Pain in the legs and lower back may be caused by compression of the sciatic nerve. Learn more about how chiropractic and massage therapy can help relieve the pain of sciatica.
Articles on Sciatica Treatment
Many people with sciatica find the pain to be so debilitating that they are forced to miss work and social gatherings. Among patients with lower back pain, those with sciatica experience the highest level of disability.1 According to public health records in Norway, patients with sciatica are disabled for an average of 72 days a year.
A recent study offers hope to patients suffering from sciatica pain. The new research suggests that chiropractic treatments may speed sciatica recovery, enabling patients to return to work faster.2 The researchers evaluated 44 Norwegian workers who had visited the hospital with severe sciatic pain. Most of the participants had been experiencing pain for at least three weeks before visiting the hospital.
In the hospital, a chiropractor evaluated each patient’s posture, gait, range of motion, and palpation of the lumbar spine. The chiropractor then performed joint adjustments to the spine, in addition to other joints that had been injured as patients compensated for the pain. Soft tissue soreness was relieved with ice treatment. Patients received daily treatments while in the hospital, and then three times a week for a period of two weeks. Some patients also underwent additional follow-up treatments, but most did not receive more than 14 treatments.
Within 21 days, 91% of patients had returned to work full-time. An additional 2 patients were back at work part-time. The researchers concluded that the study demonstrates the potential benefit of chiropractic care for sciatica patients.
Arana E, Marti-Bonmati L, Vega M, et al. Relationship between low back pain, disability, MR imaging findings and health care provider. Skeletal Radiology 2006;35(9):641-7.
Orlin JR, Didriksen A. Results of chiropractic treatment of lumbopelvic fixation in 44 patients admitted to an orthopedic department. Journal of Manipulative and Physiological Therapeutics 2007;30:135-139.
Studies on the efficacy of surgery for sciatica have produced conflicting results. An estimated 5-10% of patients that undergo microdiscectomy suffer from recurrent disc herniation after the operation. For patients undergoing another common sciatica surgery, lumbar laminectomy, 20-30% do not experience significant improvements in pain and function. Surgeries for sciatica also carry the risks of nerve root damage, infections, cerebrospinal fluid leakage, and more.
Recent research suggests that many sciatica patients could avoid the risks of surgery with exercise and chiropractic therapies. In a study published earlier this year in the journal Spine, Danish researchers tested the efficacy of active conservative treatment in patients who would normally qualify for surgery.
Half of the patients were assigned to perform symptom-targeted exercises while the other half were assigned sham exercises. The latter were designed to increase blood circulation but did not specifically target back pain. Patients were also advised to stay as active as possible without aggravating their leg pain.
By the end of the eight-week treatment, both groups had statistically and clinically significant improvements in pain, global assessment, functional status, and vocational status. But those in the targeted exercise group experienced substantially better outcomes. Although this isn’t the first study linking exercise with improved outcomes in sciatica patients, the findings confirm that surgery is not the only option for treating severe sciatica.
Previous research has also shown that patients with sciatic pain who may normally qualify for surgery could benefit from chiropractic care. In a 201o study comparing chiropractic adjustment to microdiscectomy , 63% of patients experienced substantial improvements with chiropractic treatments.
Albert HB and Manniche C. The efficacy of systematic active conservative treatment for patients with severe sciatica: a single-blind, randomized, clinical, controlled trial. Spine 2012; 37(7):531-42.
The pain condition sciatica is triggered when an injury or misalignment of the spine interferes with the nerves that run from the lower back down each leg. Often this interference is caused by a herniated disc. Patients suffering from sciatica whose symptoms don’t improve after initial treatment with painkillers are often recommended to undergo spinal decompression surgery, also known as microdiscectomy. Over 300,000 microdiscectomies are performed every year in the United States, but in 10-20% of cases, surgery does not relieve the original pain symptoms. Other patients opt to use the services of a chiropractor who performs spinal manipulation.
Researchers in Canada conducted a pilot clinical trial to compare the effects of surgery versus spinal manipulation on 40 patients with sciatica caused by lumbar disc herniation (LDH). Patients participating in the study had not seen improvement in their sciatica symptoms after at least 3 months of trying nonoperative health therapies, including lifestyle modification, massage, acupuncture, or painkillers. Half of the study participants were then randomly assigned to receive microdiscectomy surgery, while the other half went on to receive spinal manipulation. Patients from both groups attended six rehabilitation sessions after their assigned treatment. After 12 weeks, patients in both groups who were not satisfied with their results were given the option to switch treatment groups.
Among the patients who were assigned to the microdiscectomy group, 85% improved after the treatment. For those who received spinal manipulation, 60% saw clear improvement of their symptoms. The patients from this group who then opted for microdiscectomy saw the same improvement rates as those who initially had surgery, but this was not the case for those who opted for spinal decompression post-surgery.
The study findings suggest that that for more that half of people suffering from sciatica caused by a herniated disc, spinal manipulation will offer a noninvasive path to pain relief that is just as effective as surgery. Those patients who do not respond to chiropractic care will still have the option of surgery, and as the researchers conclude “the obvious risk and cost profile of operative care argues for serious physician and patient consideration of spinal manipulative therapy before surgical intervention.” This research can help inform treatment options for patients with sciatica—although spinal manipulation may not be effective for all patients, it is a viable and cost-effective alternative to consider before surgery.
McMorland G, Suter E, Casha S, du Plessis SJ, Hurlbert RJ. Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. Journal of Manipulative and Physiological Therapeutics. 2010; 33(8): 576-584.
About Sciatica, Spinal Degeneration, and Radiating Pain
Spinal degeneration refers to a gradual deterioration in the function of the spine. Aging, injury or trauma can all contribute to wearing down the cartilage discs between the vertebrae.
Four stages mark the degeneration of the spine:
Phase 1 is the stage in which the spine loses its balance. Nerves are affected and joints and discs begin to age more rapidly. At this point, response to spinal care is generally positive.
Phase 2 involves a much greater degree of decay. As discs narrow even further, changes in posture become more evident. There is more pain than at Phase 1, but significant improvement is possible with chiropractic care.
Phase 3 is marked by further imbalances in posture, more advanced nerve damage, and bone deformation. A permanent loss of height can occur and loss of energy is significant. Disabilities may become more noticeable along with mental and physical weakness. Some reversal of symptoms may be experienced with the correct chiropractic care.
Phase 4 involves severely limited motion. Serious nerve damage, permanent scar tissue, and fusion of the bones may become noticeable. Phase 4 shows a significant increase in pain levels, while mental and physical abilities are severely compromised. Although considered irreversible, some relief from the condition may be expected from the appropriate chiropractic care.
Patients who suffer from sciatica are at risk for developing muscle atrophy. A recent British study found that patients with sciatica had decreased muscle mass, also known as muscle atrophy.
Muscle atrophy occurs in people that have a restricted range of motion due to an injury or medical condition. Developing atrophy can further reduce muscle strength and mobility. In patients with low-back pain, weakened muscles can cause patients to compensate in other ways leading to further injury.
That’s why it’s important to seek treatment for sciatica before it worsens. Unlike medications, chiropractic treatment actually addresses the cause of sciatica – an injury or disc herniation pinching the sciatica nerve. Chiropractors adjust and realign the spine to reduce pressure on the sciatica nerve, and in doing so, significantly relieve the pain. Chiropractic treatment, along with strong core and back muscles, is a powerful way to recover and prevent sciatica.
Ploumis A, Michailidis N, Christodoulou P, Kalaitzoglou I, Gouvas G, Beris A. Ipsilateral atrophy of paraspinal and psoas muscle in unilateral back pain patients with monosegmental degenerative disc disease. British Journal of Radiology. November 2010.0: 58136533.
The debilitating pain caused by a herniated disc is unfortunately all too common. This condition is the end result of a longer process of degeneration. Fortunately, chiropractic care can provide relief for most simple herniated disc injuries.
A herniated disc is commonly referred to as a slipped disc. Cartilaginous discs, situated between each vertebra in the spine, act as shock absorbers for your back. They provide cushioning between the hard, bony vertebrae that make up the spine. A disc injury is more accurately referred to as a bulge or a rupture, where the bulging disc puts pressure on nerves and can no longer function properly.
A herniated disc occurs as the end result of a degenerative process. Underlying factors of a disc injury may include:
- disc dehydration, where insufficient water absorption ages the tissues and causes rigidity;
- unusual types of stress on the discs, and
- excessive weight on the discs.
These factors cause slow degeneration of disc quality, leading eventually to the herniation. A rupture can occur through sudden movement, such as lifting a heavy item or even sneezing. It is important to note that the act of sudden movement is not the cause; the degenerative process is what causes the disc to ultimately slip.
Most simple herniated disc injuries can be treated with low-force chiropractic techniques or with traditional alignment methods. However, more extreme disc injuries that involve an advanced loss of strength, sensation or reflexes should be referred to a spine specialist for further evaluation and intensive treatment.