Chiropractic Treatment of Sciatic Low Back Pain

Sciatica from lumbar disc herniation or sciatic nerve entrapment, is a self-limiting condition; most patients will experience relief without treatment in weeks to months. To learn more about the prognosis and diagnosis of sciatica click here but in short, about 10-15% of patients could experience symptoms for up to one year and 30% for up to six months.. The purpose of manual therapy and exercise treatment of sciatica provided by a chiropractor is to,

  1. Alleviate symptoms and reduce pain through manual therapy
  2. Provide exercises and activity modifications to control pain and regain strength
  3. Provide a necessary referral when needed
  4. Speed recovery and reduce the chance of chronicity 

Should I Have Surgery for my Sciatica?

The choice to have surgery is one ultimately made between a patient, their GP and their surgeon. It is out of the scope of a chiropractor to recommend or discourage surgery. I want whatever is best for my patients so I always recommend a surgical consult when desired or suggested.

The best available research suggests that surgery is recommended when (Haswell et al, 2014),

  • “red flags” indicate to your DC / MD there is serious pathology causing your sciatica
  • Pain is unresponsive to a trial of conservative management (generally 6-8 week trial)
  • Intolerable nerve (radicular) pain despite medication
  • Worsening weakness or sensation changes resulting from the injury
    • At the bare minimum, surgery is recommended when moving a muscle against gravity is difficult
  • A judgement that pain is intolerable is made by the patient

There are pros and cons to surgery as will any medical or conservative treatment. Studies have shown that there are slightly better short-term results when surgery is performed for sciatica immediately and is the reason why many professional athletes take this route; they need immediate results, have immediate access to care within the fastest referral networks, and understand the significant risks, like infection or worse, which go along with any surgery.

Studies show that conservative and surgical approaches to the treatment of sciatica demonstrate equivalent results over the long term (about 1 year).


We Want Pain Centralization with Sciatica Treatment – What’s that?

Pain centralization refers to the phenomenon in which pain associated with sciatica or disc injury moves farther away from the periphery and closer to the spine with gradual treatment. We want to see symptoms move from the toes, into the foot, then to the leg, thigh, buttock and then the low back. This signifies an improvement in the healing process and is important for recovery.

Symptoms noticed closer and close to low back = good (unnecessarily evil happy face?)
Symptoms noticed closer and close to low back = good (unnecessarily evil happy face?)

Treatments such as acupuncture or adjustments, or positions of relief that see your symptoms move out of your foot and only as far as the shin, are a huge step in the correct direction. Patients often get very concerned when the pain becomes less intense in the lower limb but intensifies in the low back. This however is a very common scenario to witness increasing low back pain with symptoms moving out of the limbs and centralize to the back. In most cases, the increase in spine symptoms following centralization resolve steadily.


Chiropractic Treatment for Sciatica – What to Expect

My sciatica patients receive treatment that is individualized to their case and needs. My approach to care is to provide my patients with the tools they need to help themselves and the treatment the body needs to feel better and move properly again.

The GOAL of treatment it to attempt to CENTRALIZE YOUR PAIN and then get rid of it all together

Activity modificationProper lifting activity modification

Positions of Relief

A McKenzie type position of relief into extension often helps to reduce sciatica symptoms if bending forward is bothersome
A McKenzie type position of relief into extension often helps to reduce sciatica symptoms if bending forward is bothersome

[youtube=https://www.youtube.com/watch?v=EDijfkUi-cc]

Interprofessional collaboration 

Pain Relief

Exercise Rehabilitation

References

Haswell, Kate, John Martin Gilmour, and Barbara Joyce Moore. “Lumbo-sacral radiculopathy referral decision-making and primary care management. A case report.” Manual therapy (2014).

Hsu et al. (2015). Lumbosacral radiculopathy: Prognosis and Treatment. In T. W. Post (Ed.), UpToDate. Retrieved from http://www.uptodate.com/home

McGill S. Low back disorders: evidence-based prevention and rehabilitation. 2nd ed. Champaign: Human Kinetics; 2007.

Peul WC, van Houwelingen HC, van den Hout WB et al. Surgery versus prolonged conservative treatment for sciatica. N. Engl. J. Med. 356, 2245–2256 (2007).

One Response

  1. Thank you for this article and video. I am finding them very informative and helpful. I have a question. You mention this, “Pain centralization refers to the phenomenon in which pain associated with sciatica or disc injury moves farther away from the periphery and closer to the spine with gradual treatment”. I have always thought that pain centralization was per exercise. For me, there is no one exercise that centralizes my pain but in the 2.5 months I’ve been suffering from severe pain down my leg and into my foot, I have just recently realized that my toes and foot are no longer in pain. It seems to stop at my ankle. It’s taking FOREVER but could this mean my pain is centralization gradually also? *Praying* It’s been the worst 2.5 months of my life. The pain has been excruiating! I haven’t been able to walk, stand, work, etc. I’m also on a lot of pain medication that I am dying to get off of. I am hoping this means I am beginning to heal finally.

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