Part of my everyday practice is to see patients with low back pain who are also experiencing related sciatic symptoms. In the course of the initial assessment one of the most important things I can do is determine if this patient is appropriate for chiropractic treatment. Through a thorough clinical evaluation, we are able to determine if the symptoms are being caused by a mechanical or structural problem that can be resolved with manual treatment. In rare cases a patient may need to be referred for more advance imaging such as a CT scan or an MRI.
When people get sciatic pain, they usually associate that with a “pinched nerve”. The pinched nerve terminology is a simplistic (and not usually accurate) view of looking at things that unfortunately chiropractors, doctors and therapists have used to describe back pain that has referral along with it. In actuality, the majority of the time, we are not talking about a disc impinging on a nerve. It can be soft tissue that is causing the problem that is something that Active Release Techniques can help resolve. The facet joints, which are the joints between the upper and lower vertebrae can also get irritated and they themselves can cause some referral of pain into the legs.
With a true herniation or bulging disc that is impinging on a nerve root, there is a certain set of clinical symptoms that can be looked at to determine what exact nerve root and what disc level is causing the problem. In the case of getting an MRI, a good physical exam is important because often times patients will get the imaging done and have bulging discs that do not correlate with the clinical presentation. A look back at a previous article in my archives regarding MRI’s highlighted some of the concerns with using them.
A chiropractic approach to treatment of disc and nerve root related problems is very effective to hopefully eliminate the need for a surgical procedure. Combining manual therapy with the correct clinically indicated rehab exercises is the first step and it all starts with performing a thorough physical assessment. Determining what relieves pain and what increases it lets us determine what exercises will be helpful and which ones will be provocative. There is an abundance of literature showing that conservative care of these problems is preferred choice with a surgery being the last resort.
A year-long study in the Journal of Manipulative Physiologic Therapy, (October 2010) compared chronic sciatica patients with symptomatic lumbar disc herniations who received either a microdiscectomy or 21 chiropractic visits. The researchers found that 60% of the patients who received chiropractic care benefited to the same degree as those who underwent surgery. The study’s authors recommend that patients with a symptomatic lumbar disc herniation try chiropractic first, before considering surgery.