Sciatica Treatment: Where To Go

Given the lack of a one-size-fits-all cure for back pain, treatment can drag on. The difficulty level of back pain treatment is attested to by the fact that many doctors have no idea how to find the cause. If you wish to avoid medications that only mask the pain, surgery that could make it worse and running to dozens of appointments with no results, it is best to educate yourself on your condition, its possible causes and its most effective treatments.

Sciatica is a very painful condition characterized by the impingement or irritation of the sciatic nerve in the lower back. This nerve, the largest in the body, travels from the lumbar spine to the foot on each side of the body. Sciatic impingement entails sharp lower back pain that travels along the nerve path into the leg, sometimes accompanied by numbness and tingling.

Before knowing where to go for sciatica treatment, it is important to know what the cause is. There are four main causes of sciatica: disc degeneration, vertebral misplacement, piriformis syndrome and sacroiliac (SI) joint dysfunction.

Note: True sciatica is identified as compression of the nerve root as it exits the spine (at the fourth and fifth lumbar vertebrae [L4 and L5]); conditions that irritate the nerve at another location are not technically considered to be true sciatica. For the purpose of this article, all instances of sciatic impingement will be called sciatica.

Disc and Vertebral Causes

As we age, our spinal discs wear. These gel-filled cushions can dry up, or uneven pressure placed on them can cause the exterior to weaken and the gel to be pushed to one side; this is called a bulging disc. If the gel breaks through the exterior, this is called a herniated disc. A bulging or herniated disc at L4 or L5 can compress and irritate the sciatic nerve. MRI testing can detect most disc abnormalities.

Discs that are drying up shrink in size. This changes the space between vertebrae, creating spinal jarring and increasing the risk of vertebral misplacement (subluxation or spondylolisthesis). If a lumbar vertebra moves out of alignment, it may press on the sciatic nerve. Misalignment can also occur due to injury or years of poor posture.

Chiropractic care is the best bet for people with sciatica caused by spinal misalignment, which can generally be detected by MRI testing or a trained professional performing a physical exam.

Some doctors are quick to prescribe surgery for bulging or herniated discs. More conservative treatments should be sought first, however. Exercises to ease the pain of this type of sciatica can be found here: http://www.spine-health.com/wellness/exercise/exercise-sciatica-a-herniated-disc. Having sessions with a physical therapist who can guide you in additional exercises and stretches would be beneficial. Another option to consider is spinal decompression treatment. There are home devices that can be purchased, or you can find a chiropractor whose office is equipped with a decompression machine. Spinal decompression consists of increasing the space between vertebrae to allow for disc re-expansion and re-absorption of lost fluids.

Muscle and Joint Causes

The piriformis muscle lies deep within the buttocks, and its role is to rotate the thigh laterally. Due to its location, this muscle is rarely stretched. It can become tight and inflamed in various ways, from sitting for long periods of time to athletic activities like running and cycling. The sciatic nerve runs past the piriformis in the buttocks. If the muscle is overly-tight, it will shorten and inflame. This causes irritation of the nerve.

SI joint dysfunction is a change in the range of motion of the SI joint, which is located where the sacrum meets the large hip bone at the base of the spine. The joint becomes inflamed if it is too stiff or too mobile. As the sciatic nerve travels by the joint, it can become irritated by this inflammation.

Piriformis syndrome is hard to diagnose; a physical therapist trained in muscle imbalance identification may have the best luck. People with piriformis syndrome generally have tight hip flexors and hamstrings and weak gluteal muscles. Piriformis syndrome treatment may be as simple as learning some new stretches, like the ones here: http://www.livestrong.com/article/36814-piriformis-stretches/. Prolonged tightness of the piriformis will require forced relaxation. A technique called self-myofascial release employs a foam roller to elongate and relax the muscle.

SI joint dysfunction can be diagnosed by moving the leg through the SI joint's range of motion. Certain positions will trigger pain if the SI joint is injured. Hypermobile joints will need to be stabilized by exercise therapy and possibly the use of a belt. Hypomobile joints can be loosened by a chiropractor.

Sciatica treatment is a process. Even with education and the best medical team, resolving back pain can take months if not longer. That is why it is important not to waste time in and out of appointments with those who can't help you. Don't be afraid to assist your doctor in a diagnosis or to ask for specific referrals based on your own knowledge.