Sciatica, pain down one leg
Symptoms by body part:
- Acute Pain
- shooting, or electrical type pain or burning
Sciatica refers to pain, weakness, numbness, or tingling in the leg. It is caused by injury to or pressure on the sciatic nerve. Sciatica is a symptom of another medical problem, not a medical condition on its own.
How does it occur?
Sciatica occurs when there is pressure or damage to the sciatic nerve. This nerve starts in the lower spine and runs down the back of the leg. There are two nerves that comprise the sciatic nerve, known as the Tibial and Peroneal nerves. They are made up of the L4-S3 nerve roots. Thus, an injury to any of those levels could contribute to dysfunction. Sciatic nerve controls the muscles of the back of the knee and lower leg and provides sensation to the back of the thigh, part of the lower leg, the sole of the foot and along the outer edge.
Often, biomechanical shifting of the sacrum, pelvis, coxofemoral and lumbar spine causes added pressure on the sciatic nerve as it travels between the Piriformis muscle and Superior Gemellus muscle. Due to the attachment of those muscles, any shifting of the aforementioned bone, muscle and joint structures will cause further compression of the sciatic nerve.
- Pain in the lower back
- Buttock pain on one side
- Hip pain on one side
- Pain down one leg and into the foot
- Tingling/numbness/burning down one leg and into the foot
- Worsens when straightening leg
- Decreased ROM when flexing forward, bending to the side, or extending backwards
- Stiffness in foot or leg
- Increased pain when sitting for longer periods of time
If you have ever had lower back pain, you are not alone. Back pain is one of the most common reasons poeple see a doctor or miss days at work. Even school-age children can have back pain. It can range from a dull, constant ache to a sudden, sharp or shooting pain. It can beging suddenly as a result of an accident or by lifting something heavy, or it can develop slowly and occur at random. Getting too little exercise followed by a strenuous workout also can cause back pain (1).
Sacro-Iliac or Pelvic Pain
Sacro-Iliac or pelvic dysfunction is often a major contributor to an individual's sciatic pain and is felt along the belt-line and buttock region off to one side, near the bony protrusions that you can feel if you rub your fingers along your lower back at the top of your buttock regoin. The sacro-iliac joint connects the spine to the pelvis/hip and injury or damage here can mimic other conditions such as hernaited disc or hip problems, but certainly contributes to sciatic pain. Accurate diagnosis is important to determine the source of pain. In our office, this seems to be the most common cause of most patient's sciatic pain as it effects multiple surrounding areas. When functioning well, it allows for the lumbar and hip regions to function appropriately. This region is often the primary source, or at least contributor to sciatic pain that is felt in the buttock and down your leg at times.
- Pain that feels like it's near, above or on either side of your tailbone
- pain when sitting
- pain when standing or walking
- it can wrap around into the groin
- pain along crest of pelvic girdle
- pain traveling up your spine on either side or both
- pain centrally, above tailbone (tailbone pain)
- pelvic misalignment
- pain or burning down the back of your leg
- pain/burning in your buttock
What sets us apart?
What sets our back pain treatments apart from so many others is the incorporation of our deep understanding of the nervosu system and how that translates into healing- it's not just about changing the structure but also changing the pathways that connect the strcuture to the brain. And it's this reconnection and reintegration that serve as the backbone of what we do. We are New England's premier center for chiropractic neurology.
We understand that everything in the body is conected. From the spine to the brain, the nervous system is the engine of feeling. And when a connection is broken, you feel it. The connection and reintegration is the inspiration behind our care, demonstrating the core of who we are: restoring connections in our patients.
A person's pain is a result of a combination of factors involving muscle, joint, nerve and brain. Thereby, a diagnostic and treatment approach that involves all of those structures will create the best possible, long-term outcome. That's what the Portland Chiropractic Neurology model incorporates, reconnecting all of these structures through a multi-modal appraoch that combines chiropractic, physical therapy, occupational therapy, neurology and hyperbaric oxygen therapy. Our analysis allows us to determine which therapies are right for you and then applied over a certain treatment plan we achieve long-lasting, permanent results if possible.
What causes back pain?
It's a combination of injury to joint, muscle, inflammation, neurological pathway disruption and sensory misperception in the brain. You can't affect one without affecting them all as described through Hilton's Law. Hilton's law is a powerful springboard to understand articular anatomy and pathophysiology (2). Through diagnostic testing, we're able to determine the source of your back pain and treat it appropriately using a multi-modal approach.
There are two types of back pain:
- Acute, or short term back pain that lasts a few days to a few weeks
- Chronic back pain, or pain that continues for 12 weeks or longer. About 20 percetn of people affected by acute low back pain develop chornic low back pain with persistent symptoms at one year (1).
What structures make up the lower back?
The lumbar spine, pelvis and sacrum are what most people are describing when they discuss their lower back pain, involving one or all of the structures. Many people point to their pelvis when telling us they have hip pain, which is just a matter of nomenclature. You have discs between your five lumbar vertebrae that act as shock absorbers and cushion your back when you're moving. There are thiry-one pairs of nerves that are rooted to the spinal cord and transmit signals from the body to brain (1).
Causes of lower back pain?
Most acute low back pain is mechanical in nature, meaning there is disruption in the way the compenents of the back (the spine, muscle, discs, and nerves) fit together and move (1). This is why multi-modal, or combining treatments, is so important to treat all the structures involved in your back pain.
Congenital issues (meaning from birth)- Scoliosis (curvature of spine), lordosis (exaggerated arch in lower back), kyphosis (excessive outward arch of spine); spina bifida (incomplete development of spional cord and/or its protective covering can cause problems involving malformation of vertebrae and abnormal sensations and even paralysis).
- Injuries- Sprains (overstretched or torn ligaments); strains (tears in tendons or muscle); spasms (sudden contraction of a muscle or group of muscles); traumatic injury (sports, car accidents, or fall)
- Degenerative problems- Intervetrebral disc degeneration (occurs when the rubbery disc wears down); Spondylosis (the general degeneration of the spine associated with wear and tear that occurs in joints, discs and bones); Arthritis or other inflammatory disease (occurs in the spine, including osteoarthritis and rheumatoid arthritis as well as spondylitis, an inflammation of the vertebrae)
Nerve and spinal cord problems- Spinal nerve compression, inflammation and/or injury; Sciatica (pressing on the sciatic nerve tha travels though the buttocks and extends down the back of the leg); Spinal stenosis (narrowing of the spinal column that puts pressure on the spinal cord and nerves); Spondylolisthesis (vertebrae of the lower spine slips out of place, pinching the nerves exiting the spinal column); Herniated or ruptured discs (occur when the disc becomes compressed and bulges outward); Infections (involving the veretebrae, a condition called osteomyelitis, in the discs it's known as discitis and the in the sacroiliac joints connected the lower spine to pelvic, it's called sacroiliitis; Cauda Equina Syndrome (occurs when a ruptured disc pushes into the spinal canal and presses on the bundle of lumbar and sacral neve roots; Osteoporosis (progressive decrease in bone density and strengh that can lead to painful fractures of vertebrae)
- Non-spine sources- Kidney stones (can cause sharp pain in lower back, usually on one side); Endometriosis (build up of uternine tissue in places outside the uterus); Fibromyalgia (a chronic pain syndrome involving the widespread muscle pain and fatigue); Tumors (press on or destroy the bony spine or spinal cord and nerves); Pregnancy (back symptoms almost always completely go away after giving birth) (1).
Influencing factors in low back pain can include age, fitness level, weight gain, genetics (ankylosing spondylitis), job-related factors, mental health, smoking, heavy backpacks in children, pyschological factors, previous concussions (3).
Previous, or undiagnosed concussions
Based on existing literature, athletes appear more likely to sustain a subsequent musculoskeletal injury in the year after sustaining a concussion. Neuromuscular contorl refers to the many aspects that contribute to how the nervous system controls muscle activation and ultimately postural control (3). Our chiropractic neurologists are trained to diagnose and treat these types of conditions, see http://www.portchiro.com/our-care/condition/post-concussion-syndrome/85/
Lower back pain testing will include a thorough clinical examination (Neurology, Proprioceptive, Respiration) as well as gait analysis and any further recommendations that may be necessary for a complete diagnosis--> imaging- x-ray, MRI , CT, bone scan, discography; EMG (electromyography) to detect if muscle weakness is due to nerve problem; evoked potential studies (EP) to detect speed of nerve transmission to brain; nerve conduction studies (NCS) to detect nerve damage.
PCN core spinal treatments (may include one, two or many within the list below, depending on your particular condition)
- Specific Corrective Spinal Chiropractic Neurological Manipulations (SCSCNM)
- Disc Decompression Therapy (traction therapy) (DDT)
- Electrical Muscle Stimulation (EMS)
- Active Muscle Release Therapy (ART)
- Percussor Muscle Therapy (PMT)
- Graston Soft Tissue Technique (GSTT)
- Postural Restoration (PR)
- Specific Corrective Chiropractic Neurological Manipulations for Oxygenation L/S/T (SCCNM-O)
- Gait protocol Non-Invasive Nerve Stimulation (NINS-gait)
- Vestibular Rehabilitation (VR)
- Occuptational Therapy (OT)
- Physical Therapy (PT)
- Co-treatment (CT)
- Functional Neurological Rehabilitation/Neuroplasticity Retraining Exercises (FNR/NRE)
(1) "Back pain fact sheet", NINDS, Publication date March 2020.
(2) Herbert-Blouin et al. Hilton's Law Revisited. Clin Anat. 2014 May (27)4: 548-455
(3) Howell et al. Neuromuscular Control Deficits and the Risk of Subsequent Injury after a Concussion: A scoping review.