What is sciatica?
Sciatica is a set of symptoms, including pain, that may be caused by compression or irritation of the nerve that runs down the back of the leg. Typically, the symptoms are only felt on one side of the body. Pain can be worsened in prolonged exposure to cold weather.
Sciatica is a relatively common form of lower back pain and leg pain, but the true meaning of the term is often misunderstood. Sciatica is a set of symptoms rather than a definitive diagnosis. This point is important, because treatment for sciatica or sciatic symptoms can be variable. The goal is to find the underlying cause of the symptoms through a very thorough history and examination.
What are the symptoms of a herniated disc?
The symptoms of sciatica can be very varied, but will usually have at least one or more of the following:
- Lower Back Pain
- Radiating Pain – can be in the in the buttock, back of the leg pain and/or into the foot
- Pins & Needles/Numbness – can be in the in the buttock, back of the leg and/or, more commonly, into the foot
- Weakness – of the lower extremity, most commonly in the foot. “Foot Drop” is a term to describe the inability to lift the foot when taking a step and is indicative of a more serious condition.
What are the testing procedures to diagnosis sciatica?
- History and Examination – this is often the most neglected, yet, by far the most important part of the diagnosis process. Quoting Sir William Osler MD, "Listen to your patients, they are telling you the diagnosis”. It is absolutely crucial to spend the time taking a detailed history.” You cannot find what you do not look for, if you do not look for it”. It is absolutely crucial to spend the time performing a detailed exam. Based upon the results, a determination will be made as to whether to begin treatment or to order further tests.
- X-Rays – used to check for bone health, degenerative changes and structural alignment. We will be able to see the space that the nerve occupies, but spinal nerves will not show up on an x-ray.
- Cat Scan(CT) – can be used to see a stenotic canal, however it is better suited to visualize the bone. While less expensive than an MRI, it will expose the patient to high levels of radiation. Generally not the test of choice.
- MRI - the gold standard test to determine an irritated or compressed sciatic nerve root. It will clearly show the nerve root and the amount of space in the canal, in addition to all the surrounding soft tissue.While this is an excellent test , there are inherent problems as well. First is the cost, which can be as high $2000. Second, is that the time to perform the test is about 30-45 minutes and you must lie still. This may be very difficult for many patients. Third and most importantly, is that most often, the findings that the MRI shows may have nothing to do with the presenting condition. Studies have shown that many asymptomatic people, who have never had any back/leg pain, will show compression of the sciatic nerve on an MRI.. This does pose a diagnostic dilemma and is why you have to “marry the patient to the MRI, not the MRI to the patient”. Again, the history and examination will determine treatment going forward, in spite of the MRI findings.
- EMG/NCV – EMG this is called electromyography. It measures the electrical activity of muscles at rest and during contraction. NCV is called Nerve Conduction Velocity. It measures how well and how fast the nerves can send electrical signals. Nerves control the muscles with electrical signals called impulses. These impulses make the muscles contract in specific ways. Nerve and muscle problems cause the muscles to contract in abnormal ways. With leg pain or numbness, these tests will help to find out to what degree the nerves are being affected. These tests check how well your spinal cord, nerve roots, nerves and muscles that control your legs are functioning.
What treatment can be done to help a sciatica?
While there are certainly many different types of treatment, that are effective for sciatica, many of which we readily use in our office, namely spinal manipulation, electric muscle stimulation, ultrasound and spinal exercises, it is not the intent of this article to list all of them but simply to introduce you to a type of treatment that you may not be aware of. SDT is not meant to necessarily replace any of the above therapies. In fact, utilizing them can be very helpful and will often enhance recovery. As a stand alone therapy or as an adjunct to pre-existing therapies, STD can be extremely effective to help you get well.
Spinal Decompression Therapy
Spinal Decompression Therapy is FDA approved and has a very high success rate for pain associated with herniated discs, degenerative disc disease and spinal stenosis.… even after failed surgery. It is a non-surgical, traction based therapy for the relief of back/ leg pain or neck/arm pain. During this procedure, we have the ability to cycle through distraction and relaxation phases and by proper positioning, a spinal disc can be isolated and placed under negative pressure, causing a vacuum effect within it, drawing it back from its herniated position and away from the nerve. If your condition is not discal and is secondary to arthritis, which can lead to spinal stenosis, we can change the parameters to focus on a more continuous shorter hold/relax phases, creating a “milking of the joints”. This will help to reduce inflammation and allow diffusion (absorption) of nutrients into the arthritic areas to lubricate and heal the irritated structures.