Expert: Dr. J. Shawn Leatherman - 4/9/2007

Question
QUESTION: What causes this pain...can stress be a factor?
ANSWER: Dear Susan,

Sciatic nerve pain (sciatica) refers to pain that radiates along the distribution of the sciatic nerve and is typically felt in the rear, down the back of the leg and possibly to the foot. Sciatica is actually a symptom and not a diagnosis. The term literally means that a patient has pain down the leg from compression/irritation on the sciatic nerve. The diagnosis is what is causing the compression (such as a disc herniation, compression from the piriformis muscle, or degenerative compression in the low back). This is one of the most common forms of pain caused by compression of the spinal nerves, and the leg pain often feels much worse than the back pain.

The sciatic nerve is the largest single nerve in the human body; it runs from each side of the lower spine through deep in the rear and back of the thigh, and all the way down to foot, connecting the spinal cord with the leg and foot muscles.

Although stress can be a factor in the pain experience, it is not generally regarded to have any causative factor in cases such as this...mechanical sources in the anatomy are the cause. Pain results when the nerve roots in the lower spine are irritated or compressed. Most often, sciatica pain is caused when the L5 or S1 nerve root in the lower spine is irritated by a herniated disc. When this happens, pain radiates into the rear and back of the thigh and calf, and occasionally may extend down to the foot. Numbness, tingling, and/or a burning or prickling sensation are also common symptoms.

Degenerative disc disease may also irritate the nerve root and cause sciatica, while conditions that mimic sciatica include piriformis syndrome and sacroiliac joint dysfunction (pelvic joints). Sciatica may also be felt if the nerve is actually mechanically compressed, such as from spondylolisthesis (slippage of one vertebra on another), spinal stenosis (narrowing of the spinal cord for any reason), or arthritis (degeneration) in the spine.

Most cases of sciatica are caused by a simple irritation to the nerve and improve with conservative care such as spinal adjustments, and active stretching protocols.

When weakness or numbness is present, this is considered to be more severe as the nerve may be damaged and it is important to have it evaluated further with radiographic diagnostics such as MRI.  Rarely there is bowel or bladder incontinence (inability to control the bowel or bladder) and/or progressive weakness or loss of sensation in the legs.  This is considered serious (sometimes called cauda equina syndrome) and immediate medical attention should be sought. If the nerve is badly compressed and the pain and symptoms are severe, surgery may be warranted.

Okay Susan, feel free to write back if you have any further questions.

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

---------- FOLLOW-UP ----------

QUESTION: So I should see an orthopedic doctor?  I have been going to a chiropractor and get relief, but it doesn't last but 8 hours or so and it's back hurting pretty bad.

Answer
Dear Susan,

First make sure that the doctor has fully explained why you are having the symptoms...what was found on physical examination and x-rays?  You should be given a diagnosis of what is the actual or suspected cause, that is how effective treatment plans are generated and implemented.  If that can be explained to your satisfaction, I would give the chiropractor some more time to work on the problem, but you should also be doing some exercises for the stabilization of the low back and spine thereby reducing the need for ongoing in office treatment as you improve, I hope that this has been addressed.  Sciatic type pain is known for being recurrent and resistive to care so it may take a bit longer.  The fact that you obtain relief after the adjustment for 8 hours is a good sign.

An orthopedist is not likely to do anything for you except prescribe some medication unless you are a surgical candidate.  That would be determined by the level of your symptoms, what is on x-ray, and if there were MRI findings of significant disk bulging or disruption.  Even then you may be referred to a neurosurgeon rather than an orthopedist depending on the nature of the problem found. If not surgical, you may be sent for physical therapy, but that should have already been addressed as stated above, if not, it should be.  Now if you have some severe muscle spasm causing the continued problems, then a targeted injection to the spasm area will help and the orthopedist would be a good choice for this.

If the chiropractor is hesitant to take the time to address the stability issues, exercises and stretching for your problem, than I would suggest you find one that will take the time.

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