C1 Blog

Rupert at C1 writes:

We regularly treat ‘sciatica’. Though as a diagnosis it really irritates me, it is nearly as bad as ‘lumbago’ and as misused as ‘special needs’. Sciatica is not a diagnosis or a disorder, it is a symptom of a disorder.

Sciatica is a description of pain that originates in the low back or buttock that travels into one or both legs.

It is a radiating or referred pain, so a neuropathy or neuralgia. The pain generating structure itself is the sciatic nerve, hence the name, which is a relatively massive thing, about the diameter of your thumb, and, as a result, more vulnerable to injury. The nerve pain varies in intensity and frequency and is described by our patients as:

Intermittent, frequent or constant
Dull, achy, sharp, toothache-like, pins and needles or similar to electric shocks
Burning, numbness and tingling sensations.

What causes sciatic pain?

Full on, no messing sciatica is generally caused by sciatic nerve compression. This can be caused by:

1. Lumbar spine dysfunction (misaligned vertebra)

2. Lumbar herniated or prolapsed discs (aka “slipped discs” gaaaahhhh, there’s another cod-diagnosis for you)

3. Changes inpPregnancy and childbirth

4. Tumors pressing on the nerve root

5. Non-spinal disorders such as diabetes, constipation or even sitting on your wallet in your back pocket of your 501s

6. Piriformis Syndrome. This is named after the piriformis muscle. This muscle is in the lower part of the bottom and connects from the pelvis to the thigh and assists in hip rotation. The sciatic nerve runs beneath or, in a percentage of the population, through ithe piriformis muscle. This muscle is susceptible to injury from a slip and fall, hip arthritis or a difference in leg length. Such situations can cause cramping and spasm to develop in the piriformis muscle, thereby, pinching the sciatic nerve and causing inflammation and pain.

In extremis the compression of the sciatic nerve may result in the loss of feeling, paralysis of a single limb or group of muscles (monoplegia).

How’s it treated?

Since there are many disorders that cause sciatica, our first step is to determine what of the above is causing your sciatica. Forming a diagnosis is the most important thing we do as, without this, what are we treating. This is why if you hear sciatica given as a diagnosis you should ‘consider your options’ and seek a second opinion. The examination involves a thoughtful review your medical history and a physical and neurological examination. Diagnostic testing can be done and includes:

X-rays, MRI, CT scan or clectrodiagnostic tests (nerve conduction velocity, electromyography).
The type of chiropractic manipulation provided depends on the cause of the patient’s sciatica
A sciatica treatment plan may include several different treatments such as ice/cold therapies, ultrasound, TENS, and spinal adjustments – sometimes called manipulation.

1. Ice/cold therapy reduces inflammation and helps to control sciatic pain

2. Ultrasound is gentle heat created by sound waves that penetrates deep into tissues. Ultrasound increases circulation and helps to reduce muscle spasms, cramping, swelling, stiffness, and pain. We rarely use US as I suspect it is less effective than we’d like to think.

3. TENS (transcutaneous electrical nerve stimulation), which is a small box-like, battery-powered, portable muscle stimulating machine. Variable intensities of electrical current control acute pain and reduce muscle spasms and it is widely used to help during labour. Larger versions of the home-use TENS units are used by chiropractors, physical therapists and other rehab professionals.

4. And the most important – spinal manipulative therapy to address the underlying causes. Adjustments (Spinal Manipulation) are the core of our chiropractic care. This frees restricted movement of the spine and helps to restore misaligned vertebral bodies to their proper position in your spinal column. Spinal adjustment help to reduce nerve irritability responsible for causing inflammation, muscle spasm, pain and other symptoms related to sciatica. Adjustments should not be painful. Spinal manipulation is proven to be safe and effective.

At University and during our training, students of chiropractic learn many different adjustment techniques enabling us to tackle several types of disorders. Techniques vary from a swift high velocity thrust to those that combine minimal force and gentle pressure. Mastery of each technique is an art that requires great skill and precision and spinal manipulation is the treatment that differentiates chiropractic care from other medical disciplines.

To prepare a patient for adjustment, we usually get you to sit up or lie down. It is not uncommon that we use totally different adjustment techniques during your subsequent visit. Treatment tables differ too. Some are stationary, flat padded tables and others are elaborate with electrically or manually operated head and foot rests.

Limitations

Sciatica can be caused by other disorders beyond the scope of chiropractic practice. If we decide that you need treatment by another type of doctor, then you may be referred to another specialty.

Rupert Clements, one of the chiros, writes:

We have patients coming in every working day with episodes of neck pain. These are either acute ones, the ones who can’t move, or chronic ones, whose who can move but are limited in some way.

Neck pan can be split into 3 broad categories:

1. Acute pain – uncomplicated

2. Acute neck pain – complicated. This involved compression of the spinal cord in the cervical spine. Patients reported an improvement of up to 70% for pain and disability following chiropractic care in a trial carried out by Donald Murphy of Rhode Island.

3. Sub-acute and chronic neck pain.

And these patients, coming into C1 Chiropractic Health Centre, with any one of these levels of neck pain are not alone:

Hill and co-workers report that in the UK many as 31% of adults have had neck pain in the last month and 48% of neck pain patients report persistent pain a year later. (Hill J, Lewis M et al. (2004) Predicting Persistent Neck Pain. Spine 29:1648-1654).

But what causes it:
Liebenson, Skaggs et al. say that it is
‘difficult to pinpoint the specific pain-generating tissue’ of neck pain and even if you can the reasons why ‘are often elusive’. Additionally, up to

71% of patients who have chronic pain following whiplash have undetected vertebral end plate fractures at the spinal levels associated with the pain that were overlooked on standard medical imaging. (Michael Freedman Dec 2001).

So how is it best treated:

Cleland et al. have shown that manipulation of the thoracic spine produces immediate analgesic effects in patients with mechanical neck pain. (Cleland JA, Childs JD et al. (2005) Immediate Effects of Thoracic Manipulation in Patients with Neck Pain: A Randomized Clinical Trail, Manipulative Therapy 10:127-135).

Liebenson recommends manual therapy and rehabilitation exercises supported by one of the strongest research trials in this field carried out by Bronfort, Evans et al. In this trial 191 patients were split into three groups:
• Spinal manipulation and low-tech exercise,
• MedX exercise – receiving dynamic progressive resistance exercises on MedX machines,
• Spinal manipulation.
Outcomes were measured at 5 and 11 weeks and 3,6 and 12 months after the trial. At the one year follow up the group that were receiving exercises and manipulation did significantly better than the group doing manipulation alone. This study suggests that patients with chronic neck pain often have weak neck muscles and that the best practice for these patients should combine manipulation with exercise.

In a literature review published by Hurwitz, Aker et al. in Spine and Aker, Gross et al. in the British Medical Journal the authors reported that manipulation and mobilization were both more effective than muscle relaxants and usual medical care in providing pain relief for patients with sub-acute or chronic neck pain.

In a new study (2003) in Spine, Giles and Muller compared acupuncture, joint manipulation and standard medication (NSAIDs). Patients in the acupuncture and medications groups had no significant improvement during the trial on any of the outcome measures and the manipulation group showed significant improvement on all measures with no patient made worse or experiencing side effects. Giles and Muller then followed up their patients a year later and reported that the manipulation group gained ‘significant broad-based beneficial…long-term outcomes’.

In a great study by Haneline at Palmer College of Chiropractic, 79% of the patients improved to the point they had only minimal or minor restriction of movement and their satisfaction rates were an astounding 94% – and I suspect few trials can report the same, with 70% indicating they were very satisfied.

When asked which provider helped the most 83% replied the chiropractor.

Couldn’t agree more