Sciatica is the condition of an inflamed or irritated sciatic nerve, a large nerve running down the back of the leg and stemming from several nerve roots that exit the spinal cord in the lower lumbar spine. There is one on the right and one on the left. The nerve ineverates or sends messages to the muscles of the leg, and carries sensation from the leg back to the spinal cord.

If any of the nerve roots that make up the sciatic nerve become irritated or pinched, radiating pain is felt down the back of the leg, sometimes all the way to the bottom of the foot. The more pressure exerted on one of these nerve roots the worse the pain, and with enough pressure you begin to loose sensation in the foot or leg, and to loose muscle strength.

What causes the pressure or irritation to the nerve root? It is usually a bulging or herniated lumbar intervertebral disc. The disc is a cushion between each vertebrae in the spine. Like the tire on a car, the disc can blow out, and it either bulges or cracks. When it cracks the inside of the disc can leak out, and this is known as herneation. Both cases will cause severe inflammation, local swelling, and pressure on the nerve root causing debilitating pain.

Other problems can also cause similar low back pain, buttock pain, and pain down the legs, so not all low back pain with leg pain is due to an injured disc. There are standard orthopedic and neurological tests we can do that help determine if the pain is from a disc injury, from a muscle strain, or from some other cause.

The treatment plan is based upon the examination and history findings. Treatment will usually include interferential electrotherapy with moist heat to help relieve pain, some deep tissue myofascial release to the lumbar and gluteal muscles to relieve spasm, and spinal decompression of the injured disc. Spinal decompression is done with spinal manipulation and flexion traction. A gentle stretching routine is also provided that can be done at home hourly if needed. Of course treatment depends upon the patient and how much pain he or she is in. Treatment can be daily with increasing relief and decreasing frequency as the treatment progresses.

In most instances this conservative and non-invasive approach is all that is needed. However with severe pain, prescription medication may be required also. When this approach is not enough, then epidural injections may be needed, and of course surgery as the last resort.

I am always happy to discuss any concerns and questions you may have. Please feel free to call Dr. Crawford at 983-3037.

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