Sciatica, a condition associated with pain in the hip that may include weakness, numbness or tingling, can start in the lower back and extend down the leg to the calf, foot or even toes. Symptoms usually occur on one side of the body only.
The sciatic nerve – the longest and widest nerve in the body – runs from the low back down the leg to the foot. It’s actually a collection of nerves that begins in the spine of the low back and later branches off to other nerves in the lower leg.
Medical professionals will offer a number of different opinions regarding the true cause of the symptoms. The most common diagnosis, however, is that sciatica results from a problem with the discs or vertebrae in the lumbar spine. Alternatively, muscle tightness or spasms in the low back and hip region can create radiating symptoms that present very much like nerve pain.
Sciatica may sometimes be caused by a contracture of the piriformis, a muscle deep in the buttocks. The sciatic nerve runs just below this muscle and, in some unlucky individuals, it runs through the piriformis.
Signs of actual nerve impingement include lack of sensation to touch (numb patch), loss of muscle function and sharp, shooting pains. Nerve pain is often described as feeling “electric” in nature.
Physicians usually confirm disc problems and changes to the spine with an MRI or X-ray. They are looking for bony changes in the spine that could cause compression on the nerve root.
When sciatica is the result of a lumbar disc herniation, most cases resolve spontaneously over weeks to months.
Course of action
How should someone suffering from sciatic pain decide whether to watch and wait versus seeking medical attention? And which intervention is best? I consulted several experts in the field to solicit their opinions and advice on how to correctly diagnose and treat sciatica.
• John Welsh, M.D., pain management specialist with a practice in Los Altos. Welsh recommends the following approach for treating sciatica: “Wait three to four weeks to see if (the pain) resolves on its own. If not or it worsens, then it might be time to consult a physician.”
In the early stages, Welsh suggests conservative treatments like physical therapy, anti-inflammatory medications and acupuncture. However, there are cases where symptoms may be of greater concern. If there is significant weakness, buckling of the knee or foot drop, Welsh advises immediate intervention, as it may be a sign of significant nerve impingement.
• Kristen Shadduck, physical therapist, owner of PT Works in Los Altos. According to Shadduck, sciatica is often the result of “abnormal stressors on the spine from poor posture or (incorrect) body mechanics.” In her practice, she uses therapies like traction, ice and electrical stimulation to relieve sciatica symptoms. Shadduck said there’s no substitute for “skilled, hands-on care” of the tissues and joints.
“I like to instruct my patients on proper posture, how to move correctly and ways to strengthen their cores so that they can take the load off their spines and allow healing to begin,” she said.
• Charmaine Tu, chiropractor with a practice in Los Altos. In cases of sciatica, Tu favors initial techniques like ice on the low back and stretching of the hamstrings and quad muscles.
“One myth I’d like to dispel is that you have to get ‘racked and cracked’ when you see a chiropractor. That’s not the case at all,” she said.
Tu said it’s important to find the root cause of the problem first, be it tight muscles, nerve root compression or bony changes in the spine.
“I first like to evaluate the pelvis and alignment of the spine before initiating treatment,” she said, adding that getting rid of inflammation is often the first step.
Acupuncture: A combined approach
In my clinic, I use acupuncture to improve circulation in the muscles of the low back and the hip, while treating trigger points to release muscle spasm. In addition, acupuncture can often calm irritated nerves by blocking some of the pain signals emanating from the brain.
Cupping is another therapy that works well to release muscle spasms in the low back and hip region.
As with any modality, there is no single best approach. In treating sciatica, I typically encourage people to start with a doctor or therapist they trust, and go from there.
Ted Ray is a licensed acupuncturist and herbalist in private practice in Mountain View. For more information, call 564-9002 or visit peninsulaacupuncture.com.