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|Lower Back and Leg Pain|
Sciatica is the term used for pain that is caused by the compression or irritation of the sciatic nerve. The pain radiates into the buttock and down the back of the thigh. It may even radiate into the lower leg and foot. The pain may be accompanied by numbness, tingling and/or muscle weakness. Sciatica is most commonly caused by disc herniation.
Another cause of sciatic pain may be the compression of the sciatic nerve by the piriformis muscle in the buttock.
Piriformis syndrome and mechanical changes to the joints, muscles, tendons, and ligaments should be considered as a possible cause of sciatic pain once disc herniation has been ruled out.
We have seen many patients over the years with herniated discs and low back pain. A common scenario is that the person bends over to pick up something when they suddenly feel a sharp, stabbing pain in the low back. They may describe it as an electrical shooting pain in the lower back, so severe they had to sit down. The next day, they may notice pain and numbness radiating down one leg, and may have difficulty walking.
Why did this occur, and what can be done about it?
Let's start with a very basic anatomy lesson. Spinal discs are weight-bearing shock absorbers. They contain a gel-like center, which is surrounded by tough fibrous cartilage, arranged in concentric, criss-crossing circles called the annulus fibrosis.1
As a person ages, the water content of the discs naturally diminishes, and cracks and fissures begin to develop in the annulus fibrosis. If a weight-bearing stress is unusual and unexpected, the gel-like material in the center of the disc can protrude or extrude through one of the fissures and then, depending upon the location, may irritate a spinal nerve.
If enough of this material pushes through the annulus fibrosis, the nerve can become inflamed, resulting in symptoms such as radiating pain and/or numbness, and possibly weakness, in one leg.
In a typical case, this pain and/or numbness will radiate down the back of the leg, and may even travel into the lower leg and possibly into the foot.
These symptoms, with or without back pain, are highly suggestive of an inflamed spinal nerve. In fact, the person will often report that their leg symptoms are much worse and more concerning than any back pain they may have.
So, what happens if the MRI confirms the disc herniation and suggests an inflamed nerve?
In the best-case scenario, conservative treatment may be sufficient and the nerve inflammation improves with time.2,3 Anti-inflammatory medication (or supplements containing natural anti-inflammatory ingredients such as boswellin, curcumin, cayenne and ginger) may be helpful. Chiropractic conservative therapy may include decompression traction (DTS) if indicated, along with other physical therapeutic modalities and gentle trigger point therapy to relieve associated muscle spasms.
A spinal surgeon should be consulted to provide an additional opinion and input. Depending upon the type and location of disc herniation, the severity of the pain, and whether or not there is neurologic loss, surgery may be the best option.
In many cases though, chiropractic care, including decompression traction (DTS), can be very effective in treating disc herniation.
Of course, the best management, as always, is prevention. Always practice safe lifting procedures. Make sure you get regular exercise and sufficient rest. Regular preventative chiropractic adjustments will help minimize long-term stress on your discs by helping to maintain proper spinal alignment. Additionally, your chiropractor will be able to provide guidance and appropriate recommendations to help you attain and maintain good health and wellness.
1Postacchini F: Lumbar Disc Herniation. Springer, 2004, Chapter 2.
2Rothoerl RD, et al: When should conservative treatment for lumbar disc herniation be ceased and surgery considered? Neurosurg Rev 25(3):162-165, 2002.
3Lumbar Disc Herniation. New Engl J Med 347(21):1728-1729, 2002.