Sciatica can be an extremely painful condition. It is a “pinched nerve” pain that radiates down the leg, and it occurs when problems in the joints, muscles and discs of the back progress to the point that they start to affect the nerves. The “pinched nerve” leg pain may come on suddenly, but most cases have a history of low back pain before the onset of the leg pain.
Current medical treatment usually starts with painkillers and anti-inflammatory meds. If those aren’t effective, the patient goes “up the scale” to more aggressive treatments, such as oral steroids to reduce swelling of the disc, to cortisone shots to the spine (called an epidural); a few go on to surgery.
Of course, the further up the scale you go, the greater the chance of serious side effects. And even the “entry level” meds have risks, including digestive, liver, kidney, and heart damage. Oral steroids seem to interfere with healing of tendons throughout the body, steroids damage tendons and can cause osteoporosis with longer term use. Epidural shots are only about 50 percent effective, and are considered a short-term treatment at best. Recently the FDA required label changes for epidural steroid shots to include warnings of “rare but serious” complications. (Because epidural steroid shots to the spine are not FDA approved, docs who do them are not required to report problems to the FDA. This makes the frequency of problems from the shots difficult to estimate.)
Most sciatic cases I see have already been through this cycle of care and are looking for more help. They did not consider trying chiropractic care first. Many are nervous about having a physical treatment when they are already in a lot of pain, while others just follow the medical process without questioning it. But chiropractic care can be very effective for sciatica; because sciatica is primarily a mechanical process, using chemical treatments (meds or shots) will not be helpful for the problem, especially in the long run.
From a chiropractic perspective, the underlying problem with sciatica involves the joints of the spine. The immediate symptoms may be from a disc pressing on the nerve, but discs are affected by the surrounding spinal joints. Realigning these joints can improve disc function and take pressure off the nerve. In the beginning of care, the treatment has to be gentle, because the area is so inflamed, and patients are often nervous about manipulation. But it is a very effective treatment; one study of 148 sciatic patients who were treated by doctors of chiropractic using manipulation found that after a month of care, 80% were better or much better, and only 1.6% were slightly worse. The improvement was maintained, with 88% doing better after a year. It is also very safe; according to the authors of the same study, “there were no adverse events reported” meaning no patients were made worse by the treatment.
Another review of the safety of chiropractic manipulation for sciatica found only one case out of 3.7 million treatments was made significantly worse (other than temporary soreness). This safety record is far better than even over the counter drugs.
Of course not every sciatic patient with sciatica responds to manipulation; some cases do need to go on to the more aggressive treatments. But it only makes sense to start with the most effective and safest treatment before the other treatments are tried. And while I am not aware of any studies on this, it makes sense that going into these more aggressive treatments with a spine in alignment will have a better outcome.
Dr. Michael Noonan practices chiropractic, chiropractic acupuncture and other wellness therapies in Old Town. He can be reached at noonanchiropractic@gmail.com.