Photo: Shutterstock, credit to "Mangostar".
by Eric Winder, DC
Sciatica causes pain that starts in the lower spine or buttock, then travels down the back of a person’s thigh and sometimes into the back of their leg. To relieve this often debilitating pain, we must understand what is causing it. Let’s look at the main triggers of sciatica to determine how each of them is best treated for maximum pain relief.
True sciatica is caused by pressure or irritation to the sciatic nerve (in the buttock) or one of its roots (in the lower back). However, what some refer to as “sciatica” is usually not the real condition. The more common causes of this “sciatic-like” pain involve muscle spasm, weak core muscles or referred pain. This referred pain occurs when the actual source of pain is different from where a person feels it. An example of this is left arm pain from a heart attack.
Finding the Source
Sciatica and sciatic-like pain have similar causes. For the sake of simplicity, I’ll refer to both as sciatica moving forward. These types of pain can be caused by repeated strenuous activity, especially lifting. However, the opposite of strenuous movement can also have the same effect. Being too sedentary and letting core trunk muscles become too weak can cause similar end results. In either case of weakness or overworked tissues, sciatica also often involves subtle problems with an important sense called proprioception.
Proprioception, or position sense, refers to the ability to know where our body parts are in space and how they relate to each other. This sense allows us to maintain muscular balance, joint alignment and stability, and upright posture. Most importantly, it allows for coordinated motion —to walk around, brush our teeth or even do back flips. This incredible and vital sense comes from millions of nerve endings in the body’s fibrous connective tissue called fascia.
In my experience, those who suffer from sciatica often have restrictions in their fascia from either past injuries or the daily wear-and-tear of living. These restrictions can cause glitches in the body’s position sense, resulting in joint instability, muscle imbalance and misalignment. In turn, these issues can cause referred pain to the sciatic nerve area, muscle spasms and, occasionally, spinal problems that exert pressure on the sciatic nerve directly. To treat sciatica correctly, we need to focus on the underlying causes of fascia restriction, weak core muscles, and strenuous or excessive lifting.
Let’s consider the case of a patient I will refer to as Helen. She had been suffering from sciatica in her right side for over a year when she came to our office. The pain started after moving heavy pots while gardening in her backyard. Physical therapy had given her temporary relief, but the pain quickly came back once she finished therapy. She had begun to take ibuprofen daily to for relief, while cutting back heavily on her normal activities.
Upon examination at our office, I found that Helen had restricted fascia in her lumbar muscles and right thigh. Her right knee had been injured two years prior in a boating accident, and I found that it also had fascia restrictions. Some core exercises that she had learned in therapy strengthened trunk area, but her lower abdominal muscles were still weak.
We started Helen’s treatment by releasing the restrictions in her fascia with hands-on treatments and low-level laser therapy. Treating the knee area relieved much of her pain in that area, but she experienced even more pain relief as we treated other areas. The release of fascia restrictions also improved function in her lower abdominal muscles. This made it possible for her to use the exercises she had already learned during her time in physical therapy to strengthen her abdominal muscles for better stability. Helen reported that she was feeling 90% improved at this point, but then she encountered a setback.
Helen had been feeling so much improvement that she restarted her gardening activities, but this seemed to cause more pain to flare. I asked her to show me the method that she normally used to move her planting pots, and she then demonstrated what I consider to be one of the most dangerous activities for back health.
She had been lifting and twisting—planting her feet in one spot, lifting her garden pots, then twisting her back to set the pots down in their new positions, all without ever shifting her feet. We treated her for new muscle injuries and fascia restrictions, and by the time she returned to gardening a few weeks later, she was pain free. She was also much more careful about how she used her body to move these heavy items.
Occasionally, I have seen more serious causes of sciatica such as a severe disk herniation pressing on the sciatic nerve or an allergic reaction to a metal hip joint that irritated the sciatic nerve. Cases like this might require more invasive intervention such as surgery. However, they are few and far between. Most cases of sciatica, whether true or sciatic-like, are caused by the three factors mentioned above. Fortunately, most sciatica cases are easily resolved after treating fascia restrictions, stabilizing the core muscles, and alleviating issues with physical movement (or lack thereof) to allow for healing and injury prevention.
Dr. Eric Winder has been practicing chiropractic for 25 years, with a focus on treatment of fascia and soft tissue for the past 22 years. Dr. Winder’s practice emphasizes relieving pain and restoring alignment and motion with gentle therapies. For more information, call 941-957-8390 or visit https://gentlebay.com/