Treatment of Sciatica
A recent medical blog reported on the disappointing options for sciatica treatment.1 Reviewing two studies, the author concluded that practitioners are in a hard place when it comes to treating sciatica. There’s no hard evidence showing an effective and long-term treatment, leaving a doctor with only empirical evidence, relying on his own experience or trial and error in treating this type of back pain.
The first study reviewed was published in the Annals of Internal Medicine in 2012. It looked at epidural injections for sciatica and found that they only provided modest short-term pain relief in some adults.2 The second study was published in the British Medical Journal and was an article review of 23 articles dealing with analgesics (pain medications) for sciatica.3 None of the 23 studies showed any significant benefits to using pain medications for sciatica. Both of these studies showed modest, temporary sciatica relief at best.
The term sciatica is thrown around loosely and is often used for any pain traveling down the leg. True sciatica is a nerve injury that causes extreme pain. In true sciatica, the sciatic nerve is being pinched due to a herniated disc, spondylolisthesis, or foraminal stenosis. However, many patients are diagnosed with “sciatica” when, in fact, their sciatic nerve is not getting pinched. Listen as Dr. Hauser explains:
Whether a patient is truly experiencing sciatica, or pseudo-sciatica, the bottom line is pain medications and epidurals do nothing but temporarily mask the pain. Prolotherapy is needed to address the underlying ligament laxity that is pinching the sciatica nerve or causing the referred pain. Prolotherapy to the low back is an excellent permanent cure for sciatica. Typically patients need about three to six visits spaced about a month apart.
Sciatica pain is a form of nerve pain that may be felt anywhere along the course of the sciatic nerve, which branches from the lower back through the hips and buttocks, and down each leg. The sciatic nerve is the largest nerve in the body and is the main nerve in each leg. Sciatica refers to pain, weakness, numbness, or tingling in the leg. It typically affects only one side of the body. In most cases, the pain, usually in the legs, disappears gradually within one to two weeks, but it may recur. Most people have at least one episode of sciatica during their lifetime.
Sciatica occurs when there is pressure or damage to the sciatic nerve. This nerve controls the muscles of the back of the knee and lower leg. It also provides sensation to the back of the thigh, part of the lower leg, and the sole of the foot.
How does sciatica pain develop?
In some cases, the cause of sciatica is unknown. However, the most common cause for people between the ages of 20 and 40 is a prolapsed or herniated disc in the spinal column that presses on a spinal nerve root. A prolapsed disc may often occur as a result of straining to lift a heavy object. In older people, sciatica may be caused by body changes in the spine as a result of various conditions, such as bone spurs and osteoarthritis. Pregnant women may develop sciatica during the last few months of pregnancy due to postural changes that cause increased pressure on the sciatic nerve. The nerve can also be damaged by diseases such as diabetes. Other risk factors include obesity, which increases the stress on the spine and can contribute to the spinal degeneration that can cause sciatica. Also, individuals with occupations that require heavy lifting or prolonged periods of sitting are more likely to develop this condition.
Muscle spasms and sitting in an awkward position for long periods of time are relatively common causes of brief episodes of sciatica in all age groups. Pain occurs when the nerve is injured or compressed, usually where it leaves the spinal cord. Often, only one leg is affected. In rare cases, sciatica is the result of a tumor on the spinal cord. Sciatica may also be due to ligament laxity in the sacroiliac joint, which can cause radiating pain down the side of the leg, as well as numbness, a symptom that has traditionally been attributed only to nerve injury.
What are the symptoms of sciatica?
The symptoms of sciatica can range from a mild tingling, dull ache, or burning sensation to pain severe enough to cause immobility. Some people experience sharp pain in one part of the leg or hip and numbness elsewhere. The pain or numbness may also be felt on the back of the calf or on the bottom of the foot. The pain may increase after prolonged standing or sitting, or be aggravated by sneezing, coughing or laughing. Symptoms may develop either gradually or suddenly, and may include a sharp, needlelike sensation running from the buttocks down the side of the leg; pain that extends down the back of the leg to the knee; pain or numbness on the back of the calf; tingling or numbness in the foot; muscle weakness; and tenderness to palpation over the sciatic nerve. Muscle weakness may make it difficult to lift the foot on the affected side. Some people, especially the elderly, may have difficulty walking.
Individuals with sciatica may have difficulty bending backward or forward, walking on their toes or heels, rising from a squatting position, lying on their back, walking more than a few yards, bending the knee due to weakness, or lifting the leg straight up due to pain. It may be difficult to bend the foot inwards as well.
Traditional methods miss the mark for chronic sciatic pain
Initial treatment is generally the application of ice or heat. Over the counter pain relievers and non-steroidal anti-inflammatories are usually part of the first line of treatment. Activity is generally curtailed, and heavy lifting is to be avoided. Abdominal strengthening exercises may be encouraged to strengthen the spine and boost flexibility of the spine.
If these measures are unsuccessful, then steroid injections to reduce inflammation around the nerve are frequently recommended. However, both anti-inflammatory medications and steroid injections have been shown to produce long-term loss of function and even more chronic pain by actually inhibiting the healing process of soft tissues and accelerating cartilage degeneration. Steroid injections often provide quick relief, but may have serious consequences.
Other medications, such as narcotics, may be prescribed to help reduce the stabbing pains of sciatica. Physical therapy may also be recommended.
When these treatments are unsuccessful, the recommendation then is frequently lumbar spine surgery. A sciatica complaint may be diagnosed from an “abnormality” on an MRI scan. It is important to note that many people have herniated disks or bone spurs that will show up on MRI’s and other imaging tests but cause no symptoms. The sciatica complaint very possibly was a simple ligament problem in the sacroiliac joint. For the majority of people who experience pain radiating down the leg, even in cases where numbness is present, the cause of the problem is not a pinched nerve but sacroiliac ligament weakness.
The problem with this surgical approach is that it does nothing to repair the weakened ligament in the sacroiliac joint and, thus, does not alleviate the symptoms that people with sciatica experience.
Prolotherapy is the ideal treatment for Sciatica
Rather than boosting degeneration in the low back with cortisone, or taking the drastic approach of surgery, we recommend regenerative ligament repair with Prolotherapy. Prolotherapy eliminates pain in the local ligament, in this case the sacroiliac ligament in the sacroiliac joint, as well as the referred pain, and is curative in most cases of sciatica. In fact, the referral pain patterns of the sciatic nerve and of the sacroiliac ligaments are similar. Both pain and numbness typically associated with sciatica can be successfully treated with Prolotherapy to the sacroiliac ligament, and can prevent thousands of dollars being spent on surgery and post-operative care.
Comprehensive Prolotherapy for sciatic pain involves treating all of the affected areas, such as the sacroiliac ligament attachments and the lumbosacral area as necessary. Prolotherapy injections stimulate the body’s own natural healing process which is through inflammation. The inflammation causes the blood supply to dramatically increase in the injured areas, alerting the body to send reparative cells to the ligament site. Ligaments, such as the sacroiliac ligament are made of collagen. In this healing process, the body deposits new collagen. The sacroiliac ligament will then be strengthened and tightened as this new collagen matures. The sacroiliac joint which was unstable, will then become strong and stabilized, and the symptoms will abate.
Are the symptoms from true sciatica?
Just about everyone who has a pain radiating down the leg is diagnosed with sciatica. We see a lot of people with sciatic type symptoms, but the majority of the sciatica cases we see are not actual sciatica. Rather, the symptoms come from referral pain from a ligament injury. The most common ligament injury that causes sciatica is an injury to the sacroiliac joint, because a sacroiliac ligament problem will cause sciatica type symptoms down the leg.
If you truly have sciatica, the pain is unbelievable. If a nerve is really pinched you will be wracked with 24/7 non-stop pain. The pain of true sciatica or any radiculopathy pain is horrible, and the person who has it will experience a“10 out of 10″ pain on the pain scale. If an individual is able to sit and talk and smile, the problem may not be actual sciatica, and the nerve may not be getting pinched. If the lower back pain is experienced on the side, and not in the middle, then the problem is most likely a sacroiliac ligament injury, because the ligament is not stabilizing the pelvis. The referral pattern or pain pattern of a sacroiliac ligament injury is on the side of the leg down to the lateral toes.
Those who have had lower back surgery and continue to experience unresolved pain, most likely have ligament injury. The treatment they need to resolve the sciatica or pseudo sciatica is Prolotherapy.
Indications the symptoms are caused by a “pseudo sciatica” ligament injury rather than nerve injury:
- You can sit in a chair and raise your leg straight out in front of you without reproducing your pain.
- Your low back pain is greater than your leg pain. Leg pain is 25% or less of the pain.
- The pain isn’t to the point of causing you to sweat.
- No numbness in your leg or foot.
- You experience numbness, but can touch the area and have sensation of touch there. This is a referral sensation, generally from a ligament injury, not a nerve injury.
What does this mean? It means that there is a great chance that Prolotherapy is going to work for you! Chronic pain down the legs can be debilitating and cause sleepless nights, uncomfortable car rides, difficulty doing household chores, and pain with sports, and other activities. Prolotherapy treatments can put an end to sciatic pain for good.
1. Leavitt, SB. (April 27, 2012). Treatments for Sciatica Pain Disappointing. <em>Pain Treatment Topics</em>. Retrieved from: <a href=”http://updates.pain-topics.org/”>http://updates.pain-topics.org/</a>.
2. Cohen SP, White RL, Kurihara C, et al. Epidural Steroids, Etanercept, or Saline in Subacute Sciatica: A Multicenter, Randomized Trial. Ann Int Med. 2012(Apr);156(8):551-559.
3. Pinto RZ, Maher CG, Ferreira ML, et al. Drugs for relief of pain in patients with sciatica: systematic review and meta-analysis. BMJ. 2012(Feb);344:e497