The pain in your low back drops you to your knees again. All you did was bend over to pick up the pen you dropped on the floor. This time is different, though. It’s worse than it’s been in the past. This time you feel pain shoot down the back of your leg. A white-hot dagger is stabbing you in the rear end and you feel numbness and tingling in your leg, perhaps all the way down to your foot. You can’t straighten up to walk and you are limping along like you’ve been shot. You remain still and pray the pain goes away…but it doesn’t go away. In fact, it’s getting worse. Your thoughts come in rapid-fire succession, “what is happening to me, what should I do, who do I call, should I go to the emergency room, will I need surgery?” Good questions.
If you are experiencing any combination of these symptoms, chances are you have a herniated disc in your lower back, one of the causes of mechanical back pain. The swelling from inflammation or the disc itself can cause an impingement or “pinching” of the spinal nerve root. The lower lumbar nerve roots eventually form the sciatic nerve in your leg. Inflammation of this nerve is commonly known as sciatica. “Mechanical low back pain is one of the most common patient complaints expressed to emergency physicians in the United States accounting for more than 6 million cases annually. Approximately two-thirds of adults are affected by mechanical low back pain at some point in their lives, making it the second most common complaint in ambulatory medicine and the third most expensive disorder in terms of health care dollars spent, surpassed only by cancer and heart disease.” 1
But just because you have these symptoms, doesn’t necessarily mean that you need to rush to the surgeon. According to a landmark study published in the medical journal Spine, “an operation should not be performed if other treatment will give equivalent results within an acceptable period of time…the patient with low back pain and sciatica should not automatically be referred to the surgeon.” 2 If that’s the case, then what are some of your other options? If you are like most people, the first place you will think to visit will be your family doctor’s office (or an emergency room, if you are really in a panic). Traditionally, medical doctors will prescribe medications, such as pain killers, muscle relaxers, anti-inflammatories or any combination of these. There are three problems with taking medication, if this is all that is done.
- Medication only treats the symptoms.
- Medication only provides temporary relief.
- Medication has many unhealthy side-effects. Take the time to read the warning insert with any of these medications and you will know what I’m talking about.
By contrast, chiropractic care has been shown to be more effective in treating chronic low back pain than traditional medical care. In one study published in the Journal of Manipulative Physiological Therapeutics (JMPT), it concluded that “…the improvement for chiropractic patients was 5 times greater [than for medical patients]. Patients with chronic low-back pain treated by chiropractors show greater improvement and satisfaction at 1 month than patients treated by family physicians.” 3
Are there times when surgery is necessary? The answer is, most definitely, yes. Absolute signs for surgical intervention are those patients with cauda equina syndrome (which is rare), in the presence of severe motor deficits resulting from a large extruded or migrated disc fragment, and in patients with intractable pain. Unless one of these conditions is present, chiropractic care for the treatment of discogenic or mild to moderate sciatic pain from intervertebral disc herniation has been proven to be safe and effective. One study shows that chiropractic treatment (in this case in the cervical spine) is 100 times safer than using Non-Steroidal Anti-Inflammatory Drugs like asprin, ibuprofen, naproxen, etc. 4 Another study shows patients had an 86% improvement in chronic low back pain after a course of chiropractic care. 5
As a side note, let me also say that medical care and chiropractic care are not mutually exclusive ways to treat mechanical low back pain and sciatica. In my experience, I have seen great results with the most severe cases when managing these conditions cooperatively with a patient’s primary care doctor or pain management specialist. In these cases the medication is useful or necessary in order for the patient to tolerate conservative care; for example, when it is extremely difficult for the patient to move or to be moved.
Lastly, not every case of sciatica is caused by a herniated disc. A condition called piriformis syndrome can cause impingement of the sciatic nerve as it exits the pelvis. Basically, the piriformis muscle attaches at the sacrum, passes through the greater sciatic notch of the pelvis, and attaches to the top of the femur (the upper leg bone). Atheletes who participate in sports where they are sitting, such as rowing or cycling are particularly vulnerable to strains of the piriformis. Runners who overpronate are also susceptible to piriformis injury. When the muscle is injured, it causes swelling due to inflammation, which can then irritate or compress the sciatic nerve as it exits the pelvis. It is important to rule out spinal injury as the cause of sciatica, but the following video will demonstrate a stretch for the piriformis muscle. If your symptoms resolve after performing the stretch for a week or two, then you probably had piriformis syndrome and should continue this stretch as part of your daily routine to help prevent future injury. However, if you are still experiencing the same symptoms or if they intensify, seek professional help as soon as possible.
- Kinkade S. Evaluation and treatment of acute low back pain. Am Fam Physician. Apr 15, 2007;74(8):1181-8.
- Weber H. Lumbar disc herniation: a controlled prospective study with ten years of observation. Spine 1983;8:131-40.
- Nyiendo J, Haas M, Goodwin P. Patient characteristics, practice activities, and one-month outcomes for chronic, recurrent low-back pain treated by chiropractors and family medicine physicians: A practice-based feasibility study. JMPT 2000 May;23(4):239-245.
- Hurwitz EL, Aker PD, Adams AH, Meeker WC, Shekelle PG. Manipulation and mobilization of the cervical spine. A systematic review of the literature. Spine 1996 Aug 1/21(15):1746-59.
- Harrison DE, Cailliet R, Harrison DD, Janik TJ, Holland B. Changes in sagittal lumbar configuration with a new method of extension traction: nonrandomized clinical controlled trial. Archives of Physical Medicine and Rehabilitation 2002 Nov;83(11):1585-91.
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