, you might decide to have surgery. The surgery may help the herniated disc symptoms initially, however if any of the other factors are present such as chronic pelvic misalignment and muscle irritation, your symptom relief may not last. We see this scenario often.
Exercises For Sciatica
There are some exercises that can be helpful for sciatica. I will discuss 2 exercises here. The first exercise is for sciatica that comes from a herniated disc. The goal of this exercise is the get the pain that is in your leg to “centralize.” Centralize is a medical term we use to describe the pain lessening in the leg and centralizing to the back. If you can find a position (by extending and leaning left or right) that relieves the leg pain, then you can hold for 5-10 seconds and then repeat. If the pain increases in the leg then this is not the right exercise for you. Even if the pain reduces in the leg during the exercise but then increases in the leg afterwards and lingers for longer than 20 minutes, then this is not the right exercise for you.
This exercise is for irritation of the sciatic nerve due to muscle tightness. This stretch is fantastic for loosening the gluteal muscles and also affects the piriformis muscle. Again if this stretch causes additional leg pain during or after the stretch, please discontinue the activity. You need to be properly diagnosed in order to get on the road to relief.
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