Expert: Dr. J. Shawn Leatherman - 5/21/2009

Question
My son is 19 years old and was suffering from back pain so he went to a doctor who told him he had sciatica and prescribed anti-inflammatory drugs and some back exercises. I can't find any information on sciatica in such a young person, and have two questions: could that be a misdiagnosis and could a visit to the chiropractor help?

Here is some background on my son:

He is not athletic and never was. He's quite sedentary, preferring to read or work and play at the computer.

He did not do anything that could have caused a back problem, such as a slipped disk.

He carried a very heavy backpack all through high school and his first year of college.

He is about 30 pounds overweight.

The anti-inflammatory drugs seemed to help, but tonight he was out running and found himself in pain again.

Anything you can tell me would be much appreciated.

Answer
Dear Kati,

First of all sciatica is BS diagnosis.  It only indicates a range of symptomatology and does not tell you anything about what is the actual cause of the problem.  Sciatica implies irritation/inflammation and/or compression of the sciatic nerve and a pain distribution down the back of the leg...now is that a real diagnosis?  No!  What is the cause of the problem?  What anatomical structure?  Does the pain distribution actually match the sciatic nerve distribution?...often it does not.

True sciatic nerve distribution pain actually extends to below the knee either in the calf musculature, the later aspect of the leg, or to the foot. Now if that is the pain distribution your son has, you still have to differentiate whether the issue is being caused in the lumbar spine (low back), or in the musculature of the buttocks (piriformis muscle).  The you also have to consider the sacroiliac joints (SIJ), which can refer pain over the entire leg.  The SIJ is often overlooked as a source of pain, especially by the medical community.  All of the above issues need to be explored with a functional orthopedic examination.

Now the fact that he is mostly sedentary and 30 pounds over weight is a factor to consider, but probably not the initiating cause of the problem.  This is more of a complicating factor or contributing factor.  I would address these issue in my office if he was a patient, but the actual anatomical tissue would be the priority.  I think from what I have already written you should expect that I would definitely recommend chiropractic care for this problem.  Chiropractic physicians are exquisitely trained in the anatomy, physiology and physical diagnosis of musculoskeletal issues such as this.

Concerning the anti-inflammatories, they help because they are actually blocking pain transmission by reducing the levels of systemic inflammation...less inflammation, less pain.  However, they do nothing to treat the issue at hand, only help to reduce pain.  There is nothing wrong with utilizing anti-inflammatory medication in the short term while in pain, but functional elimination of the anatomic insult will be the only true way to address the dysfunction which has caused the inflammation.  Hope this helps Kati.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net