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the causes of sciatica


You would probably not be wasting your time with a Blog Post on SCIATICA if you or someone you love did not have pain, numbness, tingling, weakness, or combinations of all of the above in your leg(s).  Stay with me for a few minutes and I will help you expand your knowledge-base concerning this all too common problem, what causes it, and how best to manage it.

Low back pain is not only an epidemic here in America, it is the second most common reason that people visit doctors offices.  A different study that came out just a few months ago said that low back pain is the number one reason that people miss work worldwide. How are most people dealing with this low back pain?  We’ll get to that in a moment, but suffice it to say that the standard medical recommendation of drugs and rest is not working out very well for a large segment of the population.

The impact of low back pain and sciatica is enormous in numerous areas; financially, physically, and emotionally.  We know that eight years ago, the cost of low back pain was 100 billion dollars.  It is dramatically higher now.  The UK Express said of Great Britain, which is slightly over one seventh our population, “Around 4.2 million working days were lost by workers aged 50-64 alone.  Those aged 25-34 were absent for 1.89 million days due to back pain, while those in the 35-49 bracket missed 3.86million days in the office. The statistics also show a dramatic increase in the number of sick days taken because of the chronic condition – up from 7.7 million lost days in 2013 to 9.96 million in 2014.

We also know that chronic low back pain is a serious enough problem that nearly 50% of those suffering with it have GIVEN UP SEX — and almost 3/4 have GIVEN UP ALL FORMS OF EXERCISE. In other words, it’s destroying people’s lives on almost every conceivable level.  And any time that you see studies on chronic low back pain, you have to realize that this creature is a double-headed monster that frequently involves Sciatica.

Sciatica is irritation of the Sciatic Nerve that runs down the leg.  The spinal nerves exit the spinal cord through small windows between the vertebrae.  These windows are called the IVF (Intervertebral Foramen).  If for any reason, the window is made smaller or the sciatic nerve is pinched, stretched, or rubbed, an irritation of the nerve takes place. 

The thing you have to remember is that all the nerves from the lumbar spine (the lowest 5 vertebrae in your back) as well as your sacrum (tailbone) grow together to become one nerve — the Sciatic Nerve.  The Sciatic Nerve is not only the longest nerve in your body (it stretches clear to the toes), but the biggest nerve as well (it is as big around as your thumb up where it originates).


Top Ten Causes of Sciatica

Although there are many reasons people develop Sciatica, some are much more common than others.  Sciatica is not in and of itself a diagnosis, but a symptom of an underlying cause that requires a diagnosis.  My list will try to cover the more common reasons for Sciatica first, leaving the less common (and typically more dangerous) for later in the list. 

Bear in mind that this list is being presented for informational purposes only and is not meant to diagnose, treat, or cure any specific disease or health problem.   On many of these items, I will give you a link to look at.  The link will provide far more detailed information than what I present here.  For my intents and purposes, I am referring to all leg pain (whether referred or radicular) as “Sciatica”.  It makes it easier for patients to understand.

  • SUBLUXATION:  When vertebrae get misaligned or have poor motion in relationship to each other, Chiropractors refer to this as VERTEBRAL SUBLUXATION.  This is an extremely common cause of Sciatica and can usually be dealt with effectively through Chiropractic Adjustments, and an exercise program.
  • PIRIFORMIS SYNDROME:  Although most people have never heard of Piriformis Syndrome, there is evidence touting it as the number one cause of Sciatica (NEARLY 40%).  When the Piriformis Muscle (one of the tiny stabilizers of the pelvis that make up the hip’s “Rotator Cuff”) becomes overly tight or tense, it can actually pinch the Sciatic Nerve.  Bear in mind that almost everyone who deals with PIRIFORMIS SYNDROME will initially be diagnosed with…..
  • HERNIATED DISC:  These problems go by several names, including Herniated Discs, Slipped Discs, Disc Ruptures, Disc Herniations, Disc Protrusions, Ruptured Discs, and several others.  Herniated Discs occur when the disc’s jelly center (Nucleus Pulposus) begins to bulge or push its way out of the layers of ligaments that contain it and hold it in place (Annulus Firbrosus).  Although MRI’s are usually used to diagnose this common problem (HERE), they fool most doctors.  Why?  Because as much as 70% of the adult American population has disc bulges that they do not know about because they are not causing pain (ASYMPTOMATIC DISC HERNIATIONS).
  • SACROILLIAC PAIN:  Your SACROILLIAC JOINTS are the two bony knobs of bone at either side of the top of your sacrum (tailbone).  When the pelvis goes into a ‘torqued’ position, a great deal of mechanical stress is put on the Sacroilliac Joints.  This can cause Sciatica as well as local pain.
  • SPINAL STENOSIS:  Spinal Stenosis tends to happen more often in elderly patients, and is frequently characterized by bilateral Sciatica.  SPINAL STENOSIS is caused by a thickening or buckling of the ligaments that line the Central Canal (the canal where the Spinal Cord travels).  If I have an older patient who has bilateral leg pain, you can bet your bottom dollar their problem is Spinal Stenosis.
  • DEGENERATIVE DISC DISEASE / DEGENERATIVE JOINT DISEASE:  These are usually referred to as DDD and DJD respectively.  The problem is that although DJD of the lumbar spine can certainly cause Sciatica, it might be getting more credit than it is due (HERE).
  • PREGNANCY:  As you might imagine, a baby growing inside a woman takes up a lot of space.  Sometimes the Sciatic Nerve can be pinched or irritated.  Fortunately, Chiropractic Adjustments usually work quite well to relieve Sciatica symptoms in pregnant women.
  • SPONDYLOLISTHESIS:  This is a commonly found issue that is usually something the person was born with — a common anomaly where one vertebral level slides forward on another.
  • SCAR TISSUE:  If you read our Piriformis Syndrome Page (link above) you very much understand how something like Scar Tissue can be such a huge problem as far as Chronic Pain is concerned.  More information at the bottom of the page as well.
  • CAUDA EQUINA SYNDROME:  CAUDA EQUINA SYNDROME is a serious serious problem that require immediate surgical intervention.  If your bowels or bladder do not work right, you find yourself leaking urine or feces, and you have saddle paresthesia (you cannot feel the part of your anatomy that comes in contact with a saddle while riding a horse), call 911 immediately!
  • TUMORS, INFECTIONS, & ANEURYSMS:  Although these three things certainly happen, they are not common causes of Sciatica — not by a long shot.  In fact they are quite rare.  All three require medical intervention.


Causes of Sciatica

This is where the rubber meets the road.  What can you do to effectively deal with your Sciatica?  You are likely reading this because the drugs, shots, and therapy has not worked for you thus far.  Because I am a fix-it-the-simplest-cheapest-way-first kind of guy, I will give you a few things you might want to try on your own — and prevent you having to resort to riding the MEDICAL MERRY GO ROUND.

  • EXERCISE:  I am a big fan of exercise.  Hopefully, you are exercising to prevent problems like Sciatica as opposed to waiting until you have it and then trying to play catch up.  More on EXERCISE.
  • WEIGHT LOSS & ANTI-INFLAMMATION DIET:  The first part of this bullet is a no-brainer.  The heavier you are, the greater the chance of back problems.  Do not wait until you have Sciatica to start a WEIGHT LOSS PROGRAM if that’s what you need.  The second part of this bullet encompasses both weight and INFLAMMATION.  If you are interested in solving your Sciatica, don’t neglect this STRANGE BUT SIMPLE TRICK.
  • INVERSION:  There is a right way and a wrong way to go about INVERSION THERAPY.  Make sure you know the difference

Here is a list of treatments that will require a visit to someone with some expertise in the field.

  • CHIROPRACTIC ADJUSTMENTS:  Once you understand how Vertebral Subluxations work, CHIROPRACTIC ADJUSTMENTS are the next logical step.  They can also be quite effective for disc issues as well.
  • SPINAL DECOMPRESSION:  NON-SURGICAL SPINAL DECOMPRESSION THERAPY is an incredible modality for people who are trying to avoid surgery.  Because Piriformis Syndrome is such a common cause of Sciatica; if I as much as suspect a person’s problem is Piriformis Syndrome, I will give them a Tissue Remodeling Treatment to see what happens.  This is because in my experience, Spinal Decompression Therapy always makes people with Piriformis Syndrome worse.  Case in point:  the other day I had a woman come to see me who wanted Spinal Decompression Therapy.  I saved her a bundle of money by fixing her Piriformis Syndrome / Buttock Pain on the same day.
  • TISSUE REMODELING:  TISSUE REMODELING has been shown very effective for problems related to the connective tissues of the low back and pelvis (SEE HERE & HERE — this links to a post with a “Top Ten” for solving your back problems).   Once you begin to understand SCAR TISSUE, you can understand how it can be such a devastating force on your Sciatic Nerve when it forms in MUSCLES, TENDONS, LIGAMENTS, or most particularly FASCIA.
  • LASER THERAPY:  LASER THERAPY is an amazing modality for dealing with all sorts of problems, including those associated with Sciatica.  This is why Laser Therapy is part of our Spinal Decompression Protocol.
  • ACUPUNCTURE:  I do not use needles in my clinic as far as acupuncture is concerned (I have, however, recently been using DRY NEEDLING techniques).  Instead, I stimulate certain areas using a Mens-O-Matic Microcurrent unit.
  • DRUGS:  Where do I start?  If you have read this far, you are probably not looking for drugs —- in fact you are probably looking for a way to get off of them.  First, you have to be aware that there are no drugs on the market that really work well for nerve pain (Gabbapentin and LYRICA are the two most commonly used).  Secondly, most of the drugs that doctors will give you for Sciatica and similar problems are DANGEROUS, DEGENERATIVE, or DEADLY (the first link in these last three was included because you would be surprised how many people are prescribed this class of drug for Sciatica).
  • SURGERY:  This has to be a last resort.  HERE is why.

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