There was a time last weekend when I thought my chronic sciatica was going to act up. We were in Chicago for a conference and were prepared for temperatures in the upper 70’s and lower 80’s since that is what the most accurate weather in the universe – up to the minute satellite forecasts from The Weather Channel – told us. I was so excited to be able to pack only Capri pants and sleeveless tops with my open-toed Birkenstock sandals because that meant only one suitcase and I could avoid the long lines at baggage claim by using a carry-on. On Thursday morning I needed to call into the office to check in and couldn’t get a good signal on my phone inside the Marriott in downtown Chicago, so I stepped outside to see if it was better. This Southern girl almost came undone! On May 13, it was 45 degrees and raining. My teeth were chattering as I stood outside in the cold with hardly anything on in comparison to the mid-westerners I was watching walk by. My body almost went into shock. It was a good thing that the best shopping in the mid-west is on the Magnificent Mile in Chicago, because my task was set before me and I needed some clothes. I feverishly ran up Michigan Avenue looking for anything with long sleeves that might still be on the racks in the middle of May. This power shopping is what got my sciatic nerve upset. I had not prepared my body for the physical demand of running in the cold with the wrong shoes on, and soon the tell-tale pain was shooting down the back of my right thigh. This was a forecast of a more accurate nature because we have seen no fewer than 25 people this week with sciatica and I thought it would be appropriate to visit the subject for those of you who might be suffering with it.
Sciatica is the name for the condition which involves inflammation and pain that result from irritation of the sciatic nerve. As wide as your thumb, the sciatic nerve is the largest nerve in the body. It originates at the roots of the nerves that stem from the lowest segments of the spine and travels through the muscles of the buttocks, the back of the thigh and calf, down the leg, and to the sole of the foot. This makes it one of the longest nerves in the body. Since its path is so long and tortuous, there are many opportunities for damage to it to occur. Pain associated with sciatica can vary widely depending on where the damage occurred, what activities of daily living aggravate it, and how long the problem has existed. Most often it is characterized by a burning pain that goes from the buttocks down the back of the thigh and into the leg. Occasionally sufferers report that the pain is so severe that they can’t put weight fully on one foot because the nerve is irritated on the sole of the foot. Tingling sometimes accompanies the pain, but will come and go erratically.
The two types of sciatica that we deal with regularly are those that are lumbogenic (originating from one or more of the lumbar vertebrae) or musculogenic (originating from a muscle). If the pain is lumbogenic, the cause is usually a slight bulge in a disc which is putting pressure on the nerve roots from which the sciatic nerve originates. This is treated by first discovering which segment is causing the problem then systematically adjusting that segment to decrease the disc bulge and thereby remove the pressure from the nerve roots. The pain is usually better immediately, but might take a few days to go away completely due to inflammation that has built up in the area. Several adjustments along with the use of a strategically placed ice pack usually take care of the problem. Rehabilitation is necessary to prevent the return of lumbogenic sciatica.
Musculogenic sciatica can be trickier to treat. We must first isolate exactly which muscle is causing the problem. If a lower back or large buttock muscle is the culprit, it is due to spasm in the muscle and should be treated with trigger point therapy and muscle stimulation to ease the muscular tension and inflammation. If another small muscle in the buttock is causing the problem, it is generally too lax and is therefore lying directly on the sciatic nerve. The most common offender is the piriformis, or pear-shaped, muscle. This muscle must be lifted off the nerve and exercised so that the irritation goes away. There are specialized techniques which exercise this particular muscle. Muscle stimulation, ice, and rehabilitation are all necessary to maintain the correction of musculogenic sciatica, and lifestyle alterations have to be made to prevent its return.
If you are prone to have exacerbations of sciatica, taking off in a dead run in 45 degree rainy weather is certain to leave you wondering why you were temporarily insane. As some of the members of our practice can attest, so can kamikaze gardening, cleaning out the attic, driving for hundreds of miles without stopping, and just about anything else that you know deep in your heart you have no business doing. Lucky for me I was in a room full of chiropractors for the whole weekend, so I did not have a full-blown flare-up.
I will never trust The Weather Channel again, however, even though it gave me a great excuse to do some power shopping. Treat your body well.