Sciatica - Pain Down The Leg

Sciatica

Pain that radiates from your lower (lumbar) spine to your buttock and down the back of your leg is the hallmark of sciatica. Occasionally, sciatic pain in men is caused by sitting on a wallet.

The sciatic nerve is the longest nerve in your body. It starts in the low back, runs into the pelvis, through your hip area and buttocks and down each leg. The sciatic nerve branches into smaller nerves as it travels down the legs providing feeling to your thighs, legs, and feet as well as controlling many of the muscles in your lower legs. The term sciatica refers to pain that radiates along the path of this nerve of pain that runs down the leg. 

What causes Sciatica?

Sciatica is actually a sign that you have an underlying problem putting pressure on a nerve originating in your lower back. The most common cause of this nerve compression is a bulging or herniated lumbar disc. Piriformis syndrome is another common cause of sciatica. The piriformis is a muscle that lies directly over the sciatic nerve. If this muscle becomes tight or if you have a spasm in this muscle, it puts pressure directly on the sciatic nerve. In about 10% of the population the sciatic nerve actually courses through the piriformis muscle. In those patients sciatica is more common. Occasionally, sciatic pain in men is caused by sitting on a wallet or simply sitting too much. it can also be caused by standing too long, pelvic injury or fracture or even tumors. However the last two causes are morete rare findings in most doctors offices. 

How do I know if I have sciatica?

Pain that radiates from your lower (lumbar) spine to your buttock and down the back of your leg is the hallmark of sciatica. Sciatica may be accompanied by numbness, tingling, and muscle weakness in the affected leg. This pain can vary widely, from a mild ache to a sharp, burning sensation or excruciating discomfort. Sometimes it may feel like a jolt or electric shock. Sciatic pain often starts slowly or gradually and intensifies over time. It's likely to be worse when you sit, cough or sneeze. In some cases, the pain is severe enough to make a person unable to move.

The pain most often occurs on one side. Some people have sharp pain in one part of the leg or hip and numbness in other parts. The pain or numbness may also be felt on the back of the calf or on the sole of the foot. The affected leg may feel weak.

Sciatica pain may get worse:

• After standing or sitting
• At night
• When sneezing, coughing, or laughing
• When bending backwards or walking more than a few yards, especially if caused by spinal stenosis

Signs and test

Your Millar Chiropractor will perform a thorough history and physical exam. This may show:

• Weakness of knee bending or foot movement
• Difficulty bending the foot inward or down
• Abnormal or weak reflexes
• Pain when lifting the leg straight up off the examining table

Tests determine on the suspected causes. They are often not needed unless pain is severe or long lasting. They may include:

• Blood tests
• X-rays
• MRIs or other imaging tests

Home Treatment

• Apply heat or ice to the painful area. Try ice for the first 48 - 72 hours, then use heat after that.
• Consider taking over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol) if your stomach can tolerate them.

Bed rest is not recommended. Reduce your activity for the first couple of days. Then, slowly start your usual activities after that. Avoid heavy lifting or twisting of your back after the pain begins. If you get better, you should start exercising again after 2-3 weeks. This should include exercises to strengthen your abdomen and improve flexibility of your spine. 

If at-home treatment measures do not help after 3 days see your Millar Chiropractor.

How is Sciatica Treated?

The vast majority of the time, sciatic pain can be relieved through a combination of stretches, deep tissue massage of the piriformis muscle and chiropractic care. We often utilize cold lasers, ultra sound and deep e-stimulation. Occasionally, in cases where chronic spasm of the low back or piriformis muscles is causing the sciatic pain, it may be necessary to do a procedure called a dry needling or a steroid injection, where a medical pain specialist injects a small amount of anesthetic directly into a spasmed muscle to break the spasm cycle. However, this is typically not necessary.  When the cause is a bulging or herniated disc, decompression traction may be indicated. First we need to locate the point of nerve compression and then treat that compression. Your Millar Chiropractor has many tools in his treatment toolbox to properly diagnose and treat your sciatica. Call Millar Chiropractic today and set your appointment.

Dr Greg
March 15th, 2012

       

Copyright 2012 Millar Chiropractic Associates, Inc. All rights reserved. The contents of this website including all links to other pages or websites herein including but not limited to text, graphics, images, comments, statements, or information from doctors, host or guest, and other material contained therein (Content) are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should not use this Content for diagnosing or treating a health problem or disease. Never disregard professional medical advice or delay in seeking it because of Content you have seen, read or heard.

Putting Out The Pain Fire

I see many patients that come to me every day with pain and lots of it. Often they have pain in several similar global areas. These seem to occur in groups like neck, upper back and shoulder pain some with arm pain some without; or low back, sacrum and hip pain as a group some with leg and some without leg involvement just to name a few. I have talked in the past to Drs. Spurlock, Matz and Hadley of the UAB Dept of Neurosurgery, as well as our doctors about this phenomena. They too have seen this in their practices. Over the years I have concluded that Pain is often not of a single source genesis or origin. Meaning that pain often comes from more than one cause. Further pain seems to begot pain. In that once the body is in pain the second or third pain seems to combine with the other pains to make the global area painful.

We the patients, want our pain to be from a single origin or cause as we feel that in someway it might be easier to stop or turn off the pain. However, I now believe in the multi genesis pain origin theory. This theory says that pain is often cumulative in the body. I often compare this to lighting a book of matches. If one were to light one match, one would have a small fire. Light the whole book and you get a much bigger fire composed of many smaller fires.

I find the same is true for the body. Let us take the low back pain for example. The origin of low back pain can often be traced to several pain generators. Say for example, a patient presents with low back pain radiating into the hip. How many times have we found that the patient did indeed have a disc problem, a same side facet problem, sacroiliacs, and bursitis of the hip or similar findings. This perhaps, is part of the reason for so many failed low back surgeries. Yes the surgeon dutifully decompresses the disc but does nothing to treat the co-concomitant conditions(other problems).

I often tell my doctors that if you can't find the problems you can't fix the problems. This can only be done through examination, treatment, re-examination and continued treatment. I often find it necessary to bring in other doctors or specialist in their respective areas to confirm diagnosis or treat. I find by accurately diagnosing the multi genesis pain and its several pain generators we can often separate and treat the overall pain putting out several of the pain fires and then determining the extent of the core problem. Kind of like turn off the background noise and see what is left.

Patients like this kind of treatment as they feel the progress. This progress gives them hope that their pain may be treatable. Surprisingly it is. Often the average doctor does not take the time or have the inclination to tease out the many pain generators. It is far easier to just say you have a bulging or herniated disc and treat only that problem. We encourage our doctors to look globally at our patients, diagnosing multi genesis pain generators and then treat them all.
Dr Greg


Copyright 2009 Millar Chiropractic Associates, Inc. All rights reserved. The contents of this website including all links to other pages or websites herein including but not limited to text, graphics, images, comments, statements, or information from doctors, host or guest, and other material contained therein (Content) are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should not use this Content for diagnosing or treating a health problem or disease. Never disregard professional medical advice or delay in seeking it because of Content you have seen, read or heard.

Cervical Herniated Disc

I had a 36 year old male present with a Cervical herniated disc today. He presented with neck pain rated an 8 on the 0-10 scale and radiating pain into his left arm and hand of one month duration. He felt that his wrist was beginning to get weak. He had been to his primary doctor who sent him for an MRI of the cervical spine. His medical doctor had given him a medrol dose pack and pain meds. His MRI demonstrated two herniated disc, one at C5-6 and one at C6-7. His primary then referred him to a local orthopedist who wanted to do surgery immediately. The surgeon wanted to do a two level fusion. The patient wanted another opinion.

I did a complete history and physical. After examination I concluded that he had NO neurological deficits. He had numerous positive orthopedic and neurological test but non indicated a true neurological deficit. I needed further NCV testing to differentially diagnose between radiculopathy (radiating pain from the neck) vs Carpal Tunnel Syndrome (an entrapment of the Median nerve at the wrist) both of which could produce a pain in the hand. I ordered an NCV the next day. Dr Gary Cohen our Physical Medicine doctor at Millar MultiMedical preformed the test. The test concluded that yes there was a mild radiculopathy (radiating pain) coming from the neck but also there was carpal tunnel syndrome.

I started the patient on daily CMT, Chiropractic Manipulative Therapy with the Activator and DTS - Decompression Traction of the cervical spine at 22lbs at 15 degrees for 20 min a day. I also included in his care e-stim and ultrasound treatment. I told him he would get worse before he got better and indeed he did. But after only a few pulls his pain started going down. We also started treating the carpal tunnel syndrome with e-stim, ultra sound and manipulation. He is now nearly pain free.

I think this case demonstrates always get a second and even a third opinion if surgery is the option and it's not an emergency.
Dr Greg


Copyright 2009 Millar Chiropractic Associates, Inc. All rights reserved. The contents of this website including all links to other pages or websites herein including but not limited to text, graphics, images, comments, statements, or information from doctors, host or guest, and other material contained therein (Content) are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should not use this Content for diagnosing or treating a health problem or disease. Never disregard professional medical advice or delay in seeking it because of Content you have seen, read or heard.

Leg Pain & Groin Pain with NO Back Pain

Problem: Today I had a man present with groin pain and leg pain to the foot worse on sitting and lying down and better with standing and walking. He has had similar groin pain in the past over the years but he has had no similar leg pain. He thinks he hurt himself lifting something heavy a week ago. Today, he had no back pain to speak of. In fact on examination, the low back had very little tenderness or spasms. He had a little edema over the sacrum. His groin and leg pain however he rated at a 9. During the exam his pain was so intense he could hardly carry on a conversation. My exam revealed several things. First, I could make the pain worse by having him sit on the table and raise a leg to 90 degrees. Secondly, with him lying on the table, when I lifted his uninvolved leg up to 35 degrees, pain shot down his leg and into the groin. Third when I tested his lower extremity sensory nerves (dermatomes) he had moderate hypersensitivity (too much) in one area of the involved leg followed by moderate hyposensitivity (too little) of the along the outside of the foot (S1) dermatome. Forth, his muscle strengths were somewhat diminished with some loss of strength at the involved leg quad and hamstring muscles both rated a 4/5. He had a negative heel walk and toe walk and denied any change to bowel. Finally he had a negative braggard's ruling out simple sciatica. Treatment: He had a defibrillator so e-stimulation was out. So I went with moist heat followed by laser to the sacrum and lateral/posterior leg along the nerve route and ultrasound to the upper lumbar para spinal muscles at T12 -L3 on the side of involvement. I did some manual therapy on his low back and sent him for X-rays at the local hospital as I want a radiologist to read these films. I think he has two things going on. First I think he has stenosis (narrowing of the central spinal canal) and secondly I think he has superimposed a bulging disc at L5. He also may have one at L4. I think he has neuroforaminal encroachment (disc pressing on the nerve root) causing inflammation. I will order an MRI after I get the x-rays back. I talked to him about anti inflammatory meds but he was already on Mobic. Discussion: Diagnosis is the key. If a doctor does not know what is causing the problem he can't fix it. God gives us the right to have more than one thing going on at a time. Most people have multiple pain generators. I talk everyday to patients that tell me that the doctor did not touch them in the examination. That means the doctor is guessing and that's why we have so many failures in low back pain treatment. Greg Millar DC CCEP




Copyright 2009 Millar Chiropractic Associates, Inc. All rights reserved. The contents of this website including all links to other pages or websites herein including but not limited to text, graphics, images, comments, statements, or information from doctors, host or guest, and other material contained therein (Content) are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should not use this Content for diagnosing or treating a health problem or disease. Never disregard professional medical advice or delay in seeking it because of Content you have seen, read or heard.

Fibromyalgia and Multiple Herniated Disc

Today Monday Feb 9th was a most interesting day of practice. CASE: I had a middle aged female patient in the Decatur Disc Treatment Center office who had multi level degenerative disc disease with stenosis and neuroforaminal encroachment with 2 herniations and 2 bulges in the lower cervical spine; 2 prolapsed disc in the thoracic spine at T7-8 and T8-9; and 2 herniations in the lumbar spine at L4-5 and L5-S1. She also has Rheumatoid arthritis. I have treated her for several years. She has been through several rounds of DTS decompression traction with good success particularly in the lumbar spine. She has also had several rounds of physical therapy again to good success particularly in core stabilization and in making her stronger and more vital. What made today so different was that she has for some time been experience mild fibromyalgia like symptoms. Today her FMS (fibromyalgia) was flairing and was setting off her neck and low back radiating pain. FMS is normally considered a non- inflammatory disease and her SED rate was a 2 on the 0-20 scale meaning that she had little or inflammation. However she stated that her fibro fog and fibro pain was at it's highest ever today. She also stated that the FMS pain (pain evenly divided in all 4 quadrants) was always there as background pain then as the day progressed her radicular or discogenic pain would break through and progress. Treatment: I treated the FMS by helping her to get to sleep and stay asleep. I put her on Fibromalic brand of magnesium with malic acid. I asked her to control her sleep time and make changes in her going to sleep patterns. I told her to use breath right strips at night. I ask her to take warm Epsom salt baths. I put her on (krill) fish oil 3000mg a day. I measured her anti-occident scan and it was under 12000 where it should be a min of 35-40,000. I put her on physician grade multi vitamins and water as her serum Co2 was in the 30's. I consulted in Dr. Gary Cohen Do physical medicine/rehabilitation and he suggested Gogi juice as well. We are going to repeat her NCV to make sure that no radiculopathy changes have taken place and were starting her on a round of conservative chiropractic care along with physical therapy core stablization. Results: Too new to rate. I will revisit this case in two weeks.

Copyright 2009 Millar Chiropractic Associates, Inc. All rights reserved. The contents of this website including all links to other pages or websites herein including but not limited to text, graphics, images, comments, statements, or information from doctors, host or guest, and other material contained therein (Content) are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should not use this Content for diagnosing or treating a health problem or disease. Never disregard professional medical advice or delay in seeking it because of Content you have seen, read or heard.