Sciatica is not a disease, but simply a symptom indicating any type of pain caused by the compression of the longest nerve in the body called the sciatic nerve, which runs from the back of the pelvis all the way to the foot. The underlying causes of sciatica symptoms are numerous, including:
- Lumbar herniated disc, occurring when the soft gel inside the disc is forced through a tear or crack into the thicker outer layer of the disc, irritating adjacent nervous tissue.
- Degenerative disc disease, caused by the wear and tear of the disc, which dries out and loses its flexibility with age.
- Piriformis syndrome, caused by the compression of the sciatic nerve by the flat muscle located in the buttocks called piriformis.
- Sacroiliac joint dysfunction: Trauma to the foot, ankle, knee, or hip or a muscular imbalance from performing a certain type of sport or physical activity resulting in a rotated pelvis that stresses a sacroiliac joint and the sciatic nerve running nearby.
- Other causes include lumbar spinal stenosis, isthmic spondylolisthesis, pregnancy, muscle strain, scar tissue, and infection.
How Do Epidural Steroid Injections Work for Sciatica?
For patients struggling with debilitating leg or low back pain for whom anti-inflammatory medication, physical therapy, exercising, and other conservative therapies are not effective, one solution to address chronic leg pain and back pain involves delivering steroid medication directly to the irritated nerve roots. The minimally-invasive surgical procedure is meant to reduce the inflammation of the disc herniation, thus relieving the irritation of the nervous tissue and the accompanying pain, numbness, and weakness along the nerve’s route. The steroid medication, along with an anesthetic and a saline solution meant to flush out the inflammatory proteins in the affected area, is injected directly into the epidural space (the area between the inner surface of the bony spinal column and the exterior of the spinal column called the dura).
There is, however, a growing body of evidence pointing to the limited benefits of epidural corticosteroids for sciatica pain, raising questions about the actual value of the treatment. The results of 23 randomized placebo-controlled trials showed that epidural injections with corticosteroids provide only limited relief from pain compared to placebo, and with little or no significant results over the long term.
The study findings were confirmed by the American Academy of Neurology (AAN), which stated that, “Epidural steroid injections play a limited role in providing short-term pain relief for lower back pain that radiates down a leg and do not provide long-term pain relief.” According to them, the results of corticosteroids last for only 6 weeks and may not be cost-effective for patients with debilitating sciatica symptoms.
Why Is Chiropractic Better for Sciatica?
Unlike epidural steroid injections that provide short-term relief from the symptoms, chiropractic treatment tackles the underlying cause of the nerve irritation in order to restore the body’s correct skeletal motion and performance. Depending on the cause of the patient’s sciatica and medical history, a licensed chiropractor will design a treatment plan that can include:
- Chiropractic adjustment/manipulation – The core of chiropractic care, spinal manipulation aims to restore the correct spinal movement by realigning the vertebrae to their correct position within the spinal column. For sciatica patients, this approach will relieve the pressure applied on the sciatic nerve, thereby reducing inflammation, swelling, pain, spasms, and other discomfort linked to sciatic nerve compression.
- Heat/cold therapy – Alternating ice and heat sources can provide positive results in reducing sciatica pain. Applying an ice pack reduces swelling, while heat relaxes tight muscles around the nervous tissue and in the structures pressing on the sciatic nerve. The treatment is also readily available, inexpensive, and effective.
- Massage therapy – A licensed massage therapist will apply various techniques to structures compressing the sciatic nerve, enabling the muscles to release their hold on the nerve and reduce the spasms.
It often starts with a bit of tingling and occasional numbness, but the compression of the sciatic nerve can evolve into constant, debilitating pain that makes it difficult for sufferers to stand up and even walk. Simple treatments such as ice/heat therapy or spinal manipulation performed by your local chiropractic office can provide relief from pain from even the first session, so ensure you seek specialized help before turning to invasive procedures for your sciatica pain.
About the Author
Dr. Marc Browner is the Founder of iChiropractic and Wellness in Naples, Florida. A graduate of the University of Florida in 1991, he earned his Doctor of Chiropractic degree from Life Chiropractic in 1995. In private practice since 1998, Dr. Browner is a member of the Florida Chiropractic Society, the Florida Chiropractic Association, and he attends continuing education seminars, classes, and workshops to remain abreast of the most current treatment methods and technological advances in the field.