Sciatica and Back Pain – A Chiropractic Expectation
“The most distressing feature of these pathological processes is that they persist long after healing of the damaged peripheral tissue.”
I hate this quote because it’s true. But here the good news: it will get better. A swollen disc (aka bulging disc, herniated disc) that causes sciatica is often visible on x-ray. MRI is today’s gold standard for making the diagnosis, but good clinical skills are more reliable than a MRI—I’ll address that reason some time later. From my perspective, finding the fixation/misaligned bone/subluxation or myofascial adhesion is important for relief. Too often patients find themselves thinking that they have a disc problem when in reality it's not. When you have back pain, you have to differentiate its cause. It can be:
1. Lumbar disc pain
2. SI joint dysfunction
3. Piriformis syndrome
4. Hamstring myofascial adhesion
All four of these cause leg pain and the label is only appropriate for lumbar disc pain and piriformis syndrome.
Lumbar disc pain from a herniation or bulge often causes low back pain and leg pain. The leg pain typically starts in the glut (but) area and with time starts to progress all the way down the leg (past the knee). In bad cases, the pain is accompanied with numbness and tingling all the way down the leg.
SI (sacro-iliac) joint dysfunction mimics lumbar disc pain with sciatica. One of the key features of SI joint pain is that the pain is not centrally located. Instead, it feels like its on the boney ridge on either the left or right side of your back (the ilium area). From there, the pain can progress down the leg into the hamstring, but not past the knee. Other features include pain that does not get better when walking. Conversely, lumbar disc pain tends to feel better with prolonged walking.
Piriformis syndrome starts with pain in the glut and travels down the leg mimicking sciatica.
A hamstring myofascial adhesion is a term I borrowed from ART specialists (www.activerelease.com). A pulled hamstring lcan leave you with months or even years of residual leg pain. Too often, health care providers label diffuse leg pain as sciatica.
Ultimately, the key to relief is a proper diagnosis. Time coupled with good spinal adjustments (or ART work) yields positive results in two to three months for the leg pain syndromes listed above.
Its always takes time,
Dr. Matt
