Acute, Chronic, Alternating, and Bilateral Sciatica Back Clinic

Sciatica is common and affects up to 40% of the general population. Different types include acute, chronic, alternating, and bilateral sciatica. The sciatic nerve comprises three specific nerve roots in the lower back. The three nerves originate in the L4 and L5 vertebrae and the sacrum, just below the vertebrae. The nerve then branches off and runs through the back of each thigh. Injury, compression, or irritation of these nerves can cause various symptoms, including numbness, tingling, electrical shooting pain, and muscle spasms in the low back, the leg, and the foot. Chiropractic care can realign the spine, relax the muscles, release compression and relieve sciatica.

Acute, Chronic, Alternating, and Bilateral Sciatica

Acute

• Acute pain can be brought on by sudden irritation to the nerves that have become pinched, compressed, or a combination.
• Causes a constant burning or shooting sensation through the low back, buttocks, down the leg, and possible hip discomfort.
• It becomes worse when sitting.
• It can cause immediate and short-term pain lasting for 1-2 weeks.

Chronic

• Chronic sciatica can last for months or years on and off or continuously.
• It can be caused or worsened by inflammatory conditions like rheumatoid arthritis, injuries, infections, and spinal misalignment issues.
• It can resolve but will come back without treatment or lifestyle and activity adjustments.

Bilateral

• Sciatica typically takes place in one leg; it has been known to be bilateral and experienced in both legs.
• This type of sciatica is rare but can occur from degenerative changes in the vertebrae and/or the discs at several spinal levels.
• If there is pain in both legs, it is likely not a herniation but degenerative changes like spinal stenosis.
• The symptoms can range from infrequent to irritating to severe and debilitating.
• It could be a red flag symptom of cauda equina syndrome.
• Weakness may be felt in the leg and foot, or a feeling of heaviness, making it difficult to lift the foot off the floor.

Alternating

• Alternating sciatica affects both legs alternately. It is usually connected to bilateral sciatica that switches sides.
• This type is rare and can result from degenerative problems in the sacroiliac joint, the joint connecting the spine to the hips, or sacroiliac arthritis.

Spinal Sources

Sciatica occurs when L4, L5, and/or S1 nerve roots are affected.

L4 Nerve Root

• Pain in the hip, thigh, inner medial areas or the knee, and the calf.
• Weakness in the thigh and hip muscles.
• Reduced knee-jerk reflex.
• Loss of sensation around the calf.

L5 Nerve Root

• Pain in the buttock and the outer area of the thigh.
• Weakness in the buttock and leg muscles.
• Difficulty moving the ankle and lifting the big toe upward.
• Loss of sensation between the big toe and the second toe.

S1 Nerve Root

• Known as classic sciatica.
• Pain in the buttock, back of the calf, and side of the foot.
• Fatigue in the buttock and foot muscles.
• Difficulty and discomfort raising the heel off the ground or walking on tiptoes.
• Loss of sensation in the foot’s outer side, including the third, fourth, and fifth toes.
• Reduced ankle-jerk reflex.

Chiropractic Care

Chiropractic care can directly address the root cause of the problem, treat the cause, and alleviate the symptoms. Chiropractic manipulation is recommended by the American College of Physicians as a first line of treatment for back pain before medication, muscle relaxants, injections, and surgery. Treatments to address sciatic nerve impingement:

Ice/Cold Therapy

• Reduces inflammation and swelling.
• Prepares the patient for massage and adjustments.

Therapeutic Tissue Massage

• This therapy promotes muscle relaxation and lessens the muscle spasm/recoil response.

Ultrasound

• Soothing heat created by sound waves penetrates the muscles, increases circulation, and relaxes the muscles to alleviate spasms, stiffness, and pain.

Transcutaneous Electrical Nerve Stimulation/Tens Unit

• A muscle stimulation machine applies electrical impulses to relax the muscles and untangle muscle knots.

Spinal Manipulation

• This process realigns the spine to move properly and restores vertebral health.

Stretches and Exercises

• This ensures treatment will last once treatment has or is coming to an end.

Spinal Decompression

• Pulls and stretches the body to release any compression on the nerve roots and infuse circulation back into the discs.

The pressure is taken off the sciatic nerve, and routine adjustments will retrain the muscles to maintain their re-alignment. The duration of treatment will vary based on the root cause of sciatica. Each treatment plan is tailored to the individual patient’s situation.

Severe and Complex Sciatica Syndromes

References

Davis D, Maini K, Vasudevan A. Sciatica. [Updated 2022 May 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK507908/

Hernández C.P., Sanchez N., Navarro-Siguero A., Saldaña M.T. (2013) What is Sciatica and Radicular Pain?. In: Laroche F., Perrot S. (eds) Managing Sciatica and Radicular Pain in Primary Care Practice. Springer Healthcare, Tarporley. doi.org/10.1007/978-1-907673-56-6_1

Kumar, M. Epidemiology, pathophysiology and symptomatic treatment of sciatica: A review. nt. J. Pharm. Bio. Arch. 2011, 2.

Ngnitewe Massa R, Mesfin FB. Herniation, Disc. [Updated 2018 Oct 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK441822/

Ombregt L. The dural concept. In: A System of Orthopaedic Medicine. Elsevier; 2013:447-472.e4. doi:10.1016/b978-0-7020-3145-8.00033-8

Witenko, Corey, et al. “Considerations for the appropriate use of skeletal muscle relaxants for the management of acute low-back pain.” P & T : a peer-reviewed journal for formulary management vol. 39,6 (2014): 427-35.

Wright R, Inbody SB. Radiculopathy and Degenerative Spine Disease. In: Neurology Secrets. Elsevier; 2010:121-130. doi:10.1016/b978-0-323-05712-7.00007-6