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,
- Alleviate symptoms and reduce pain through manual therapy
- Provide exercises and activity modifications to control pain and regain strength
- Provide a necessary referral when needed
- 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.
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
- Learning how to brace your core, get up from a chair, roll over in bed, dress, bend over to pick something up – things that are incredibly painful when you have sciatica – need to be temporary relearned to stay as pain-free as possible
Positions of Relief
- It is important to provide patients with certain positions that take pressure off of the injured disc / nerve / tissue that is causing your symptoms. A thorough chiropractic examination is needed to determine what forces (is it compression, flexion, shear, lateral bending, extension, rotation?) exacerbate your symptoms. After learning what positions should be avoided, we teach you how to move, rest, and sleep to feel less pain and improve your symptoms.
- Working with your doctor, pharmacist, surgeon, RMT or physio is important to provide the best possible care. Sometimes there is a place for medication and the input from other professionals and I fully support this!
- Providing symptom relief is one of the most vital parts of the treatment process to reduce the need for medication, speed recovery and to allow for a return to normal activities and work. A combination of soft tissue therapy / massage, acupuncture, joint mobilizations or manipulations and IFC / TENS helps muscles to relax, joints to move properly again and to reduce you pain. These treatments are incredibly safe even in the case of a disc injury and will be openly discussed should you require them
- As with any low back injury, exercise rehab to improve strength, flexibility, movement coordination and power is vital to reducing the risk of future injury and speed the recovery of the existing problem
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).