Sciatica is a condition associated with pain in the hip and may include weakness, numbness or tingling. It can start in the lower back and extend down the leg to the calf, foot or even the toes. Symptoms are usually just on one side of the body.
The sciatic nerve – the longest and widest nerve in the body – runs from the low back and down the leg to the foot. It’s a collection of nerves that begin in spine of the low back that branch off to nerves in the lower leg.
Depending on to whom you speak, there are a number of different opinions as to the true cause of sciatica symptoms. The most common diagnosis, however, is that the condition 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 look very much like nerve pain.
So, how do you know when you should “watch and wait” versus seek medical attention? And which intervention is best? I spoke with several experts in the field to get their advice on how to diagnose and treat sciatica.
• John Welsh, M.D. A pain management specialist at Los Altos Spine & Sports, 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, he recommends conservative treatments such as physical therapy, anti-inflammatory medications and acupuncture. However, he added, there are cases where symptoms may be of greater concern, such as “if there is significant weakness, buckling of the knee or foot drop.” Welsh recommends immediate intervention, as this may be a sign of nerve impingement.
• Kristine Shadduck, P.T. According to physical therapist Shadduck, owner of PT Works in Los Altos, sciatica is often the result of “abnormal stressors on the spine from poor posture or (incorrect) body mechanics.” In her practice, she uses therapies such as traction, ice and electrical stimulation to relieve symptoms, and said there’s no substitute for “skilled, hands-on care” of the tissues and joints.
“A physical therapist will instruct in positions of comfort, proper posture, correct movement mechanics and exercises to strengthen the core,” Shadduck said. “My end goal is to reduce stress on the spine while allowing the healing to begin.”
• Charmaine Tu, D.C. In her Los Altos chiropractic practice, Tu favors initial techniques such as ice on the low back and stretching of the hamstrings and quad muscles. She noted that it’s important to find the root cause of the issue first, be it tight muscles, nerve root compression or bony changes in the spine.
“One myth I’d like to dispel is that you have to be ‘racked and cracked’ when you see a chiropractor,” she said. “That’s not the case at all – chiropractic can be both a gentle and effective sciatica treatment.”
Tu evaluates the pelvis and alignment of the spine before initiating treatment. She added that getting rid of inflammation is often the first step.
Sciatica may sometimes be caused by a contracture of a muscle deep in the buttocks called the piriformis. The sciatic nerve runs just below this muscle and in some unlucky individuals, the sciatic nerve 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.
A combined approach
In my clinic, I use acupuncture to improve circulation of the muscles of the low back and the hip, while treating trigger points to release muscle spasm. Acupuncture can calm down irritated nerves by blocking some of the pain signals coming from the brain. Cupping is also a therapy that works well to release muscle spasms in the low back and hip.
As with any modality, there is no one best approach. In treating sciatica, I typically encourage people to start with a doctor or therapist they trust.
When the cause of sciatica is due to a lumbar disc herniation, most cases resolve spontaneously over weeks to months.
According to a New England Journal of Medicine study, bed rest is not better than “watchful waiting” when it comes to recovery.
Ted Ray, licensed acupuncturist and herbalist, is owner of Peninsula Acupuncture in Mountain View. For more information, call 564-9002 or visit peninsulaacupuncture.com.