What Causes Sciatica?
Many people come in to see me saying they need chiropractic treatment for sciatica. Some of them are right! The truth is that back pain with leg pain is often sciatica, but there are several other possiblities. True sciatica is irritation of the sciatic nerve, our longest and widest nerve. It combines several nerves coming off the spinal cord in the lower back and travels down the back of the leg. It branches behind the knee with those branches going all the way to the foot.
Classic sciatica comes from a bulging or herniated disc in the Lumbar Spine with pain both in the back and back of the leg down to the foot. Sciatica is any pain in the sciatic nerve, but it can come from the nerve being pinched anywhere along it’s path, not just at the spine.
There are other nerves that can cause pain in the leg with or without back pain. The second most common one is the Femoral Nerve. The Femoral nerve also comes from Lumbar nerve roots then travels down the interior of the pelvis past the Sacroiliac joint and through the Psoas muscle to the front of the thigh. It’s mostly associated with Sacroiliac joint issues and psoas tension.
How Does a Nerve get “Pinched”
Pressure or tension on a nerve can create persistent dull achey pain or sudden shooting pain, especially with movement. This is typically called a “Pinched Nerve”. The difficult part is determing where the nerve is pinched. In the case of the Sciatic and Femoral nerves, the pinch can occur right at the spine due to inflammation around a joint that isn’t moving well, a bulging or herniated disc or malposition of a joint. With the Femoral nerve especially such a pinch will be related to the SacroIliac joint on that side.
While it is very common for a nerve to be pinched where it starts, it can be pinched anywhere along it’s path. Each nerve has it’s own typical pinch points. For sciatica, a very common pinch point is under the Piriformis muscle AKA Piriformis Syndrome. Another common spot the sciatic nerve gets caught in other tissue is behind the knee. The nerve branches there as it passes through a lot of tendons and fascia. After it branches, one branch the Peroneal branch can get snagged as it goes past the top of the Fibula on the outside of the calf.
The Femoral Nerve also has it’s typical pinch points, the most common being a tight Psoas muscle.
Chiropractic Techniques for Pinched Nerves
Chiropractic adjusting is perfect for treating a pinched nerve near the spine or where it passes another joint like the Fibula. SOT chiropractic has a special protocol just for disc issues and another for SacroIliac joint issues. Chiropractic adjustments are the most common and cost-effective solution for these types of issues.
What Can You Do when the Pinch is not from a Joint?
When a nerve entrapment happens under a tight muscle or tangled fascia, it gets stretched when you move. Nerves do not like to be stretched. Rather they should glide through soft tissue as you move. Stretch causes nerve inflammation resulting in pain, numbness, tingling or weakness. Because nerves are long tubes, the inflammation inside a nerve can travel all along the nerve. This can make it difficult to determine where the nerve entrapment is because symptoms can show up anywhere that particular nerve goes.
The solution for this type of issue is a technique called Nerve Mobilization. This is a very gentle kind of massage along the course of the nerve to free it up from surrounding tissue. Normally nerves can not be felt, but if a nerve is inflamed, not only does it get wider, it feels like a bunch of loose rubber bands twisted up under the skin. Also, it tends to be tender to touch. Once identified, the nerve can be teased out from the tissue pinning it down. It is not uncommon for a nerve to be pinched in more that one place, this is called a Double Crush. It is important to address areas of nerve irritation both at the spine and along the course of the nerve.
