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Neuropathy - sciatic nerve; Sciatic nerve dysfunction
Sciatica refers to pain, weakness, numbness, or tingling in the leg. It is caused by injury to or pressure on the sciatic nerve. Sciatica may be a symptom of another medical problem, not a medical condition on its own.
Causes, incidence, and risk factors
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 each leg. This nerve controls the muscles of the back of the knee and lower leg and provides sensation to the back of the thigh, the whole lower leg below the knee, and the sole of the foot.
Common causes of sciatica include:
Slipped or herniated disc(s)
Piriformis syndrome (a pain disorder involving the narrow muscle in the buttocks)
Pelvic injury or fracture
Sciatica pain can vary widely. It may feel like a mild tingling, dull ache, or a burning sensation. In some cases, the pain is severe enough to make a person unable to move.
The pain most often occurs on one side. Some people have sharp pain in one part of the leg or hip and numbness in other parts. The pain or numbness may also be felt on the back of the calf or on the sole of the foot. The affected leg may feel weak.
The pain often starts slowly. Sciatica pain may get worse:
After standing or sitting
When sneezing, coughing, or laughing
When bending backwards or walking more than a few yards, especially if caused by spinal stenosis
Signs and tests
The health care provider will perform a physical exam. This may show:
Weakness of knee bending or foot movement
Difficulty bending the foot inward or down, or standing on one’s toes
Abnormal or weak reflexes
Loss of sensation or numbness
Pain when lifting the leg straight up off the examining table
Tests determine on the suspected causes. They are often not needed unless pain is severe or long lasting. They may include:
Because sciatica may be a symptom of another medical condition, the underlying cause should be identified and treated.
In some cases, no treatment is required and recovery occurs on its own. This may take weeks or months to fully resolve.
Conservative treatment is what your medical doctor recommends in many cases. Your doctor may recommend the following steps to calm your symptoms and reduce inflammation.
Apply heat or ice to the painful area. Try ice for the first 48 - 72 hours, and then use heat after that. Never use heat if the area has swelling, as the heat will increase the swelling and lead to more pain.
Take over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol).
Bed rest is not recommended. Reduce your activity for the first couple of days. Then, slowly start your usual activities after that. Avoid heavy lifting or twisting of your back for the first 6 weeks after the pain begins. You should start exercising again after 2-3 weeks. This should include exercises to strengthen your abdomen and improve flexibility of your spine. You and your doctor will know if this is possible for you based on what your symptoms are and if there is improvement.
If at-home measures do not help, your medical doctor may recommend injections to reduce inflammation around the nerve. Other medicines may be prescribed to help reduce the stabbing pains associated with sciatica.
Physical therapy exercises may also be recommended. Additional treatments depend on the condition that is causing the sciatica.
Nerve pain is very difficult to treat. If you have ongoing problems with pain, you may want to see a neurologist or a pain specialist to ensure that you have access to the widest range of treatment options.
Addressing the underlying cause is always prudent. Working with a Holistic Chiropractor is the best method for relieving sciatic pain, as most cases are due to pinching and pressure on the sciatic nerve. With spinal manipulation by a trained chiropractor, sciatica is a condition that can be handled quite easily. With simple muscle tests, your Holistic Chiropractor can determine the cause of your sciatica and the best course of treatment for your condition. Always be sure to treat the cause of the sciatica and not just the symptom.
Acupuncture and massage therapy have also been helpful when dealing with the symptoms of sciatica.
Sometimes, sciatica can get better on its own. However, it is common for it to return. That is why it is best to see a Holistic Chiropractor for this condition. If your sciatica stays with you for more than 3 days, alternative treatment with a Holistic Chiropractor is warranted.
More serious complications depend on the cause of sciatica. These can be due to the following:
Addressing the underlying cause is always prudent. Working with a Holistic Chiropractor is the best method for addressing sciatic pain. As most cases are due to pinching and pressure on the nerve, conservative treatment to relieve the pressure on the nerve or spinal cord is appropriate. Chiropractors are the only profession that is able to do this. With simple muscle tests, your Holistic Chiropractor can determine the cause of your sciatica and the best course of treatment for your condition.
Calling your health care provider
Call your doctor right away if you have:
Unexplained fever with back pain
Back pain after a severe blow or fall
Redness or swelling on the back or spine
Pain traveling down your legs below the knee
Weakness or numbness in your buttocks, thigh, leg, or pelvis
Burning with urination or blood in your urine
Pain that is worse when you lie down, or awakens you at night
Severe pain and you cannot get comfortable
Loss of control of urine or stool (incontinence)
Also call if:
You have been losing weight unintentionally
You use steroids or intravenous drugs
You have had back pain before but this episode is different and feels worse
This episode of back pain has lasted longer than 2 weeks
Prevention varies depending on the cause of the nerve damage. Avoid prolonged sitting or lying with pressure on the buttocks.
Receiving regular Chiropractic care to keep pressure off your spinal nerves, thus preventing nerve damage is the best form of prevention. Your Holistic Chiropractor can help you determine the course of prevention best for you and keep you from having sciatica.
Chou R, Qaseem A, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478-491.
Chou R, Atlas SJ, Stanos SP, Rosenquist RW. Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. Spine. 2009;34(10):1078-93.
Jegede KA, Ndu A, Grauer JN. Contemporary management of symptomatic lumbar disc herniations. Orthop Clin North Am. 2010 Apr;41(2):217-24.
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