Case of the Month July 2010

Illustration of the pain pathway in René Desca...
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A patient, that we will call Ben, reported to my office with low back pain that was traveling down his right leg all the way to the foot.  Upon exam it was pretty clear to me that Ben had a pretty tough case of sciatica, and trust me when I tell this, sciatica is no fun.

Let’s do a quick anatomy review.  The sciatic nerve begins in the low back, right around the top of your hips, or what you will hear as L4 and L5.  This nerve runs through the buttocks and continues down the leg.  When a person has sciatica, pressure is placed on the nerve somewhere along the path and the result is usually pain, although numbness can also be present.

Back to Ben.  When asked to rate the pain on a scale of 1 to 10, with 10 being miserable, Ben was a 9, which indicates it was quite severe.  Upon exam, Ben was showing tight musculature in the low back, decreased movement in the low back and tight musculature in the right buttocks.  Ben’s posture was a mess and several tests revealed the sciatic nerve was aggravated, to say the least.  X-ray was unremarkable.

I suggested to Ben that we try a short trial to make sure that this was the right course of action for him.  He agreed and we began with chiropractic adjustments, exercise, trigger point therapy and traction.  Ice was also applied after each visit.

At first we made some crazy improvements.  Ben’s pain rating dropped from 9 to 5 after 3 visits.  That gave us some information that this was the right course of action and not necessarily a disc herniation as can often be the case with leg pain cases.

The going after that was much slower.  Over the course of 3.5 weeks, we have been able to get Ben’s pain down from a 5 to a 2.  Ben is thrilled with his progress, me I am a little impatient.

In the coming weeks we are looking to improve Ben’s pain to a zero, while helping him with strength and conditioning to increase the chances that this doesn’t happen again.

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Who Else Doesn’t Understand Sciatica?

Have you ever woken up and had burning pain going down the back of your leg.  As a chiropractor, I see this everyday. You are going along, everything is great, and then BAM, your leg is killing you and you feel like it will never go away.

Nerves of right leg, anterior and posterior as...
Image via Wikipedia

A brief review of anatomy is in store here.  The sciatic nerve begins in the low back, travels through your buttocks and heads down the leg.  If anywhere in the course of the nerve, pressure is put on it, pain and numbness can occur.  The most common form of pressure is swelling from a misalignment.  As the pressure builds up, the nerve compresses and WHAM, you have sciatica.

What to do when I get sciatica.

Once we have it, the key is getting rid of it quickly.  Here is where ice and Dr. Harrington are your best friend.  If the sciatica is from the spine being out of place a few adjutments will go a long way to helping you reduce the pressure on your nerves.  While we are reducing the pressure on your nerves by putting your spine in place, ice will help calm the swelling down thereby taking pressure off the affected nerve.

How Can I Keep the Sciatica from Coming Back?

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