Sciatica is Sciatica, Low Back Pain is Not Sciatica

What is Sciatica?

Sciatica is a diagnoses or term that describes a specific type of pain caused by a specific reason.

Sciatica “The Pain”:

Classic sciatica pain is a radiating pain, often described as like lighting or an electric shock. Sciatica most commonly starts at the buttocks and shoots down to the back of the knee often going to the calf and sometimes all the way down the back of the leg and to the heel and foot. The radiating pain can run down one or both legs.  When in both legs and sciatica pain is not always equal. i.e. to the pain to the calf in one leg and pain to the foot in the other leg.

Sciatica pain can be extremely painful. Some women have described it as much worse than childbirth. Often one of the most frustrating details about sciatica is that the pain is in areas where there is no problem. Despite the bulging disc being in your low back, it causes excruciating pain in your leg or foot. Other descriptions of sciatica pain include it being unrelenting or conversely and more commonly “fine” one minute until the patient moves a specific way. It’s these seemingly random and severe shooting pains that “come out of nowhere” that can make sciatica almost unbearable.

Sciatica “The Causes”:

Sciatica pain is caused by irritation or pressure on the nerve or nerve roots that make up the Sciatic nerve. The Sciatic Nerve is compromised of the L4, L5, S1, S2, & S3 spinal nerves.  In the case of Sciatica, the irritation typically comes from a herniated disc or a bulging disc pressing on the nerve or nerve root(s).

The reason for the pain seeming random is simple. The disc bulge or disc herniation is not constantly putting pressure on the nerve. They only push outward onto the nerves, due to the disc damage causing the bulge or herniation, when your spine is in certain positions. A normal spine with normal shape will have equal and balanced spine will have the weight or load of your body equally dispersed through your spine. Abnormal shapes or spinal structures will cause excess loading on your spine and discs.

Think of the disc like a balloon cushion between your vertebras. As you spine and vertebras move, the pressure on the disc changes. If you sit on a balloon and lean forward the pressure from your weight is placed on the front of the balloon so the balloon will bulge out towards the back. Your discs act the same way. The difference is that the disc is damaged. That normally very small bulge becomes much larger to the point that it is pressing on the nerve roots which causes the sciatica pain.

Sometimes this pain can be as a result of bone spurs pressing on the nerve or nerve root(s).

Stress on the bone will result in more bone being created. This is known as Wolff’s Law. This is a good thing if you are building muscle that puts more “stress” on the bone but if you are putting pathological stress on the bone due to unequal load displacement because of an abnormally shaped spine…. That type of stress is abnormal and pathological and results in bones spurs that can take up precious space in the Intervertebral Foramen (the hole where the nerves come out of your spine or the spinal canal itself (where the spinal cord is). When they take up too much space they will start pressing on the nerves… and can cause sciatica.

These abnormal spinal shapes can also put excess stress on the discs and not just the bones in your spine. It is possible to injury a once healthy and normal spine, resulting in a disc bulge or disc herniation that causes sciatica. However, it is far more common to see patients with sciatica because their spine was not properly maintained or corrected, which allowed the uneven stresses of a misshapen spine to wear out the disc or discs with what should have been normal and activities. This is the case of the “I picked up of tissue and my back ‘went out’.”

Common Sciatica Misnomers

• All back pain is not Sciatica. I repeat all back pain in NOT sciatica!

• Sciatica is not a disease.

  • The diagnosis or sciatica is just a description of what kind of pain you are having and that the sciatic nerve or nerve roots are involved. The sciatica diagnosis doesn’t even tell you exactly WHAT the cause is. It’s like saying you were diagnosed with radiation low back pain.

• Sciatica never “requires” low back surgery.

  • The danger of sciatica is only that is causes pain.
    • Remember, technically the diagnosis itself is just pain. The actual cause, which should be diagnosed by a good chiropractor or medical doctor, is the real issue. If the disc bulge or bones spurs are bad enough they can cause other symptoms (loss of control of bowel and bladder, muscle weakness) that may benefit from surgery. However, even in those extreme cases, you could argue that they are not “emergency” cases. If you’re willing to deal with the symptoms during chiropractic care, it’s possible and even likely that you can correct the cause of the bulging or herniating disc causing the loss of control of bowel and bladder or muscle weakness.
  • Even in cases of bone spurs causing spinal stenosis, structurally focused chiropractic care can help.
    • Stenosis is another crap “diagnosis”. Stenosis literally just means narrowing. The narrowing is talking about the spinal canal or the opening the nerve exit the spine. Stenosis is typically caused by those bone spurs we talked about. While changing the structure of your spine with chiropractic care will not cause these bones spur to go away, it is possible to reduce the effect resulting in stenosis by putting the spine in its proper position. When a spine is closer to normal the loads on the spine are more evenly distributed. In the same way, the closer the spine is to normal the less likely that stenosis (narrowing) of the spinal canal and intervertebral foramen (nerve holes) will be.