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Back Clinic Sciatica Chiropractic Team. Dr. Alex Jimenez organized a variety of article archives associated with sciatica, a common and frequently reported series of symptoms affecting a majority of the population. Sciatica pain can vary widely. It may feel like a mild tingling, dull ache, or burning sensation. In some cases, the pain is severe enough to make a person unable to move. The pain most often occurs on one side.

Sciatica occurs when there is pressure or damage to the sciatic nerve. This nerve starts in the lower back and runs down the back of each leg as it 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. Dr. Jimenez explains how sciatica and its symptoms can be relieved through the use of chiropractic treatment. For more information, please feel free to contact us at (915) 850-0900 or text to call Dr. Jimenez personally at (915) 540-8444.

Sciatica Foot and Ankle Issues: El Paso Back Clinic

Sciatica Foot and Ankle Issues: El Paso Back Clinic

It didn’t happen at work, school, or exercise, and there haven’t been any trips and/or falls, but you can’t pinpoint what is causing foot and ankle discomfort and sensations. However, the cause could be originating in the lumbar spinal region. Sciatica is a set of symptoms that refer to pain, numbness, and tingling radiating down the leg from the lower back, affecting the legs, hips, buttocks, and feet. Injury Medical Chiropractic and Functional Medicine Clinic can release the compressed nerve, massage circulation back into the nerve, and restore mobility and function.Sciatica Foot and Ankle Issues: Injury Medical Chiropractic

Sciatica Foot and Ankle

Sciatic nerve sensations can run down the back of the leg down into the foot.

  • Compression or irritation to any nerve roots can present with symptoms in the hip, thigh, calf, and foot.
  • Sciatica foot and ankle symptoms can accompany numbness and muscle weakness.
  • Sciatic nerve irritation mostly causes symptoms on the outside of the foot but can spread to other areas.

Nerve Roots

One or more of the lower spine’s sciatic nerve roots are being compressed or pinched. The foot symptoms location depends on which nerve root is affected.

  • If the S1 root is affected, symptoms will radiate to the sole and side of the foot.
  • If L5 is affected, symptoms will radiate to the top of the foot and the big toe.
  • If the L4 root is affected, symptoms can radiate to the medial or inside the ankle area.

Chiropractic Care and Relief

Foot Massage

A foot massage can be helpful.

  • A massage therapist finds points around the ankles that are tender.
  • Tenderness indicates a lymphatic blockage or muscle tension that needs to be worked out.
  • They will apply varying pressures to massage the muscles and get the circulation flowing.
  • The therapist will loosen the tarsal and metatarsal bones to loosen the muscles and nerves.
  • Moving the bones resupplies the joints, forces out inflammatory metabolic waste, opens the space for the nerves, and allows improved lymphatic drainage and blood flow to expedite healing.

Nerve Flossing

Nerve flossing exercises can help stretch and maintain the released nerve.

  • A chiropractor will perform and train the individual on targeted stretches to the Achilles tendon and plantar fascia.
  • They will stretch, release, and open the ankle and sciatic nerve.


A cortisone injection where the nerve is affected can help in certain cases.

  • Injections of a corticosteroid, an anti-inflammatory medicine, can offer relief for up to three months and are given under local anesthesia.
  • The medicine reduces the inflammation and swelling around the nerve roots.

Foot Orthotics

  • Custom foot orthotics can help support a postural foot or ankle problem.
  • Overpronation is when the ankles collapse inward, which creates an imbalance of leg lengths that affects the hips, pelvis, and spine.
  • Orthotics can help provide symptom relief.


Part of a treatment plan will include an anti-inflammatory and antioxidant nutritional plan.

  • A professional nutritionist will make recommendations based on the individual’s case.
  • Magnesium-rich foods are generally recommended for sciatica as this nutrient aids the body in releasing muscle contractions.
  • 99 percent of the body’s magnesium is stored in the bones, muscles, and soft tissues, with only 1 percent concentrated in the blood.

Foods rich in magnesium include:

  • Avocado
  • Bananas
  • Apricots
  • Dried pumpkin seeds
  • Dairy
  • Dark chocolate
  • Dried figs
  • Black beans
  • Brown rice
  • Fish
  • Spinach
  • Swiss chard
  • Yogurt

Benefits of Custom Foot Orthotics


Davis, David, et al. “Sciatica.” StatPearls, StatPearls Publishing, 6 May 2022.

Ge, Phillip S et al. “Iatrogenic pseudoaneurysm of the superior gluteal artery presenting as pelvic mass with foot drop and sciatica: case report and review of the literature.” Vascular and endovascular surgery vol. 44,1 (2010): 64-8. doi:10.1177/1538574409351990

Hughes, Michael S et al. “Post-traumatic catamenial sciatica.” Orthopedics vol. 31,4 (2008): 400. doi:10.3928/01477447-20080401-15

Mayo Clinic. “Sciatica.”

National Institutes of Health. “Sciatica.”

Pan, Hung-Chuan, et al. “Magnesium supplement promotes sciatic nerve regeneration and down-regulates inflammatory response.” Magnesium research vol. 24,2 (2011): 54-70. doi:10.1684/mrh.2011.0280

Sciatica Pain & The Gluteus Minimus Muscles

Sciatica Pain & The Gluteus Minimus Muscles


The buttock and the lower back have a casual relationship to the body, as the lower back has various muscles and nerves surrounding the spinal column. In contrast, the buttock region has multiple muscles and the sciatic nerve to keep the body upright. The sciatic nerve travels from the lumbar region of the spine across the gluteus muscles and down to the legs. The gluteus muscles include the Maximus, medius, and minimus, and they work with the sciatic nerve regarding good posture. When normal or traumatic factors begin to affect the body, like sciatica or poor posture, it can lead to developing trigger points associated with the gluteus minimus affecting the sciatic nerve. Today’s article examines the gluteus minimus, how trigger points mimic sciatic pain on the gluteus minimus, and various treatments to relieve sciatic nerve pain. We refer patients to certified providers who incorporate multiple methods in the lower body extremities, like sciatic pain treatments related to trigger points, to aid individuals dealing with pain symptoms along the gluteus medius muscles associated with sciatica. We encourage and appreciate patients by referring them to associated medical providers based on their diagnosis, especially when it is appropriate. We understand that education is an excellent solution to asking our providers complex questions at the patient’s request. Dr. Jimenez, D.C., utilizes this information as an educational service only. Disclaimer


What Is The Gluteus Minimus?


Have you been experiencing radiating pain traveling down to your leg? Do you have difficulty walking or sitting down? Do you feel tenderness or referred pain near your buttock region? Some of the issues correlate with trigger points affecting the gluteus minimus, causing pain in the sciatic nerve. As the smallest muscle in the gluteal region of the buttock, the gluteus minimus shares similar characteristics to the gluteus medius while being located beneath the medius muscle. One of the primary functions of the gluteus minimus is that it predominantly acts as a hip stabilizer and abductor. The nerves from the gluteal muscles include the sciatic nerve, which is on top of the gluteus muscles and the other nerves help supply the muscles to function in the posterior region of the body. Studies reveal that the structural integrity of the gluteus minimus muscles is the key to the lateral hip muscle, which contributes to pelvic stability and lower extremity function. However, when issues affect the gluteal muscles’ posterior region could trigger point pain mimicking sciatica.


How Trigger Points Mimic Sciatic Pain On The Gluteus Minimus?

When the lower body extremities begin to suffer from multiple issues that cause the individual to have mobility dysfunction, various factors could correlate to the dysfunction. When the gluteus minimus muscles have been overused or been through a traumatic experience, they can develop trigger points along the muscle fibers and even cause nerve entrapment along the sciatic nerve. Trigger points along the gluteus minimus can mimic sciatic nerve pain down to the back or even the side of the legs that causes excruciating and deep pain in the posterior region. Studies reveal that pain in the buttock region is a deep gluteal syndrome caused by non-discogenic pain that causes sciatic nerve entrapment.



The book, “Myofascial Pain and Dysfunction,” written by Dr. Janet G. Travell, M.D., states that many patients with active trigger points located in their gluteus minimus would complain about hip pain that could cause them to limp-walk when they are going to places. The pain caused by the active trigger points can make it difficult to stand up from a seated position due to the painful movements. The associated pain that the trigger points are causing to the gluteus minimus can be constant and excruciating; even small stretches can not alleviate the pain. The book also mentioned that trigger points could cause referred pain to the gluteus minimus that can cause various somato-visceral issues to the hips, legs, and knees if the pain worsens.

Sciatic Type Pain: Gluteus Minimus Trigger Points- Video

Are you dealing with pain in your hips, low back, and legs? Do you find it difficult to walk or stand up constantly? Or are you experiencing sciatic nerve pain that is radiating down your leg? All these pain-like symptoms are associated with trigger points along the gluteus minimus affecting the sciatic nerve. The gluteus minimus is the smallest of the gluteal muscles with the same function as the gluteus medius and predominately acts as the hip’s stabilizer and abductor. When the gluteus minimus muscles have been overused from traumatic events or normal factors, they can develop trigger points in the muscle fibers, entrap the sciatic nerve and irritate the nerve causing sciatica. The video above explain where the gluteus minimus is located and pinpoints where the trigger points are in the muscle fibers. Trigger points along the gluteus minimus can mimic sciatica by causing referred pain to travel down the leg. This can cause the individual to be unable to walk or even stand up due to the excruciating pain that they are in. Luckily, trigger points are treatable even though they are tricky to diagnose.

Various Treatments To Release Sciatic Nerve Pain


Even though trigger points along the gluteus minimus are tricky to diagnose, they are treatable through various treatments to alleviate the pain that the person is experiencing and can reduce sciatic nerve pain from causing more issues in the legs. Studies reveal that the effectiveness of active soft tissue release and trigger point block treatments combined can release entrapped nerves from the gluteus minimus and reduce low back and sciatic pain from the lower extremities. Now the treatments alone can only do so much to the individual, as many doctors tell their patients to take corrective actions or techniques to reduce the chances of trigger points from forming again on the gluteus minimus. Techniques like glute stretches, ischemic compressions, or using a foam roller can break the myofascial triggers from the gluteus minimus muscles and reduce the pain in the glutes and legs. This will help bring mobility back to the lower extremities.



As the smallest muscle in the body’s gluteal region, the gluteus minimus is the lower body’s predominant hip stabilizer and abductor. The gluteus minimus contributes to pelvic stability and lower extremity functionality that can be overused and can develop trigger points associated with sciatica. Trigger points along the gluteus minimus can cause referred pain to the legs and lower back while mimicking sciatic nerve pain. Thankfully various treatments and techniques can help reduce the chances of trigger points forming along the gluteus minimus and release nerve entrapment from the aggravated muscles pressing on the sciatic nerve, bringing back lower extremity mobility to the body.



Greco, Anthony J, and Renato C Vilella. “Anatomy, Bony Pelvis and Lower Limb, Gluteus Minimus Muscle.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 29 May 2022,

Kameda, Masahiro, and Hideyuki Tanimae. “Effectiveness of Active Soft Tissue Release and Trigger Point Block for the Diagnosis and Treatment of Low Back and Leg Pain of Predominantly Gluteus Medius Origin: A Report of 115 Cases.” Journal of Physical Therapy Science, The Society of Physical Therapy Science, Feb. 2019,

Martin, Hal David, et al. “Deep Gluteal Syndrome.” Journal of Hip Preservation Surgery, Oxford University Press, July 2015,

Travell, J. G., et al. Myofascial Pain and Dysfunction: The Trigger Point Manual: Vol. 2:the Lower Extremities. Williams & Wilkins, 1999.

Whiler, Lisa, et al. “Gluteus Medius and Minimus Muscle Structure, Strength, and Function in Healthy Adults: Brief Report.” Physiotherapy Canada. Physiotherapie Canada, University of Toronto Press, 2017,


Pregnancy Sciatica Chiropractic Back Clinic

Pregnancy Sciatica Chiropractic Back Clinic

The body experiences physical changes during pregnancy. As the baby grows, the body has to adjust, which can cause unfamiliar aches and pains. A common issue for pregnant women is sciatica symptoms or lumbar radiculopathy, which radiates discomfort sensations that travel down the lower spine, down the back of the thigh, and into the foot. Chiropractic care and massage therapy can realign the spine and hips, therapeutically massage circulation through the body, relieve symptoms, and restore function.Pregnancy Sciatica Chiropractor

Pregnancy Sciatica

The sciatic nerve is the largest in the body and the main nerve in the legs. In most cases, sciatica happens when this nerve gets compressed by bulging, slipped, or ruptured spinal discs, arthritis, or spinal stenosis.


Aches and pains that result from sciatica range from mild to severe sensations. Symptoms include:

  • Pain that travels from the pelvis down the back of the leg.
  • A burning sensation in the low back and buttocks.
  • Jolting pain that feels like an electric shock.
  • Numbness, muscle weakness, or tingling in one leg or foot.
  • Tingling sensation in one part of the body and pain in another.
  • Pain that worsens when coughing, sneezing or sitting for long periods.


Sciatica during pregnancy can be caused by:

  • Weight gain is going to pull the spine and muscles down.
  • Increased fluid retention can place added pressure on the nerve as it passes through the pelvis.
  • The expanding uterus can press down on the nerve in the lower part of the spine.
  • The growing belly and breasts shift the center of gravity forward and stretch the lordotic curve causing the muscles in the:
  • Buttocks and pelvis to tighten up and compress the sciatic nerve.
  • The baby’s head can rest directly on the nerve when settling into the proper birth position in the third trimester.
  • A herniated or slipped disc caused by the extra pressure of the growing uterus can be the cause, although this is less common.
  • Pregnancy also causes the body to release a hormone called relaxin, designed to relax the ligaments and prepare the pelvis for childbirth.
  • Loose ligaments can cause spinal compression and affect the sciatic nerve.

Sciatica will most likely occur during the third trimester when mother and baby are bulking up, but it can develop earlier, although this is less common. Most women experience symptoms on one side, though it can affect both legs. The condition can be constant or intermittent, depending on the amount of pressure placed on the nerve, and can remain for a few months after giving birth when the excess weight and fluid are gone.

Treatment Techniques

Simple home remedies and treatment to help ease the symptoms. These include:

Sleep on Your Side

  • Rest on the side of the body that does not present symptoms when lying down.
  • This takes the pressure off the compressed nerve.
  • Use a full-body pillow to support the hips and legs.

A Hot Shower, Heat, and Ice

  • Heat relaxes tight muscles and increases circulation.
  • Putting a cold pack on your lower back and rear pelvis can also help.

Consistent Movement

  • Consistent gentle movement that does not include too much bending or twisting is helpful to keep the musculoskeletal system active and limber.
  • Going for a light walk is recommended.
  • A prenatal yoga class can soothe muscles and the mind.
  • Low-impact activities like swimming can also be beneficial.

Prenatal Massage

  • Prenatal massage can reduce stress, improve blood circulation, and regulate hormones.

Chiropractic and Physical Therapy

  • Chiropractic is non-invasive and drug-free, making it a safe and gentle option for mom and baby.
  • A professional chiropractor can evaluate the condition.
  • Identify and remove interferences in the nervous system from the source.
  • Realign the bones.
  • Provide a personalized treatment plan to alleviate symptoms and stretches and strength-building exercises.

Sciatica In Pregnancy


American Pregnancy Association: “Prenatal Massage Therapy.

American Pregnancy Association: “Sciatic Nerve Pain During Pregnancy: Causes and Treatment.”

FRIEDMANN, E. “Narrowing of the spinal canal due to thickened lamina a cause of low-back pain and sciatica.” Clinical orthopedics vol. 21 (1961): 190-7.

Goldsmith, Laura T, and Gerson Weiss. “Relaxin in human pregnancy.” Annals of the New York Academy of Sciences vol. 1160 (2009): 130-5. doi:10.1111/j.1749-6632.2008.03800.x

KULOWSKI, J. “Unusual causes of low back pain and sciatica during pregnancy.” American journal of obstetrics and gynecology vol. 84 (1962): 627-30. doi:10.1016/0002-9378(62)90156-4

Trager, Robert J et al. “Ischial osteochondroma as an unusual source of pregnancy-related sciatic pain: a case report.” Chiropractic & manual therapies vol. 30,1 45. 17 Oct. 2022, doi:10.1186/s12998-022-00451-3

Staying Active With Sciatica: Back Clinic

Staying Active With Sciatica: Back Clinic

Sciatica is one of the most common injuries, with as many as 40% of individuals experiencing the condition, and it becomes more frequent as the body ages. The pain originates with the sciatic nerves and can go on for several weeks, months, or years. Staying active is a major recommendation to relieve the pain and prevent future flare-ups. Injury Medical Chiropractic and Functional Medicine Clinic can decompress and release the nerve and educate individuals on an anti-inflammatory diet and staying active to expedite healing.Staying Active With Sciatica

Staying Active

Sciatica is most commonly caused by a slipped disc, which puts pressure or irritates the sciatic nerve, and causes discomfort and painful sensations. The most common factors for developing sciatica include the following:

  • As the body ages, the spinal discs wear out and break down, leading to the spine shifting out of alignment.
  • Job occupations that place added strain on the back, like sitting or standing for extended periods, repetitive heavy lifting, or bending, reaching, and twisting movements.
  • Practicing unhealthy postures.

Doctors and chiropractors have found that only resting with sciatica can worsen the injury.

  • This is because if it is a slipped/bulging/herniated disc, the disc remains in this state, the nerve stays compressed or irritated, and the muscles that control the low back become weak and unable to provide support.


Don’t Sit For Too Long

  • Prolonged periods of sitting place added pressure on the discs and ligaments in the low back.
  • Even when sitting doesn’t make it worse, the muscles can develop unhealthy muscle memory that causes partial contracting when there shouldn’t be any that tightens the gluteal muscles causing added strain.
  • Individuals with a job requiring a lot of sitting or standing are recommended to take frequent breaks to stretch out their muscles or use a standing desk to change positions.

Posture Adjustments

Slouching, hunching, and continuing to practice unhealthy postures will exacerbate sciatica.

  • Pay attention to the body’s position when standing or sitting.
  • To prevent slouching, pull the shoulders down and back.
  • Imagine the shoulder blades touching.
  • Individuals working at a desk or workstation should take frequent breaks.
  • Position the screen to see it without tilting the head down.

Increase Physical Activity and Exercise

Exercise is highly recommended to keep the muscles and nerves moving and circulation flowing.


  • Walking, light jogging, swimming, cycling, and dancing, increase heart rate without causing added strain or pain.

Strength Training

  • Exercises using free weights, weight machines, or isometric exercises strengthen the muscles and can help restore their position.

Stretching and Flexibility Training

  • Yoga, tai chi, and Pilates increase flexibility and strength.
  • The stretching will keep the nerves and muscles from spasms that can worsen the injury.

Strengthen The Core

A stronger core will improve spinal health. Actively engaging the abdominal muscles protects sciatic nerve roots by minimizing spinal pressure.

  • The back muscles can become increasingly stressed and tired when they have to do all the work without core muscle support.
  • A weak core can cause additional back pain and worsen sciatica symptoms.

Stand Up Straight

  • Keep the head and shoulders straight.

Focus On Breathing

Core Muscles

  • The back, side, pelvis, and buttock muscles are also part of the core.
  • Strengthening all of these muscles helps to support the spine.
  • Exercises for core strengthening include yoga and Pilates, planks, and bridges.

Nerve Recovery

As the nerve recovers, the area the nerve supplies could experience tingling discomfort.

  • This could be accompanied by an electric sensation at the level of the healing nerve fibers.
  • The location of this sensation should move as the nerve heals.
  • With time the sensations should subside, and the area should begin to feel more normal.

Spinal Decompression Demonstration


Jensen, Rikke K et al. “Diagnosis and treatment of sciatica.” BMJ (Clinical research ed.) vol. 367 l6273. 19 Nov. 2019, doi:10.1136/bmj.l6273

Kuai, Shengzheng, et al. “Influences of lumbar disc herniation on the kinematics in multi-segmental spine, pelvis, and lower extremities during five activities of daily living.” BMC musculoskeletal disorders vol. 18,1 216. 25 May. 2017, doi:10.1186/s12891-017-1572-7

Ma, Xiao, et al. “The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults.” Frontiers in psychology vol. 8 874. 6 Jun. 2017, doi:10.3389/fps.2017.00874

Ramaswami, Ramya, et al. “Management of Sciatica.” The New England journal of medicine vol. 376,12 (2017): 1175-1177. doi:10.1056/NEJMclde1701008

Acute, Chronic, Alternating, and Bilateral Sciatica Back Clinic

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 Chiropractor

Acute, Chronic, Alternating, and Bilateral Sciatica


  • 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 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.


  • 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 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.


  • 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


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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.

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:

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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

Sciatica Pain Can Radiate To The Knee: Back Clinic

Sciatica Pain Can Radiate To The Knee: Back Clinic

Sciatica pain can radiate to the knee. Individuals with sciatica do report unique/unusual knee pain that was never there and no past or recent physical injuries. Sciatica is the culprit, as the knee muscles are powered and controlled by nerves in the lower spine. Irritation or compression of these nerves can cause symptoms that can include: random back pain, hamstring tightness, weakness in the hips or quadriceps, the development of bunions, and knee pain and/or weakness. Chiropractic treatment can release the compression, heal the sciatic nerve, and alleviate knee problems.

Sciatica Pain Can Radiate To The Knee: Injury Medical Chiropractic

Sciatica Pain Can Radiate To The Knee

Spine conditions that can cause sciatica include:

  • Disc herniation – Where the inside of the discs leak out and compress and/or irritate surrounding nerves.
  • Degeneration of the discs – The discs between the vertebrae wears down naturally as the body ages.
  • Spinal stenosis – The spinal canal begins to narrow, not allowing enough space for the nerves to rest comfortably, resulting in compressed nerves.
  • Spondylolisthesis – A condition that occurs when a vertebrae slips forward onto the vertebrae below it.

Any can cause irritation, inflammation, or compression of the sciatic nerve leading to painful sensations that extends from the lower back down through the leg.


Common knee symptoms that may be experienced with sciatica include:

  • A dull ache, warm sensation, or sharp pain around the knee.
  • Tightness in the hamstrings.
  • Weakness in the hips or quadriceps.
  • Unable to put weight on the knee.
  • Buckling/Collapsing giving out of the knee.
  • Difficulty or inability to straighten the knee.
  • Weakness when extending the knee.
  • Bunions form from weakened stabilizing muscles that affect walking, running, and standing posture.

As sciatica pain can radiate to the knee, individuals will usually also experience pain in their buttocks, thigh, calf, and/or foot. The nerve sensations and other symptoms in the knee can be felt through a branch of the sciatic nerve known as the peroneal nerve.


The knee pain will last as long as sciatica does, depending on the type of sciatica, whether it is acute or chronic.

  • An acute sciatic episode usually resolves after a few weeks, with possible future flare-ups.
  • Chronic sciatica is a long-term condition that does not resolve independently and necessitates intervention by a specialist.

Chiropractic Treatment Plan

Depending on the diagnosis, a chiropractor will develop a personalized treatment plan to address the root cause and heal the injury. The treatment plan will include therapeutic massage, posture training, and at-home self-care to help heal and prevent future sciatica.

Massage Rehabilitation

  • Physical therapy and therapeutic massage will loosen and relax the muscles, nerves, tendons, and ligaments.
  • Heat and ice, exercises, and stretches will prepare the muscles and nerves for chiropractic decompression adjustments.

Posture Training

  • Training will be provided to maintain the back, hips, knees, and feet in proper alignment.
  • Training on removing pressure from the lower back and restabilizing the rest of the body.
  • Training on proper body mechanics, safe lifting techniques, and injury prevention.

Self-Pain Management

  • Training on self-care habits that include healthy weight, core strengthening exercises and stretches for the back muscles, and proper rest for a full recovery.
  • Discomfort and pain management skills.

Health Coaching

  • An anti-inflammatory diet to reduce/eliminate inflammation and achieve a healthy weight and a nutrition plan to maintain overall health.


  • Surgery is the final option when conservative treatments are not working.


Dydyk AM, Khan MZ, Singh P. Radicular Back Pain. [Updated 2021 Nov 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:

Hirabayashi, Hiroki, et al. “Characteristics of L3 nerve root radiculopathy.” Surgical neurology vol. 72,1 (2009): 36-40; discussion 40. doi:10.1016/j.surneu.2008.08.073

Jandre Reis, Felipe Jose, and Adriana Ribeiro Macedo. “Influence of Hamstring Tightness in Pelvic, Lumbar and Trunk Range of Motion in Low Back Pain and Asymptomatic Volunteers during forwarding Bending.” Asian spine journal vol. 9,4 (2015): 535-40. doi:10.4184/asj.2015.9.4.535

Jeong, Ui-Cheol, et al. “The effects of self-mobilization techniques for the sciatic nerves on physical functions and health of low back pain patients with lower limb radiating pain.” Journal of physical therapy science vol. 28,1 (2016): 46-50. doi:10.1589/jpts.28.46

Muscle Memory: Lower Back Pain and Sciatica

Muscle Memory: Lower Back Pain and Sciatica

The lower back core muscles initiate and control movement and posture. Total body movements start at the pelvis and are carried out by the low back and abdominal muscles. These core muscles provide control and stability when moving. When the body is not moving, standing and sitting posture habits (healthy and unhealthy) develop based on how an individual controls/holds their pelvis posture. The lower back muscles are in constant demand for performing repetitive motions or forceful actions. The muscles become chronically tight and sore,  joints and nerves get compressed, and bones and connective tissue stay in a stressed state, causing intense pain and damage to the body’s structure. These problems can result from muscle memory, the nervous system’s operating procedure to make movements automatic.

Muscle Memory, Back Pain and Sciatica

Muscle Memory

The nervous system controls the movement and contraction in the muscles and constantly reinforces and learns new movement patterns to become more efficient through muscle memory. However, this learning process allows for the development of healthy muscle habits and unhealthy muscular habits. An example is sitting using a slouching posture. The nervous system will store that posture data and subconsciously contract the abdominal and pectoral muscles, so the slouched posture takes over. Because of the continual usage and compromised postures, various muscles start to tighten up. Individuals are typically not aware of the gradual tightening until stiffness, soreness, and pain sets in. Tight muscles pull the skeleton in awkward ways that cause body misalignments, causing:

Individuals develop unique muscle patterns and tension levels throughout the body due to repetitive daily activities, stress responses, injuries sustained, and physical activities. Muscle memory issues can contribute to chronic back pain and sciatica. Unhealthy muscle memory causes the muscles not to return to their natural state but to the awkward position and makes that the natural state. Healthy muscle memory leads to instant reflexes that make movements smooth and effortless.

Chiropractic will relieve back and sciatica pain by inducing deep muscle relaxation that releases endorphins. The soreness and tension will be massaged, and mechanical decompression if necessary. Massage and stretching will help retrain muscle and movement memory, along with exercises to reinforce the retraining.

Spinal Decompression Therapy


Campbell, James N, and Richard A Meyer. “Mechanisms of neuropathic pain.” Neuron vol. 52,1 (2006): 77-92. doi:10.1016/j.neuron.2006.09.021

Wilder, David G et al. “Effect of spinal manipulation on sensorimotor functions in back pain patients: study protocol for a randomized controlled trial.” Trials vol. 12 161. 28 Jun. 2011, doi:10.1186/1745-6215-12-161

Factors Leading To Sciatica Can Be Relieve By Decompression

Factors Leading To Sciatica Can Be Relieve By Decompression


In the lower half region of the body, a large nerve connects to the lumbar region of the spine that travels down to the legs. This is the sciatic nerve, and its primary function is to provide mobility to the legs. The legs use the sciatic nerve to move, feel, and stabilize the body as it is in motion. When the lumbar region of the spine begins to natural wear and tear from injuries or ordinary factors like lifting heavy objects can cause the spinal discs in the spine to herniate and press on the sciatic nerve. When this happens, the sciatic nerve sends out pain signals that travel down the legs and back to the brain, causing symptoms like sciatica to develop. Luckily some therapies can help prevent sciatica from developing further and provide relief to many suffering individuals. Today’s article focuses on the factors that cause sciatica and how treatments like decompression therapy can help prevent sciatica-like factors from progressing further for many individuals. Referring patients to qualified and skilled providers who specialize in spinal decompression therapy. We guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is essential for asking insightful questions to our providers. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer


Can my insurance cover it? Yes, it may. If you are uncertain, here is the link to all the insurance providers we cover. If you have any questions or concerns, please call Dr. Jimenez at 915-850-0900.

SpineMed #2

What Is Sciatica?


Do you feel pain running down your legs? Does it hurt when you are walking, even for a short distance? How about muscle stiffness that is occurring in your lower back and legs? All these symptoms are signs that you are experiencing sciatica. Research studies have defined sciatica as a throbbing, sharp pain that affects one side of the body and travels down each leg. Whenever a person is suffering from sciatica, the pain symptoms usually vary, depending on how severe it affects the legs. Sciatica usually forms when the spine suffers from a herniated disc, or the piriformis muscle starts to compress on the sciatic nerve, causing it to become irritated. Additional information shows that various conditions that can structurally impact or even compress the sciatic nerve can result in sciatica symptoms that can hinder a person’s ability to walk. Injuries to the spine are not the only factors that can cause sciatica to occur, as ordinary factors can also be an issue.


Factors That Cause Sciatica

Now many factors can cause sciatica to develop. Some of these factors can be ordinary everyday habits that many have adopted that don’t realize are causing sciatica pain. Research studies have shown that many individuals that are suffering from low back pain from strenuous working conditions like sitting down in a desk job for long periods can cause an increased risk of developing sciatica. Sitting for an extended period can cause a person to create poor posture, which leads to low back pain and thus developing sciatica. Another factor that can lead to sciatica is lifting heavy objects. Additional research studies have shown that when workers handle carrying or lifting heavy objects can affect their lower back. The heavyweight of the object causes stress and tension on the lower muscles causing the individual to ache in pain. These painful symptoms can cause the lower muscles to compress and aggravate the sciatic nerve. Luckily some treatments can help prevent these factors from irritating the sciatic nerve and prevent sciatica from progressing.

Things To Avoid With Sciatica-Video

Are you feeling muscle strain from lifting or carrying heavy objects? Does your lower back ache after an extended period of sitting down? Do you feel aggravating pain in the back of your legs? You could be suffering from sciatica, and decompression therapy might be able to help. The video above explains the ten things to avoid when dealing with sciatica. Decompression therapy allows the individual experiencing sciatica to feel relief in their lower back. It uses gentle traction on the spine to enable the aggravated sciatic nerve to relax while also loosening up the stiff muscles that are causing immobility to the lower back. Incorporating decompression therapy as a wellness treatment is beneficial. This link will explain how decompression offers optimal comfort for many people who suffer from sciatica while also returning them to their health and wellness journey.

How Decompression Can Alleviate Sciatica Factors


Many treatments are available to help with sciatica symptoms and low back pain symptoms that can relieve the suffering individual. Research studies have shown that decompression treatments for sciatica can be delivered to many individuals by reducing the pain that the piriformis muscle has trapped. When the piriformis muscle is gently moved away from the sciatic nerve, the pain signals will lessen from sending information to the brain. Other research studies have shown that decompression treatments for trapped sciatic nerves will provide pain reduction to the leg muscles and relieve the buttock muscles from suffering from muscle spasms. Many individuals that suffer from sciatica will also feel relief from the negative pressure that decompression treatment has provided. 



Overall, sciatica can be caused by factors that can be ordinary, like sitting for an extended period, lifting, or carrying heavy objects. Other factors can be simple as a herniated disc or piriformis syndrome. Decompression treatments allow the individual to feel instant relief from sciatica by gently stretching the spine to alleviate the pressure off of the sciatic nerve. Once the sciatic nerve starts to feel better after being aggravated, the lower half of the body will begin to relax, and the individual will become pain-free.



Davis, David, et al. “Sciatica – Statpearls – NCBI Bookshelf.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 6 May 2022,

Euro, Ulla, et al. “Work-Related Risk Factors for Sciatica Leading to Hospitalization.” Scientific Reports, Nature Publishing Group UK, 25 Apr. 2019,

Hogan, Elizabeth, et al. “A Minimally Invasive Surgical Approach for the Treatment of Piriformis Syndrome: A Case Series.” Chinese Neurosurgical Journal, BioMed Central, 30 Mar. 2020,

Lis, Angela Maria, et al. “Association between Sitting and Occupational LBP.” European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, Springer-Verlag, Feb. 2007,

Park, Myung-Sik, et al. “Clinical Results of Endoscopic Sciatic Nerve Decompression for Deep Gluteal Syndrome: Mean 2-Year Follow-Up.” BMC Musculoskeletal Disorders, BioMed Central, 20 May 2016,

Staff, Mayo Clinic. “Sciatica.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 1 Aug. 2020,


Decompression Therapy For Trapped Sciatic Nerves

Decompression Therapy For Trapped Sciatic Nerves


The lower half of the body helps provide stability to the upper half of the body. The hips, legs, and feet have sensory and motor functions from the nerves part of the peripheral nervous system. These nerves are connected to the lumbar region of the spine that makes the hips rotate, the feet sense where it is going, and the legs move around freely. One of the nerves connected to the lumbar regions of the spine is the sciatic nerve. The sciatic nerve extends from the spinal cord’s lower lumbar region through the buttock muscle region and travels down to the legs. When unwanted symptoms start to affect the lower half of the body, it can cause the sciatic nerves to become trapped in the buttock muscle region and irritated, causing sciatica to develop. Today’s article will focus on the deep gluteal syndrome, how it affects the sciatic nerve, and how decompression treatments can help relieve trapped sciatic nerves. Referring patients to qualified and skilled providers who specialize in spinal decompression therapy. We guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is essential for asking insightful questions to our providers. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer


Can my insurance cover it? Yes, it may. If you are uncertain, here is the link to all the insurance providers we cover. If you have any questions or concerns, please call Dr. Jimenez at 915-850-0900.

Prone VAX D Research

What Is Deep Gluteal Syndrome?

Do you feel pain in your hips and buttock regions? How about stinging, burning pain that is causing leg pain? Do your buttock muscles gradually begin to feel numbness or spasms throughout the day? If you have been dealing with these symptoms, it could be deep gluteal syndrome. Research studies have defined deep gluteal syndrome as a presence of pain located in the buttock region that causes the surrounding muscles to press on the nerve roots and cause unwanted pain. When a person suffers from an accident like falling and landing on their butt, the muscles feel the effects of that fall and start to compress the sciatic nerve that is traveling down the leg and causes pain to the body’s lower extremities. Other studies have shown that deep gluteal syndrome factors can cause this condition to develop over time due to increased muscle tension that aggravates the sciatic nerve. Other causes of the deep gluteal syndrome can include prolonged sitting. The butt muscles start to pinch the sciatic nerves constantly, the muscles from the buttock start to feel tender to the touch, and abnormalities in the piriformis muscles can lead to the development of sciatica. 


How Does It Affect The Sciatic Nerve & Symptoms?

Since deep gluteal syndrome causes muscle tension in the buttock region, it can aggravate the sciatic nerve and causes sciatica-like symptoms in the legs. Research studies have mentioned that deep gluteal syndrome can cause a painful presence in the buttock muscles while trapping the sciatic nerve within the gluteal space, causing the sciatic nerve to become irritated. Since the sciatic nerve is located in the spinal cord and goes all the way to the legs, sciatica is presented whenever the lower half of the body is suffering from factors like herniated discs, piriformis syndrome, and even deep gluteal syndrome.


Some of the symptoms that deep gluteal syndrome causes to the lower regions of the body are sciatica. Since the sciatic nerve is located in the lower back and runs across the butt and down to the legs, it can cause leg pain since the nerves are either trapped by the buttock muscles or irritated due to a compressed disc in the spine. Other symptoms that are caused by deep gluteal syndrome involve:

  • Muscle tenderness
  • Tingling sensations traveling down the legs
  • Pain becomes worse during light to moderate exercises
  • Muscle aches on the hips, lower back, and buttock

Spinal Decompression With The DRX9000- Video

Do you feel less mobility in your hips? How about the excruciating pain that travels down to your legs? Does it hurt when you walk or sit down for long periods? This could result from deep gluteal syndrome associated with sciatica, and decompression therapy might be the relief you are looking for. The video above explains how the DRX9000 helps relieve herniated discs from aggravating the sciatic nerve. The DRX9000 is part of a wellness treatment known as decompression therapy that incorporates gentle traction on the spinal discs by increasing their height between the spinal joints and promoting a healing factor for those suffering from low back pain issues. Decompression therapy can be in surgical and non-surgical treatments depending on the severity of pain that the spine is in. Incorporating spinal decompression as part of your wellness treatment is beneficial. This link will explain how decompression offers optimal comfort for many people who suffer from sciatica and deep gluteal syndrome while also getting them back to their health and wellness journey.

How Decompression Can Help Relieve Deep Gluteal Syndrome


With sciatica-like symptoms associated with deep gluteal syndrome affecting the buttock and the legs, many people have turned to find some relief to ease the tense muscles that aggravate the sciatic nerve. Research studies have shown that endoscopic decompression surgery allows the individual to be supine while physicians gently move the piriformis muscle away from the sciatic nerve and relieve the pain. Other decompression treatments can also help lower the sciatic nerve’s inflammation, causing the legs to be under and reducing muscle spasms occurring, as research has found.



Overall, having pain in the lower half of the body is never a good thing. The lower half of the body allows stability for the upper half as the motor functions provide the legs to move around. When an injury starts to affect the lower half, it can cause sciatica-like symptoms associated with the deep gluteal syndrome. These conditions can cause motor dysfunction in the legs and cause a person to become unstable. Treatments like decompression therapy allow the buttock muscles to ease off the sciatic nerve and provide relief to the legs. As part of a person’s wellness journey, decompression treatments will enable the return of leg mobility to the individual without feeling pain around the lower regions of the body.



Ham, Dong Hun, et al. “Effectiveness of Endoscopic Sciatic Nerve Decompression for the Treatment of Deep Gluteal Syndrome.” Hip & Pelvis, Korean Hip Society, Mar. 2018,

Hopayian, Kevork, and James Heathcote. “Deep Gluteal Syndrome: An Overlooked Cause of Sciatica.” The British Journal of General Practice : the Journal of the Royal College of General Practitioners, Royal College of General Practitioners, 26 Sept. 2019,

Martin, Hal David, et al. “Deep Gluteal Syndrome.” Journal of Hip Preservation Surgery, Oxford University Press, July 2015,

Professionals, Intermountain Healthcare. “Deep Gluteal Syndrome: Intermountain Home.” Intermountain Healthcare, 2022,

Son, Byung-Chul, et al. “Decompression of the Sciatic Nerve Entrapment Caused by Post-Inflammatory Scarring.” Journal of Korean Neurosurgical Society, The Korean Neurosurgical Society, Feb. 2015,


Prescription Medications Sciatica and Decompression

Prescription Medications Sciatica and Decompression

Prescription Medications: Sciatica is a term used to describe neuropathic/nerve pain. It is a prevalent condition known as a lumbosacral radicular syndrome. It’s discomforting, numbness, and tingling, combined with sharp shooting pain that can present anywhere from the low back where the nerve begins and down the leg into the foot. The most common cause is a bulging or herniated disc. The first medical recommendations are:

  • Ice and Heat packs
  • Physical therapy
  • Chiropractic
  • Over-the-counter pain relievers:
  • Acetaminophen – Tylenol
  • Non-steroidal anti-inflammatory drugs – NSAIDs:
  • Naproxen – Aleve
  • Ibuprofen – Advil, Motrin

However, when that is not enough, the next step usually involves prescription medications to treat the nerve pain.

Prescription Medications For Sciatica and Decompression

Prescription Medications

The following are a few prescription medications for sciatica:

When it comes to prescription medications for non-specific lower back pain, medical guidelines are in agreement. Here’s a look at what the research shows about their effectiveness.


Inflammation is a normal response of the immune system. However, the inflammation can irritate the nerves of the spinal column to the rest of the body, causing swelling and sciatica symptoms. NSAIDs are available as over-the-counter and prescription meds and can reduce inflammation, bringing relief from nerve pain, including sciatica.


Diclofenac is taken by mouth with its total daily dose or TDD and can range from 75 to 200 mg.

Side Effects

Possible short-term side effects of NSAIDs can include:

  • Upset stomach
  • Heartburn
  • Nausea
  • Headache
  • Dizziness


Gabapentin is commonly used to treat diabetic neuropathy and chronic sciatica nerve pain. However, it can take some time, possibly more than two weeks, to activate, and its effectiveness relieves sciatic nerve pain for up to 3 months. It works by calming down nerve cells to relieve neuropathic/nerve pain. It calms down the nerves by lowering the amounts of chemicals in the nervous system. An overabundance of chemicals can excite the nerve cells to the point of inflammation. Substance P is a neurotransmitter and a neuromodulator that plays a role in how the body perceives pain. Gabapentin helps to lower substance P levels.


It is taken by mouth with its TDD typically between 900 to 3,600 mg, divided into multiple daily doses.

Side Effects

Common side effects include:

  • Drowsiness/sleepiness
  • Dizziness
  • Arms and/or Leg swelling
  • Diarrhea
  • Weakness


Like the other anti-seizure medications, topiramate is thought to relieve nerve pain by calming down the nerve cells by attaching to the glutamate receptor and preventing it from activating pain signals. Topiramate is commonly used to alleviate sciatica symptoms but may not be as effective after three months and does not lower disability from the low back and sciatic pain.


The TDD for topiramate ranges between 50 to 400 mg.

Side Effects

Side effects can include:

  • Drowsiness/sleepiness
  • Sleep problems
  • Mood/behavioral changes
  • Trouble with memory
  • Nervousness
  • Appetite loss
  • Weight loss
  • Dizziness
  • Numbness or tingling sensations

Decompression Diagnostics Specialists


Baron, R., et al. (2010). The efficacy and safety of pregabalin in the treatment of neuropathic pain associated with chronic lumbosacral radiculopathy. Pain.

Dydyk AM, Conermann T. Chronic Pain. [Updated 2021 Nov 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:

Oliver Enke, Heather A. New, Charles H. New, Stephanie Mathieson, Andrew J. McLachlan, Jane Latimer, Christopher G. Maher, C.-W. Christine Lin. Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis. CMAJ Jul 2018, 190 (26) E786-E793; DOI: 10.1503/cmaj.171333

Rasmussen-Barr, Eva, et al. “Non-steroidal anti-inflammatory drugs for sciatica.” The Cochrane database of systematic reviews vol. 10,10 CD012382. 15 Oct. 2016, doi:10.1002/14651858.CD012382

Nonsurgical Decompression Treatments For Piriformis Syndrome

Nonsurgical Decompression Treatments For Piriformis Syndrome


The sciatic nerve is considered the largest in the lower half of the body that helps control sensory and motor functions of the legs. As part of the nervous system, the sciatic nerve resides in the lumbar region of the spine, traveling down to the legs and feet while succumbing to injuries and unwanted factors. When there are injuries or unwanted symptoms that start to affect the lumbar regions of the spine like herniation or a slipped disc, it can press on the sciatic nerve causing sharp, searing pain that can radiate down to the legs and feet. This type of pain can lead to sciatica and dampen a person’s mood if not treated right away. Luckily, there are treatments available for reducing sciatic nerve pain and other issues that affect the body’s lower extremities. Today’s article focuses on a condition that can cause sciatica known as piriformis syndrome, its symptoms, and how decompression therapy can help many people alleviate the sciatic nerve from piriformis syndrome. Referring patients to qualified and skilled providers who specialize in spinal decompression therapy. We guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is essential for asking insightful questions to our providers. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer


Can my insurance cover it? Yes, it may. If you are uncertain, here is the link to all the insurance providers we cover. If you have any questions or concerns, please call Dr. Jimenez at 915-850-0900.

G-11 - Decompression and Sensory nerves

What Is Piriformis Syndrome?


Do you feel muscle spasms occur in your lower back or buttock? How about radiating pain that is traveling down the legs? Do the muscles in the lower body regions feel tender and weak to the touch? Experiencing these symptoms mean that you are suffering from piriformis syndrome. Research studies have defined piriformis syndrome as a condition in which the piriformis muscles in the buttocks region irritate the nearby sciatic nerve, causing it to be trapped. As the sciatic nerve becomes trapped in the piriformis muscle, it can cause sciatica pain-like symptoms that run down the leg. Additional research studies mentioned that since sciatica is a musculoskeletal pain disorder associated with piriformis syndrome, the compressed, irritated sciatic nerve root causes the individual to suffer from painful symptoms that are causing the piriformis muscle to tense up. Piriformis syndrome can affect the sciatic nerve root with or without spinal disorders like herniationstenosis, or slipped discs.


The Symptoms

When the piriformis muscle aggravates the sciatic nerve, many symptoms can pop up over time, causing painful issues that collide with sciatica and piriformis syndrome. Research studies have shown that piriformis syndrome is a deliberate condition caused by traumatic events, inflammation in the lower back, and spinal degeneration. Most of the causes do hinder a person’s quality of life. Since the sciatic nerve is trapped in the piriformis muscle, it can cause excruciating, burning pain that affects the lower back down to the leg muscles. Other studies have found that other symptoms that are caused by piriformis syndrome are:

The DOC Decompression Table-Video

Feeling a limited range of motion on your hips? How about radiating, burning pain that travels down to your feet? Does it hurt to walk up the stairs? Piriformis syndrome can cause sciatica pain-like symptoms that can hinder your ability to walk and function. Decompression therapy can be the solution you are looking for. The video above explains and introduces the DOC decompression table and how it is used to alleviate sciatica pain-like symptoms that are causing pain to the individual. Decompression therapy can help with low back and leg pain by gently pulling the spine to allow the necessary supplements for the spine and to take the pressure off the sciatic nerve roots. Decompression therapy can benefit many individuals suffering from leg pain and who want to get back on their wellness journey. Incorporating spinal decompression as part of your wellness treatment is beneficial. This link will explain how decompression offers optimal comfort for many people who suffer from piriformis syndrome and get them back to their health and wellness journey.

How Decompression Therapy Can Alleviate Piriformis Syndrome


Since the sciatic nerve is trapped in the piriformis muscle and causes leg pain, some treatments handle piriformis syndrome by decompressing the sciatic nerve. Research studies have found that endoscope decompression surgery can help alleviate piriformis syndrome by relaxing the sciatic nerve to ease the pain from affecting the buttock and leg muscles. For non-surgical decompression therapy, additional research has found that decompression therapy helps widen the spinal disc space in the spine while creating negative pressure in the affected areas. This negative pressure allows the sciatic nerve to relax and reposition the intervertebral disc back in the spine. Decompression treatments combined with physical therapy can even reduce the chances of piriformis syndrome coming back and affecting the sciatic nerve again.



Overall, muscle spasms around the lower body regions can cause piriformis syndrome to develop and cause havoc on the sciatic nerve. Since the piriformis muscle is close to the sciatic nerve, it can trap and aggravate it constantly by sending sciatica pain-like symptoms to the legs. This condition causes muscle weakness and mobility dysfunction in the legs, making a simple walk on the stairs complicated. Treatments like decompression therapy provided in surgical and non-surgical forms can be beneficial for those suffering from piriformis syndrome and sciatica. Decompression therapy allows the negative pressure to release the trapped, irritated sciatic nerve from causing more pain to the legs and helps loosen up the tight muscles in the lower regions of the body. Utilizing decompression as part of your treatment will allow you to continue pain-free your wellness journey.



Amjad, Fareeha, et al. “Effects of Non-Surgical Decompression Therapy in Addition to Routine Physical Therapy on Pain, Range of Motion, Endurance, Functional Disability and Quality of Life versus Routine Physical Therapy Alone in Patients with Lumbar Radiculopathy; a Randomized Controlled Trial.” BMC Musculoskeletal Disorders, BioMed Central, 16 Mar. 2022,

Hicks, Brandon L, et al. “Piriformis Syndrome.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 12 Feb. 2022,

Hopayian, Kevork, et al. “The Clinical Features of the Piriformis Syndrome: A Systematic Review.” European Spine Journal: Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, Springer-Verlag, Dec. 2010,

Revord, John. “Symptoms and Diagnosis of Piriformis Syndrome.” Spine, Spine-Health, 14 Sept. 2012,

Ro, Tae Hoon, and Lance Edmonds. “Diagnosis and Management of Piriformis Syndrome: A Rare Anatomic Variant Analyzed by Magnetic Resonance Imaging.” Journal of Clinical Imaging Science, Medknow Publications & Media Pvt Ltd, 21 Feb. 2018,

Vij, Neeraj, et al. “Surgical and Non-Surgical Treatment Options for Piriformis Syndrome: A Literature Review.” Anesthesiology and Pain Medicine, Kowsar, 2 Feb. 2021,


Non-surgical Decompression Therapy For Sciatic Radiculopathy

Non-surgical Decompression Therapy For Sciatic Radiculopathy


Inside the body are countless nerves that intertwine with each other and are all spread out. These nerves are functioned to give motor and sensory function to the body that allows a person to feel, sense, touch, and move. As part of the peripheral system in the body, these nerves are connected to the spinal cord and spine as they branch out in the spinal columns and send signals to and forth to the brain. When the body suffers from an accident or an injury, the nerves send the pain signals to the brain allowing the immune system to go to the affected area and start healing the injury. Sometimes the body suffers from natural wear and tear and that causes pain to the nerves, making the body lose the sensory and motor functions that the nerves provide. This causes radiculopathy in the body and there are treatments that allow relief to reduce the effects of radiculopathy. Today’s article post will discuss the sciatic nerve and radiculopathy, its symptoms, and how decompression therapy can help individuals that are suffering from sciatic radiculopathy. Referring patients to qualified and skilled providers who specialize in spinal decompression therapy. We guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is essential for asking insightful questions to our providers. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer


Can my insurance cover it? Yes, it may. If you are uncertain, here is the link to all the insurance providers we cover. If you have any questions or concerns, please call Dr. Jimenez at 915-850-0900.

G-9 - DRX_ClinicalTrial

The Sciatic Nerve & Radiculopathy

Have you been experiencing pain traveling down to the lower extremities of your body? Does the pain feel hot to the touch? Is the pain a sharp, stabbing pain or a burning, searing pain in the sciatic nerve? If you have encountered these symptoms, these symptoms might be due to radiculopathy along the sciatic nerve. The sciatic nerve is part of the peripheral nervous system; its primary sensory and motor functions ensure that the legs move and stand in the body. When the body goes through natural aging, wear and tear, accidents and injuries, it can cause radicular pain along the spine while compressing the nerve roots, including the sciatic nerve. Research studies have shown that radicular pain along the sciatic nerve root can cause deficits in the lower extremities’ motor and sensory function. This radicular pain can cause many problems and conditions when not treated right away. 


Research studies have defined radiculopathy as one of the reasons that many people have been suffering from low back pain. Radicular pain is located along the spine in the cervical, thoracic, and lumbar areas. When these areas are affected, it can severely damage the underlying nerve roots, thus causing the lower extremities to lose all sensory and motor functions. Additional information has found that sciatica is a type of radiculopathy that pinch the sciatic nerve causing sharp, radiating pain that travels from the lower back down to the legs. Depending on how severe the radicular pain is, it can affect the sciatic nerve over time and develop into sciatica. 


The Symptoms

When the sciatic nerve is pinched and irritated, it can send radiating pain down the legs and transmit signals to the brain. These pain signals can disrupt the brain signals and cause the immune system to constantly send inflammatory cytokines to the affected areas along the legs, lower back, and buttocks regions. Some of the common symptoms that occur when a person is dealing with sciatic radicular pain or sciatica will experience:

The Chatanooga Decompression Table-Video

Feeling muscle weakness alongside the lower back, legs, and feet? Does the pain range from mild to a burning sensation after physical activity? How about feeling discomfort or relief after shifting positions while relaxing? If you have experienced these symptoms, you might be experiencing sciatic radiculopathy, and non-surgical decompression treatment is the answer you are seeking. Suppose you want to learn more about decompression treatments and how they can benefit you in providing relief from sciatic radiculopathy? The video above introduces the Chatanooga traction machine that allows the person suffering from sciatic radiculopathy to feel relief. This traction machine is part of non-surgical decompression therapy. It enables the spine to be gently pulled slowly to allow the compressed spinal discs to release their hold on the irritated sciatic nerve. After the pressure has been removed from the pinched sciatic nerve, the affected leg, low back, and buttock muscles will begin to relax, and the pain signals to the brain will start to diminish. Incorporating spinal decompression as part of your wellness treatment is beneficial. This link will explain how decompression offers optimal comfort for many people who suffer from sciatica or other sciatic radicular pain.

How Decompression Therapy Can Help With Sciatic Radiculopathy


When radiating pain is shooting down to the leg and feet, many individuals try to find relief for sciatic radiculopathy. Some people will incorporate heat and ice compressed pads to be placed in the affected areas. At the same time, others use electromagnetic pulses along their legs to relax the muscles trapping the sciatic nerve roots. One of the treatments that many people have incorporated into their wellness treatments is decompression therapy. Research studies have learned that when the gluteal muscles entrap the sciatic nerve, it can become irritated or pinched, causing radiating pain down the legs. Decompression can help release the trapped sciatic nerve from the gluteal muscles and reduce the pain. Another reason that decompression therapy can help with sciatic radiculopathy is because it can help dampen the effects that the inflammatory cytokines have caused along the lower region of the body. Additional research studies have found that decompression surgery has provided less soft tissue and muscle damage, reduced pain symptoms along the legs, decreased the risk of re-herniation occurring, and faster recovery. Many individuals will experience less leg pain and low back pain from occurring when they add decompression into their wellness treatment.



The sciatic nerve can succumb to radicular pain like herniated discs or gluteal muscles trap the sciatic nerve making it irritated or aggravated. When this happens, the sciatic nerve causes motor and sensory dysfunction in the legs and radiating, throbbing pain to the side. Treatments like decompression therapy can help alleviate sciatic radiculopathy by releasing the compressed disc or muscle off the sciatic nerve and dampening the painful effects it causes. Decompression therapy is a beautiful addition to any wellness treatment for individuals trying to regain their health and wellness.



Aljawadi, Ahmed, et al. “Sciatica Presentations and Predictors of Poor Outcomes Following Surgical Decompression of Herniated Lumbar Discs: A Review Article.” Cureus, Cureus, 21 Nov. 2020,

Dydyk, Alexander M, et al. “Radicular Back Pain.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 2 Nov. 2021,

Feinberg, Joseph, and Shikha Sethi. “Sciatic Neuropathy: Case Report and Discussion of the Literature on Postoperative Sciatic Neuropathy and Sciatic Nerve Tumors.” HSS Journal : the Musculoskeletal Journal of Hospital for Special Surgery, Springer-Verlag, Sept. 2006,

Medical Professionals, Cleveland Clinic. “Radiculopathy: Symptoms, Causes & Treatment.” Cleveland Clinic, 16 Mar. 2022,

Park, Myung-Sik, et al. “Clinical Results of Endoscopic Sciatic Nerve Decompression for Deep Gluteal Syndrome: Mean 2-Year Follow-Up.” BMC Musculoskeletal Disorders, BioMed Central, 20 May 2016,


The Treatments To Alleviate Sciatica Pain

The Treatments To Alleviate Sciatica Pain


As part of the peripheral nervous system, the sciatic nerve is the largest nerve providing sensory and motor functions to the legs. The sciatic nerve is located in the lumbar regions of the spine that travels down to the leg. When the spine becomes injured or herniated, it can press on the sciatic nerve causing it to be irritated and cause throbbing, radiating pain that can cause symptoms like sciatica to invoke muscle weakness in the legs. Luckily, it’s rare for sciatica to affect both legs since it usually affects one leg at a time. However, various treatments provide relief for many people dealing with sciatica pain in their legs. Today’s article will focus on sciatica and how different treatments can help many individuals alleviate sciatica pain and reclaim their health and wellness. Referring patients to qualified and skilled providers who specialize in spinal decompression therapy. We guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is essential for asking insightful questions to our providers. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer


Can my insurance cover it? Yes, it may. If you are uncertain, here is the link to all the insurance providers we cover. If you have any questions or concerns, please call Dr. Jimenez at 915-850-0900.


What Is Sciatica?


Feeling radiating, throbbing pain that runs down to your legs? How about muscle weakness in your thighs, legs, and feet? Does it hurt when moving around or shifting to relieve the pain? You could be suffering from sciatica, and research studies have mentioned that sciatica affects everyone, women, especially during their pregnancy, as it causes radiating leg pain and muscle disabilities in the lower regions of the body. Sciatica has a wide range of pain scales from short, sharp, shooting pain irritating to a burning, searing, throbbing pain that causes numbness and muscle weakness in the legs. Sciatica is usually caused by strenuous activities that require frequent lifting of heavy objects, which can cause the spine to over-twist and bend constantly. Additional information also mentioned that sciatica could be associated with other spinal disorders like spondylolisthesis, herniated discs, or muscle spasms that impact the spinal nerve and pressure it. This pressure causes the sciatic nerve to send pain signals to the brain and allows the inflammatory cytokines to irritate the sciatic nerve. Fortunately, various treatments help alleviate sciatica from causing more harm to the body and alleviate lower back pain and other chronic symptoms that affect the spine.

Non-Surgical Decompression Ft. DRX9000-Video

Feeling numbness and muscle weakness occurring in the back of your legs? How about a wide range of pain that hinders your ability to walk? Do you feel relief after shifting your position so you won’t feel any pain? You may be suffering from sciatica, and treatments like non-surgical decompression therapy can be the answer to alleviating sciatica pain. The video above introduces the DRX9000, a non-surgical decompression machine that utilizes many individuals through gentle traction and helps take the pressure off the sciatic nerve root that is causing sciatica. Decompression therapy allows the beneficial nutrients in the body to help repair the compressed spinal discs that aggravate the nerve roots in the lumbar region of the spine. When people use decompression therapy are part of their wellness treatment, they will feel a difference in their lower back and spine as decompression increases intervertebral disc height and relieve aggravating nerve roots from causing more pain to the body. Suppose you want to learn more about decompression and how it can benefit you in providing relief from sciatica and other spinal issues? This link will explain how decompression offers optimal comfort for many people that suffer from sciatica.

The Various Treatments For Sciatica: Decompression


When sciatica starts to affect the lower half of the body, it can hinder a person’s quality of life. Many people have tried to alleviate the pain by shifting their weight to a more comfortable position, while others go to various treatments that specialize in treating sciatica. One of the multiple treatments is decompression therapy. Research studies have proven that decompression therapy has provided many individuals relief from sciatica by increasing spinal height so the compressed discs that aggravate the sciatic nerve can return to their original form. Decompression therapy can reduce the pain that has been afflicted in the lumbar region and provide disc restoration to the spine. Additional research studies have also mentioned that decompression therapy has even helped reduce pain, disability, and straight leg individuals suffering from sciatica. Decompression uses negative pressure on the lumbar spine. It helps supply the necessary substances like nutrients and oxygen back into the compressed disc and relieves the sciatic nerve’s pain.


Physical Activities

Another form of treatment for sciatica that many individuals can utilize is physical activities. Incorporating light to moderate physical activities that can benefit those with sciatica can provide the relief they are searching for. Research studies have shown that individuals exercising for a while can help reduce the effects of sciatica or even lumbar radicular pain from developing. Exercises like yoga, jogging, and workout plans that focus on the legs and back help strengthen the muscles and spine from developing sciatica. Other research studies have shown that therapeutic exercises have helped support the core while stretching tight muscles like the hamstrings and even transporting beneficial fluids throughout the entire body. This will provide much-needed relief to many suffering individuals hindered by sciatica.



Overall, sciatica happens to everybody; it causes pain in the lower regions of the body. When a compressed spinal disc starts to irritate the sciatic nerve root, it can send radiating, searing pain that travels down the leg. Since the sciatic nerve root is the largest in the peripheral nervous system, it provides sensory and motor functions to the legs, allowing them to move around from place to place. When the spine gets injured and starts to affect the sciatic nerve, sciatica begins to develop, causing leg pain and spinal issues. Incorporating various treatments that help alleviate sciatica provides much-needed relief for many suffering individuals.



Apfel, Christian C, et al. “Restoration of Disk Height through Non-Surgical Spinal Decompression Is Associated with Decreased Discogenic Low Back Pain: A Retrospective Cohort Study.” BMC Musculoskeletal Disorders, BioMed Central, 8 July 2010,

Choi, Jioun, et al. “Influences of Spinal Decompression Therapy and General Traction Therapy on the Pain, Disability, and Straight Leg Raising of Patients with Intervertebral Disc Herniation.” Journal of Physical Therapy Science, The Society of Physical Therapy Science, Feb. 2015,

Davis, David, et al. “Sciatica – Statpearls – NCBI Bookshelf.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 4 Feb. 2022,

Hochschuler, Stephen. “Sciatica Treatment.” Spine, Spine-Health, 5 June 2019,

Koes, B W, et al. “Diagnosis and Treatment of Sciatica.” BMJ (Clinical Research Ed.), BMJ Publishing Group Ltd., 23 June 2007,

Shiri, R, et al. “Leisure-Time Physical Activity and Sciatica: A Systematic Review and Meta-Analysis.” European Journal of Pain (London, England), U.S. National Library of Medicine, Nov. 2016,


Understanding Sciatic Nerve Injury With Decompression

Understanding Sciatic Nerve Injury With Decompression


Throughout the entire body, the nerves that start from the brain in the central nervous system and branch out from the spine, allow the user to feel, sense, and move wherever it is going. These nerve roots allow many of us to send the information that we are experiencing to and forth in the brain. These nerves also help with our motor functions such as walking, sitting, standing, and running in any location that we are currently at.  When unforeseen circumstances like an injury to the body or accidents that start to affect the nerves, it can cause a variety of issues to occur and dampen the quality of life in a person. Fortunately, there are treatments that can help alleviate nerve injuries and reduce the pain that it is causing in each region of the body. Today’s article will look at spinal nerve injury, its symptoms, and how decompression therapy can help individuals that are suffering from sciatic nerve pain. Referring patients to qualified and skilled providers who specialize in spinal decompression therapy. We guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is essential for asking insightful questions to our providers. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer


Can my insurance cover it? Yes, it may. If you are uncertain, here is the link to all the insurance providers we cover. If you have any questions or concerns, please call Dr. Jimenez at 915-850-0900.

G-7 -110 mm HG

What Is Sciatic Nerve Injury?


Do you feel a throbbing, radiating pain that travels from the lower back to the back of the leg? Does the back of your leg feel tender to the touch? Or does it hurt to walk or run, even for a short distance? These symptoms are caused by sciatic nerve pain and can be excruciating for many people. As mentioned in research studies, the sciatic nerve in the body is considered the largest nerve that resides in the lower back and travels down the buttock area to the legs. The sciatic nerve is responsible for the motor function of the legs to move around. When the spine succumbs to injury, the compressed discs between the spinal joints crack and herniate out of the spine, aggravating the sciatic nerve by producing pain signals, known as neuropathy, to the brain and radiating down the leg, causing leg painAdditional studies have found that sciatic neuropathy causes deficits in the sensory and motor function of the legs while also mimicking other neuro- and radiculopathies factors that affect the lower half of the body. When the sciatic nerve root is aggravated on either side of the legs, symptoms like sciatica will develop and cause excruciating pain.


The Symptoms

When the sciatic nerve becomes aggravated, it can lead to sciatica and affect the legs’ motor and sensory functions. Research studies have found that sciatica is often mistaken for any low back or radicular leg pain when the sciatic nerve becomes irritated from a compressed spinal disc. When a person suffers from sciatica, the pain worsens when their bodies do everyday movements, depending on the severity. Additional research has found that symptoms and areas that are affected by sciatic nerve pain can include:

  • Electric shocking-like pain
  • A constant dull ache
  • Muscle weakness in the tighs, legs, and feet muscles
  • Paresthesia
  • Come and go discomfort

All is not lost, though, as treatments can help alleviate sciatic nerve pain and can help restore the compressed spinal discs back to their original functioning state.

Causes Of Sciatic Nerve Pain-Video

Have you started to feel radiating pain that travels down your leg? How about the discomfort that comes and goes when you shift your position? Do the muscles from your legs, thighs, and feet starting to feel weak? You might be experiencing sciatic nerve pain, and decompression therapy is the possible answer that you are looking for. The video explains the causes of sciatic nerve pain and how it affects the functionality of the legs. So by adding decompression therapy as part of your treatment, the sciatic nerve pain will be alleviated as the herniated discs return to the spine and take the pressure off the nerve root. Many individuals suffering from sciatic nerve pain will begin to feel relief in their legs when they go in for decompression therapy. Suppose you want to learn more about decompression and how it can benefit you in providing relief from sciatic nerve pain? This link will explain how decompression offers optimal comfort for sciatic nerve pain.

How Decompression Therapy Can Alleviate Sciatic Nerve Pain


When the sciatic nerve becomes irritated, it can send radiating throbbing pain down from the buttock to the legs. When sciatic nerve pain occurs, treatments like anti-inflammatory medication, physical activities, and chiropractic adjustments can help reduce the pain arising along the sciatic nerve. One of the treatments is spinal decompression. Research has shown that spinal decompression can help take the pressure off the sciatic nerves trapped in the piriformis muscles and relieve the lower half of the body. Decompression therapy uses gentle traction on the spine to pull the compressed spinal discs back into the spine. The pressure from the irritated sciatic nerve is relieved, and the pain signals are diminished.



Overall, the sciatic nerve is the largest in the central nervous system that can become irritated and cause pain in the lower half of the body. This is due to compressed spinal discs pressing on the sciatic nerve that sends throbbing, radiating pain down to the legs. When this happens, treatments like decompression therapy are there to help pull the compressed spinal discs back to the spine gently and relieve the pressure off the sciatic nerve. People that utilize decompression therapy are part of their wellness treatment and will begin to feel relief from leg pain and be able to restore motor function back to the leg muscles.



Davis, David, et al. “Sciatica – Statpearls – NCBI Bookshelf.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 4 Feb. 2022,

Feinberg, Joseph, and Shikha Sethi. “Sciatic Neuropathy: Case Report and Discussion of the Literature on Postoperative Sciatic Neuropathy and Sciatic Nerve Tumors.” HSS Journal : the Musculoskeletal Journal of Hospital for Special Surgery, Springer-Verlag, Sept. 2006,

Guiffre, Brittney A, and Rebecca Jeanmonod. “Anatomy, Sciatic Nerve.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 29 July 2021,

Son, Byung-Chul, et al. “Decompression of the Sciatic Nerve Entrapment Caused by Post-Inflammatory Scarring.” Journal of Korean Neurosurgical Society, The Korean Neurosurgical Society, Feb. 2015,

Yeomans, Steven. “Types of Sciatic Nerve Pain.” Spine, Spine-Health, 7 June 2019,


Disc Bulge & Herniation Chiropractic Care Overview

Disc Bulge & Herniation Chiropractic Care Overview

Disc bulge and disc herniation are some of the most common conditions affecting the spine of both young and middle-aged patients. It is estimated that approximately 2.6% of the US population annually visits a clinician to treat spinal disorders. Roughly $ 7.1 billion alone is lost due to the time away from work.

Disc herniation is when the whole or part of the nucleus pulposus is protruded through the torn or weakened outer annulus fibrosus of the intervertebral disc. This is also known as the slipped disc and frequently occurs in the lower back, sometimes also affecting the cervical region. Herniation of the intervertebral disc is defined as a localized displacement of disc material with 25% or less of the disc circumference on an MRI scan, according to the North American Spine Society 2014. The herniation may consist of nucleus pulposus, annulus fibrosus, apophyseal bone or osteophytes, and the vertebral endplate cartilage in contrast to disc bulge.

There are also mainly two types of disc herniation. Disc protrusion is when a focal or symmetrical extension of the disc comes out of its confines in the intervertebral space. It is situated at the intervertebral disc level, and its outer annular fibers are intact. A disc extrusion is when the intervertebral disc extends above or below the adjacent vertebrae or endplates with a complete annular tear. In this type of disc extrusion, a neck or base is narrower than the dome or the herniation.

A disc bulge is when the outer fibers of the annulus fibrosus are displaced from the margins of the adjacent vertebral bodies. Here, the displacement is more than 25% of the circumference of the intervertebral disc. It also does not extend below or above the margins of the disc because the annulus fibrosus attachment limits it. It differs from disc herniation because it involves less than 25% of the disc’s circumference. Usually, the disc bulge is a gradual process and is broad. The disc bulge can be divided into two types. In a circumferential bulge, the whole disc circumference is involved. More than 90 degrees of the rim is involved asymmetrically in asymmetrical bulging.

Normal Intervertebral Disc Anatomy

Before going into detail about the definition of disc herniation and disc bulge, we need to look at the standard intervertebral disc. According to spine guidelines in 2014, a standard disc is something that has a classic shape without any evidence of degenerative disc changes. Intervertebral discs are responsible for one-third to one-fourth of the height of the spinal column.

One intervertebral disc is about 7 -10 mm thick and measures 4 cm in anterior-posterior diameter in the lumbar region of the spine. These spinal discs are located between two adjacent vertebral bodies. However, no discs can be found between the atlas and axis and the coccyx. About 23 discs are found in the spine, with six in the cervical spine, 12 in the thoracic spine, and only five in the lumbar spine.

Intervertebral discs are made of fibro cartilages, forming a fibrocartilaginous joint. The outer ring of the intervertebral disc is known as the annulus fibrosus, while the inner gel-like structure in the center is known as the nucleus pulposus. The cartilage endplates sandwich the nucleus pulposus superiorly and inferiorly. The annulus fibrosus comprises concentric collagen fiber sheets arranged in a radial tire-like structure into lamellae. The fibers are attached to the vertebral endplates and oriented at different angles. With their cartilaginous part, the endplates anchor the discs in their proper place.

The nucleus pulposus is composed of water, collagen, and proteoglycans. Proteoglycans attract and retain moisture, giving the nucleus pulposus a hydrated gel-like consistency. Interestingly, throughout the day, the amount of water found in the nucleus pulposus varies according to the person’s level of activity. This feature in the intervertebral disc serves as a cushion or a spinal shock-absorbing system to protect the adjacent vertebra, spinal nerves, spinal cord, brain, and other structures against various forces. Although the individual movement of the intervertebral discs is limited, some form of vertebral motion like flexion and extension is still possible due to the features of the intervertebral disc.

Effect of Intervertebral Disc Morphology on Structure and Function

The type of components present in the intervertebral disc and how it is arranged determine the morphology of the intervertebral disc. This is important in how effectively the disc does its function. As the disc is the most important element which bears the load and allows movement in the otherwise rigid spine, the constituents it is made up of have a significant bearing.

The complexity of the lamellae increases with advancing age as a result of the synthetic response of the intervertebral disc cells to the variations in the mechanical load. These changes in lamellae with more bifurcations, interdigitation and irregular size and number of lamellar bands will lead to the altered bearing of weight. This in turn establishes a self-perpetuated disruption cycle leading to the destruction of the intervertebral discs. Once this process is started it is irreversible. As there is an increased number of cells, the amount of nutrition the disc requires is also increasingly changing the normal concentration gradient of both metabolites and nutrients. Due to this increased demand, the cells may also die increasingly by necrosis or apoptosis.

Human intervertebral discs are avascular and hence the nutrients are diffused from the nearby blood vessels in the margin of the disc. The main nutrients; oxygen and glucose reach the cells in the disc through diffusion according to the gradient determined by the rate of transport to the cells through the tissues and the rate of demand. Cells also increasingly produce lactic acid as a metabolic end product. This is also removed via the capillaries and venules back to the circulation.

Since diffusion depends on the distance, the cells lying far from the blood capillaries can have a reduced concentration of nutrients because of the reduced supply. With disease processes, the normally avascular intervertebral disc can become vascular and innervated in degeneration and in disease processes. Although this may increase the oxygen and nutrient supply to the cells in the disc, this can also give rise to many other types of cells that are normally not found in the disc with the introduction of cytokines and growth factors.

The morphology of the intervertebral disc in different parts of the spine also varies although many clinicians base the clinical theories based on the assumption that both cervical and lumbar intervertebral discs have the same structure. The height of the disc was the minimum in the T4-5 level of the thoracic column probably due to the fact that thoracic intervertebral discs are less wedge-shaped than those of cervical and lumbar spinal regions.

From the cranial to caudal direction, the cross-sectional area of the spine increased. Therefore, by the L5-S1 level, the nucleus pulposus was occupying a higher proportion of the intervertebral disc area. The cervical discs have an elliptical shape on cross-section while the thoracic discs had a more circular shape. The lumbar discs also have an elliptical shape though it is more flattened or re-entrant posteriorly.

What is a Disc Bulge?

The bulging disc is when the disc simply bulges outside the intervertebral disc space it normally occupies without the rupture of the outer annulus fibrosus. The bulging area is quite large when compared to a herniated disc. Moreover, in a herniated disc, the annulus fibrosus ruptures or cracks. Although disc bulging is more common than disc herniation, it causes little or no pain to the patient. In contrast, the herniated disc causes a lot of pain.

Causes for Disc Bulging

A bulging disc can be due to several causes. It can occur due to normal age-related changes such as those seen in degenerative disc disease. The aging process can lead to structural and biochemical changes in the intervertebral discs and lead to reduced water content in the nucleus pulposus. These changes can make the patient vulnerable to disc bulges with only minor trauma. Some unhealthy lifestyle habits such as a sedentary lifestyle and smoking can potentiate this process and give rise to more severe changes with the weakening of the disc.

General wear and tear due to repeated microtrauma can also weaken the disc and give rise to disc bulging. This is because when the discs are strained, the normal distribution of weight loading changes. Accumulated micro-trauma over a long period of time can occur in bad posture. Bad posture when sitting, standing, sleeping, and working can increase the pressure in the intervertebral discs.

When a person maintains a forward bending posture, it can lead to overstretching and eventually weakness of the posterior part of the annulus fibrosus. Over time, the intervertebral disc can bulge posteriorly. In occupations that require frequent and repetitive lifting, standing, driving, or bending, the bulging disc may be an occupational hazard. Improper lifting up of items, and improper carrying of heavy objects can also increase the pressure on the spine and lead to disc bulges eventually.

The bulging intervertebral discs usually occur over a long period of time. However, the discs can bulge due to acute trauma too. The unexpected sudden mechanical load can damage the disc resulting in micro-tears. After an accident, the disc can become weakened causing long-term microdamage ultimately leading to bulging of the disc. There may also be a genetic component to the disc bulging. The individual may have a reduced density of elastin in the annulus fibrosus with increased susceptibility to disc diseases. Other environmental facts may also play a part in this disease process.

Symptoms of Disc Bulging

As mentioned previously, bulging discs do not cause pain and even if they do the severity is mild. In the cervical region, the disease will cause pain running down the neck, deep pain in the shoulder region, pain radiating along the upper arm, and forearm up to the fingers.

This may give rise to a diagnostic dilemma as to whether the patient is suffering from a myocardial infarction as the site of referred pain and the radiation is similar. Tingling feeling on the neck may also occur due to the bulging disc.

In the thoracic region, there may be pain in the upper back that radiates to the chest or the upper abdominal region. This may also suggest upper gastrointestinal, lung, or cardiac pathology and hence need to be careful when analyzing these symptoms.

The bulging discs of the lumbar region may present as lower back pain and tingling feeling in the lower back region of the spine. This is the most common site for disc bulges since this area holds the weight of the upper body. The pain or the discomfort can spread through the gluteal area, thighs, and to the feet. There may also be muscle weakness, numbness or tingling sensation. When the disc presses on the spinal cord, the reflexes of both legs can increase leading to spasticity.

Some patients may even have paralysis from the waist down. When the bulging disc compresses on the cauda equine, the bladder and bowel functions can also change. The bulging disc can press on the sciatic nerve leading to sciatica where the pain radiates in one leg from the back down to the feet.

The pain from the bulging disc can get worse during some activities as the bulge can then compress on some of the nerves. Depending on what nerve is affected, the clinical features can also vary.

Diagnosis of Disc Bulging

The diagnosis may not be apparent from clinical history due to similar presentations in more serious problems. But the chronic nature of the disease may give some clues. Complete history and a physical examination need to be done to rule out myocardial infarction, gastritis, gastro-oesophageal reflux disease, and chronic lung pathology.

MRI of Disc Bulge

Investigations are necessary for the diagnosis. X-ray spine is performed to look for gross pathology although it may not show the bulging disc directly. There may be indirect findings of disk degeneration such as osteophytes in the endplates, gas in the disc due to the vacuum phenomenon, and the loss of height of the intervertebral disc. In the case of moderate bulges, it may sometimes appear as non-focal intervertebral disc material that is protruded beyond the borders of the vertebra which is broad-based, circumferential, and symmetrical.

Magnetic resonance imaging or MRI can exquisitely define the anatomy of the intervertebral discs especially the nucleus pulposus and its relationships. The early findings seen on MRI in disc bulging include the loss of normal concavity of the posterior disc. The bulges can be seen as broad-based, circumferential, and symmetrical areas. In moderate bulging, the disc material will protrude beyond the borders of the vertebrae in a non-focal manner. Ct myelogram may also give detailed disc anatomy and may be useful in the diagnosis.

Treatment of Disc Bulging

The treatment for the bulging disc can be conservative, but sometimes surgery is required.

Conservative Treatment

When the disc bulging is asymptomatic, the patient does not need any treatment since it does not pose an increased risk. However, if the patient is symptomatic, the management can be directed at relieving the symptoms. The pain is usually resolved with time. Till then, potent pain killers such as non-steroidal anti-inflammatory drugs like ibuprofen should be prescribed. In unresolved pain, steroid injections can also be given to the affected area and if it still does not work, the lumbar sympathetic block can be tried in most severe cases.

The patient can also be given the option of choosing alternative therapies such as professional massage, physical therapy, ice packs, and heating pads which may alleviate symptoms. Maintaining correct posture, tapes, or braces to support the spine are used with the aid of a physiotherapist. This may fasten the recovery process by avoiding further damage and keeping the damaged or torn fibers in the intervertebral disc without leakage of the fluid portion of the disc. This helps maintain the normal structure of the annulus and may increase the recovery rate. Usually, the painful symptoms which present initially get resolved over time and lead to no pain. However, if the symptoms get worse steadily, the patient may need surgery

If the symptoms are resolved, physiotherapy can be used to strengthen the muscles of the back with the use of exercises. Gradual exercises can be used for the return of function and for preventing recurrences.

Surgical Treatment

When conservative therapy does not work with a few months of treatment, surgical treatment can be considered. Most would prefer minimally invasive surgery which uses advanced technology to correct the intervertebral disc without having to grossly dissect the back. These procedures such as microdiscectomy have a lower recovery period and reduced risk of scar formation, major blood loss, and trauma to adjacent structures when compared to open surgery.

Previously, laminectomy and discectomy have been a mainstay of treatment. However, due to the invasiveness of the procedure and due to increased damage to the nerves these procedures are currently abandoned by many clinicians for disc bulging.

Disc bulging in the thoracic spine is being treated surgically with costotransversectomy where a section of the transverse process is resected to allow access to the intervertebral disc. The spinal cord and spinal nerves are decompressed by using thoracic decompression by removing a part of the vertebral body and making a small opening. The patient may also need a spinal fusion later on if the removed spinal body was significant.

Video-assisted thoracoscopic surgery can also be used where only a small incision is made and the surgeon can perform the surgery with the assistance of the camera. If the surgical procedure involved removing a large portion of the spinal bone and disc material, it may lead to spinal instability. This may need bone grafting to replace the lost portion with plates and screws to hold them in place.

What is a Disc Herniation?

As mentioned in the first section of this article, disc herniation occurs when there is disc material displaces beyond the limits of the intervertebral disc focally. The disc space consists of endplates of the vertebral bodies superiorly and inferiorly while the outer edges of the vertebral apophyses consist of the peripheral margin. The osteophytes are not considered a disc margin. There may be irritation or compression of the nerve roots and dural sac due to the volume of the herniated material leading to pain. When this occurs in the lumbar region, this is classically known as sciatica. This condition has been mentioned since ancient times although a connection between disc herniation and sciatica was made only in the 20th century. Disc herniation is one of the commonest diagnoses seen in the spine due to degenerative changes and is the commonest cause of spinal surgery.

Classifications of Disc Herniation

There are many classifications regarding intervertebral disc herniation. In focal disc herniation, there is a localized displacement of the disc material in the horizontal or axial plane. In this type, only less than 25% of the circumference of the disc is involved. In broad-based disc herniation, about 25 – 50 % of the disc circumference is herniated. The disc bulge is when 50 – 100 % of the disc material is extended beyond the normal confines of the intervertebral space. This is not considered a form of disc herniation. Furthermore, the intervertebral disc deformities associated with severe cases of scoliosis and spondylolisthesis are not classified as a herniation but rather adaptive changes of the contour of the disc due to the adjacent deformity.

Depending on the contour of the displaced material, the herniated discs can be further classified as protrusions and extrusions. In disc protrusion, the distance measured in any plane involving the edges of the disc material beyond intervertebral disc space (the highest measure is taken) is lower than the distance measured in the same plane between the edges of the base.

Imaging can show the disc displacement as a protrusion on the horizontal section and as an extrusion on the sagittal section due to the fact that the posterior longitudinal ligament contains the disc material that is displaced posteriorly. Then the herniation should be considered an extrusion. Sometimes the intervertebral disc herniation can occur in the craniocaudal or vertical direction through a defect in the vertebral body endplates. This type of herniation is known as intravertebral herniation.

The disc protrusion can also be divided into two focal protrusion and broad-based protrusion. In focal protrusion, the herniation is less than 25% of the circumference of the disc whereas, in broad-based protrusion, the herniated disc consists of 25 – 50 % of the circumference of the disc.

In disc extrusion, it is diagnosed if any of the two following criteria are satisfied. The first one is; that the distance measured between the edges of the disc material that is beyond the intervertebral disc space is greater than the distance measured in the same plane between the edges of the base. The second one is; that the material in the intervertebral disc space and material beyond the intervertebral disc space is having a lack continuity.

This can be further characterized as sequestrated which is a subtype of the extruded disc. It is called disc migration when disk material is pushed away from the site of extrusion without considering whether there is continuity of disc or not. This term is useful in interpreting imaging modalities as it is often difficult to show continuity in imaging.

The intervertebral disc herniation can be further classified as contained discs and discs that are unconfined. The term contained disc is used to refer to the integrity of the peripheral annulus fibrosus which is covering the intervertebral disc herniation. When fluid is injected into the intervertebral disc, the fluid does not leak into the vertebral canal in herniations that are contained.

Sometimes there are displaced disc fragments that are characterized as free. However, there should be no continuity between disc material and the fragment and the original intervertebral disc for it to be called a free fragment or a sequestered one. In a migrated disc and in a migrated fragment, there is an extrusion of disc material through the opening in the annulus fibrosus with a displacement of the disc material away from the annulus.

Even though some fragments that are migrated can be sequestered the term migrated means just to the position and it is not referred to the continuity of the disc. The displaced intervertebral disc material can be further described with regard to the posterior longitudinal ligament as submembranous, subcapsular, subligamentous, extra ligamentous, transligamentous, subcapsular, and perforated.

The spinal canal can also get affected by an intervertebral disc herniation. This compromise of the canal can also be classified as mild, moderate, and severe depending on the area that is compromised. If the canal at that section is compromised only less than one third, it is called mild whereas if it is only compromised less than two-thirds and more than one third it is considered moderate. In a severe compromise, more than two-thirds of the spinal canal is affected. For the foraminal involvement, this same grading system can be applied.

The displaced material can be named according to the position that they are in the axial plane from the center to the right lateral region. They are termed as central, right central, right subarticular, right foraminal, and right extraforaminal. The displaced intervertebral disc material’s composition can be further classified as gaseous, liquefied, desiccated, scarred, calcified, ossified, bony, nuclear, and cartilaginous.

Before going into detail on how to diagnose and treat intervertebral disc herniation, let us differentiate how cervical disc herniation differs from lumbar herniation since they are the most common regions to undergo herniation.

Cervical Disc Herniation vs. Thoracic Disc Herniation vs Lumbar Disc Herniation

Lumbar disc herniation is the most commonest type of herniation found in the spine which is approximately 90% of the total. However, cervical disc herniation can also occur in about one-tenth of patients. This difference is mainly due to the fact that the lumbar spine has more pressure due to the increased load. Moreover, it has comparatively large intervertebral disc material. The most common sites of intervertebral disc herniation in the lumbar region are L 5 – 6, in the Cervical region between C7, and in the thoracic region T12.

Cervical disc herniation can occur relatively commonly because the cervical spine acts as a pivoting point for the head and it is a vulnerable area for trauma and therefore prone to damage in the disc. Thoracic disc herniation occurs more infrequently than any of the two. This is due to the fact that thoracic vertebrae are attached to the ribs and the thoracic cage which limits the range of movement in the thoracic spine when compared to the cervical and lumbar spinal discs. However, thoracic intervertebral disc herniation can still occur.

Cervical disc herniation gives rise to neck pain, shoulder pain, pain radiating from the neck to the arm, tingling, etc. Lumbar disc herniation can similarly cause lower back pain as well as pain, tingling, numbness, and muscle weakness seen in the lower limbs. Thoracic disc herniation can give rise to pain in the upper back radiating to the torso.


Although disc herniation can occur in all age groups, it predominantly occurs between the fourth and fifth decade of life with the mean age of 37 years. There have been reports that estimate the prevalence of intervertebral disc herniation to be 2 – 3 % of the general population. It is more commonly seen in men over 35 years with a prevalence of 4.8% and while in women this figure is around 2.5%. Due to its high prevalence, it is considered a worldwide problem as it is also associated with significant disability.

Risk Factors

In most instances, a herniated disc occurs due to the natural aging process in the intervertebral disc. Due to the disc degeneration, the amount of water that was previously seen in the intervertebral disc gets dried out leading to the shrinking of the disc with the narrowing of the intervertebral space. These changes are markedly seen in degenerative disc disease. In addition to these gradual changes due to normal wear and tear, other factors may also contribute to increasing the risk of intervertebral disc herniation.

Being overweight can increase the load on the spine and increase the risk of herniation. A sedentary life can also increase the risk and therefore an active lifestyle is recommended in preventing this condition. Improper posture with prolonged standing, sitting, and especially driving can put a strain on the intervertebral discs due to the additional vibration from the vehicle engine leading to microtrauma and cracks in the disc. The occupations which require constant bending, twisting, pulling and lifting can put a strain on the back. Improper weight lifting techniques are one of the major reasons.

When back muscles are used in lifting heavy objects instead of lifting with the legs and twisting while lifting can make the lumbar discs more vulnerable to herniation. Therefore patients should always be advised to lift weights with their legs and not the back. Smoking has been thought to increase disc herniation by reducing the blood supply to the intervertebral disc leading to degenerative changes of the disc.

Although the above factors are frequently assumed to be the causes for disc herniation, some studies have shown that the difference in risk is very small when this particular population was compared with the control groups of the normal population.

There have been several types of research done on genetic predisposition and intervertebral disc herniation. Some of the genes that are implicated in this disease include vitamin D receptor (VDR) which is a gene that codes for the polypeptides of important collagen called collagen IX (COL9A2).

Another gene called the human aggrecan gene (AGC) is also implicated as it codes for proteoglycans which is the most important structural protein found in the cartilage. It supports the biochemical and mechanical function of the cartilage tissue and hence when this gene is defective, it can predispose an individual to intervertebral disc herniation.

Apart from these, there are many other genes that are being researched due to the association between disc herniation such as matrix metalloproteinase (MMP) cartilage intermediate layer protein, thrombospondin (THBS2), collagen 11A1, carbohydrate sulfotransferase, and asporin (ASPN). They may also be regarded as potential gene markers for lumbar disc disease.

Pathogenesis of Sciatica and Disc Herniation

The sciatic pain originated from the extruded nucleus pulposus inducing various phenomena. It can directly compress the nerve roots leading to ischemia or without it, mechanically stimulate the nerve endings of the outer portion of the fibrous ring and release inflammatory substances suggesting its multifactorial origin. When the disc herniation causes mechanical compression of the nerve roots, the nerve membrane is sensitized to pain and other stimuli due to ischemia. It has been shown that in sensitized and compromised nerve roots, the threshold for neuronal sensitization is around half of that of a normal and non-compromised nerve root.

The inflammatory cell infiltration is different in extruded discs and non-extruded discs. Usually, in non-extruded discs, the inflammation is less. The extruded disc herniation causes the posterior longitudinal ligament to rupture which exposes the herniated part to the vascular bed of the epidural space. It is believed that inflammatory cells are originating from these blood vessels situated in the outermost part of the intervertebral disc.

These cells may help secrete substances that cause inflammation and irritation of the nerve roots causing sciatic pain. Therefore, extruded herniations are more likely to cause pain and clinical impairment than those that are contained. In contained herniations, the mechanical effect is predominant while in the unconfined or the extruded discs the inflammatory effect is predominant.

Clinical Disc Herniation and What to Look for in the History

The symptoms of the disc herniation can vary a great deal depending on the location of the pain, the type of herniation, and the individual. Therefore, history should focus on the analysis of the main complaint among the many other symptoms.

The chief complaint can be neck pain in cervical disc herniation and there can be referred pain in the arms, shoulders, neck, head, face, and even the lower back region. However, it is most commonly referred to as the interscapular region. The radiation of pain can occur according to the level at the herniation is taking place. When the nerve roots of the cervical region are affected and compressed, there can be sensory, and motor changes with changes in the reflexes.

The pain that occurs due to nerve root compression is called radicular pain and it can be described as deep, aching, burning, dull, achy, and electric depending on whether there is mainly motor dysfunction or sensory dysfunction. In the upper limb, the radicular pain can follow a dermatomal or myotomal pattern. Radiculopathy usually does not accompany neck pain. There can be unilateral as well as bilateral symptoms. These symptoms can be aggravated by activities that increase the pressure inside the intervertebral discs such as the Valsalva maneuver and lifting.

Driving can also exacerbate pain due to disc herniation due to stress because of vibration. Some studies have shown that shock loading and stress from vibration can cause a mechanical force to exacerbate small herniations but flexed posture had no influence. Similarly, activities that decrease intradiscal pressure can reduce the symptoms such as lying down.

The main complaint in lumbar disc herniation is lower back pain. Other associated symptoms can be a pain in the thigh, buttocks, and anogenital region which can radiate to the foot and toe. The main nerve affected in this region is the sciatic nerve causing sciatica and its associated symptoms such as intense pain in the buttocks, leg pain, muscle weakness, numbness, impairment of sensation, hot and burning or tingling sensation in the legs, dysfunction of gait, impairment of reflexes, edema, dysesthesia or paresthesia in the lower limbs. However, sciatica can be caused by causes other than herniation such as tumors, infection, or instability which need to be ruled out before arriving at a diagnosis.

The herniated disc can also compress on the femoral nerve and can give rise to symptoms such as numbness, tingling sensation in one or both legs, and a burning sensation in the legs and hips. Usually, the nerve roots that are affected in herniation in the lumbar region are the ones exiting below the intervertebral disc. It is thought that the level of the nerve root irritation determines the distribution of leg pain. In herniations at the third and fourth lumbar vertebral levels, the pain may radiate to the anterior thigh or the groin. In radiculopathy at the level of the fifth lumbar vertebra, the pain may occur in the lateral and anterior thigh region. In herniations at the level of the first sacrum, the pain may occur in the bottom of the foot and the calf. There can also be numbness and tingling sensation occurring in the same area of distribution. The weakness in the muscles may not be able to be recognized if the pain is very severe.

When changing positions the patient is often relieved from pain. Maintaining a supine position with the legs raised can improve the pain. Short pain relief can be brought by having short walks while long walks, standing for prolonged periods, and sitting for extended periods of time such as in driving can worsen the pain.

The lateral disc herniation is seen in foraminal and extraforaminal herniations and they have different clinical features to that of medial disc herniation seen in subarticular and central herniations. The lateral intervertebral disc herniations can when compared to medial herniations more directly irritate and mechanically compress the nerve roots that are exiting and the dorsal root ganglions situated inside the narrowed spinal canal.

Therefore, lateral herniation is seen more frequently in older age with more radicular pain and neurological deficits. There is also more radiating leg pain and intervertebral disc herniations in multiple levels in the lateral groups when compared to medial disc herniations.

The herniated disc in the thoracic region may not present with back pain at all. Instead, there are predominant symptoms due to referred pain in the thorax due to irritation of nerves. There can also be predominant pain in the body that travels to the legs, tingling sensation and numbness in one or both legs, muscle weakness, and spasticity of one or both legs due to exaggerated reflexes.

The clinician should look out for atypical presentations as there could be other differential diagnoses. The onset of symptoms should be inquired about to determine whether the disease is acute, sub-acute, or chronic in onset. Past medical history has to be inquired about in detail to exclude red flag symptoms such as pain that occurs at night without activity which can be seen in pelvic vein compression, and non-mechanical pain which may be seen in tumors or infections.

If there is a progressive neurological deficit, with bowel and bladder involvement is there, it is considered a neurological emergency and urgently investigated because cauda equine syndrome may occur which if untreated, can lead to permanent neurological deficit.

Getting a detailed history is important including the occupation of the patient as some activities in the job may be exacerbating the patient’s symptoms. The patient should be assessed regarding which activities he can and cannot do.

Differential Diagnosis

  • Degenerative disc disease
  • Mechanical pain
  • Myofascial pain leading to sensory disturbances and local or referred pain
  • Hematoma
  • Cyst leading to occasional motor deficits and sensory disturbances
  • Spondylosis or spondylolisthesis
  • Discitis or osteomyelitis
  • Malignancy, neurinoma or mass lesion causing atrophy of thigh muscles, glutei
  • Spinal stenosis is seen mainly in the lumbar region with mild low back pain, motor deficits, and pain in one or both legs.
  • An epidural  abscess can cause symptoms similar to radicular pain involving spinal disc herniation
  • Aortic aneurysm which can cause low back pain and leg pain due to compression can also rupture and lead to hemorrhagic shock.
  • Hodgkin’s lymphoma in advanced stages can lead to space-occupying lesions in the spinal column leading to symptoms like that of intervertebral disc herniation
  • Tumors
  • Pelvic endometriosis
  • Facet hypertrophy
  • Lumbar nerve root schwannoma
  • Herpes zoster infection results in inflammation along with the sciatic or lumbosacral nerve roots

Examination in Disc Herniation

Complete physical examination is necessary to diagnose intervertebral disc herniation and exclude other important differential diagnoses. The range of motion has to be tested but may have a poor correlation with disc herniation as it is mainly reduced in elderly patients with a degenerative disease and due to disease of the joints.

A complete neurological examination is often necessary. This should test muscle weakness and sensory weakness. In order to detect muscle weakness in small toe muscles, the patient can be asked to walk on tiptoe. The strength of muscle can also be tested by comparing the strength to that of the clinician. There may be dermatomal sensory loss suggesting the respective nerve root involvement. The reflexes may be exaggerated or sometimes maybe even absent.

There are many neurologic examination maneuvers described in relation to intervertebral disc herniation such as the Braggart sign, flip the sign, Lasegue rebound sign, Lasegue differential sign, Mendel Bechterew sign, Deyerle sign both legs or Milgram test, and well leg or Fajersztajin test. However, all these are based on testing the sciatic nerve root tension by using the same principles in the straight leg raising test. These tests are used for specific situations to detect subtle differences.

Nearly almost all of them depend on the pain radiating down the leg and if it occurs above the knee it is assumed to be due to a neuronal compressive lesion and if the pain goes below the knee, it is considered to be due to the compression of the sciatic nerve root. For lumbar disc herniation detection, the most sensitive test is considered to be radiating pain occurring down the leg due to provocation.

In the straight leg raising test also called the Lasegue’s sign, the patient stays on his or her back and keeps the legs straight. The clinician then lifts the legs by flexing the hip while keeping the knee straight. The angle at which the patient feels pain going down the leg below the knee is noted. In a normal healthy individual, the patient can flex the hip to 80- 90? without having any pain or difficulty.

However, if the angle is just 30 -70? degrees, it is suggestive of lumbar intervertebral disc herniation at the L4 to S1 nerve root levels. If the angle of hip flexion without pain is less than 30 degrees, it usually indicates some other causes such as tumor of the gluteal region, gluteal abscess, spondylolisthesis, disc extrusion, and protrusion, malingering patient, and acute inflammation of the dura mater. If pain with hip flexion occurs at more than 70 degrees, it may be due to tightness of the muscles such as gluteus maximus and hamstrings, tightness of the capsule of the hip joint, or pathology of sacroiliac or hip joints.

The reverse straight leg raising test or hip extension test can be used to test higher lumbar lesions by stretching the nerve roots of the femoral nerve which is similar to the straight leg raising test. In the cervical spine, in order to detect stenosis of the foramina, the Spurling test is done and is not specific to cervical intervertebral disc herniation or tension of the nerve roots. The Kemp test is the analogous test in the lumbar region to detect foraminal stenosis. Complications due to the disc herniation include careful examination of the hip region, digital rectal examination, and urogenital examination is needed.

Investigation of Disc Herniation

For the diagnosis of intervertebral disc herniation, diagnostic tests such as Magnetic resonance imaging (MRI), Computed tomography (CT), myelography, and plain radiography can be used either alone or in combination with other imaging modalities. Objective detection of disc herniation is important because only after such a finding the surgical intervention is even considered. Serum biochemical tests such as prostate-specific antigen (PSA) level, Alkaline phosphatize value, erythrocyte sedimentation rate (ESR), urine analysis for Bence Jones protein, serum glucose level, and serum protein electrophoresis may also be needed in specific circumstances guided by history.

Magnetic Resonance Imaging (MRI)

MRI is considered the best imaging modality in patients with history and physical examination findings suggestive of lumbar disc herniation associated with radiculopathy according to North American Spinal Society guidelines in 2014. The anatomy of the herniated nucleus pulposus and its associated relationships with soft tissue in the adjacent areas can be delineated exquisitely by MRI in cervical, thoracic, and lumbosacral areas. Beyond the confines of the annulus, the herniated nucleus can be seen as a focal, asymmetric disc material protrusion on MRI.

On sagittal T2 weighted images, the posterior annulus is usually seen as a high signal intensity area due to radial annular tear associated with the herniation of the disc although the herniated nucleus is itself hypointense. The relationship between the herniated nucleus and degenerated facets with the nerve roots which are exiting through the neural foramina are well-demarcated on sagittal images of MRI. Free fragments of the intervertebral disc can also be distinguished from MRI images.

There may be associated signs of intervertebral disc herniation on MRI such as radial tears on the annulus fibrosus which is also a sign of degenerative disc disease. There may be other telling signs such as loss of disc height, bulging annulus, and changes in the endplates. Atypical signs may also be seen with MRI such as abnormal disc locations, and lesions located completely outside the intervertebral disc space.

MRI can detect abnormalities in the intervertebral discs superiorly to other modalities although its bone imaging is a little less inferior. However, there are limitations with MRI in patients with metal implant devices such as pacemakers because the electromagnetic field can lead to abnormal functioning of the pacemakers. In patients with claustrophobia, it may become a problem to go to the narrow canal to be scanned by the MRI machine. Although some units contain open MRI, it has less magnetic power and hence delineates less superior quality imaging.

This is also a problem in children and anxious patients undergoing MRI because good image quality depends on the patient staying still. They may require sedation. The contrast used in MRI which is gadolinium can induce nephrogenic systemic fibrosis in patients who had pre-existing renal disease. MRI is also generally avoided in pregnancy especially during the first 12 weeks although it has not been clinically proven to be hazardous to the fetus. MRI is not very useful when a tumor contains calcium and in distinguishing edema fluid from tumor tissue.

Computed Tomography (CT)

CT scanning is also considered another good method to assess spinal disc herniation when MRI is not available. It is also recommended as a first-line investigation in unstable patients with severe bleeding. CT scanning is superior to myelography although when the two are combined, it is superior both of them. CT scans can show calcification more clearly and sometimes even gas in images. In order to achieve a superior imaging quality, the imaging should be focused on the site of pathology and thin sections taken to better determine the extent of the herniation.

However, a CT scan is difficult to be used in patients who have already undergone laminectomy surgical procedures because the presence of scar tissue and fibrosis causes the identification of the structures difficult although bony changes and deformity in nerve sheath are helpful in making a diagnosis.

The herniated intervertebral discs in the cervical disc can be identified by studying the uncinate process. It is usually projected posteriorly and laterally to the intervertebral discs and superiorly to the vertebral bodies. The uncinate process undergoes sclerosis, and hypertrophy when there is an abnormal relationship between the uncinate process and adjacent structures as seen in degenerative disc disease, intervertebral disc space narrowing, and general wear and tear.

Myelopathy can occur when the spinal canal is affected due to disc disease. Similarly, when neural foramina are involved, radiculopathy occurs. Even small herniated discs and protrusions can cause impingement of the dural sac because the cervical epidural space is narrowed naturally. The intervertebral discs have attenuation a little bit greater than the sac characterized in the CT scan.

In the thoracic region, a CT scan can diagnose an intervertebral disc herniation with ease due to the fact that there is an increased amount of calcium found in the thoracic discs. Lateral to the dural sac, the herniated disc material can be seen on CT as a clearly defined mass that is surrounded by epidural fat. When there is a lack of epidural fat, the disc appears as a higher attenuated mass compared to the surrounding.


Plain radiography is not needed in diagnosing herniation of the intervertebral discs, because plain radiographs cannot detect the disc and therefore are used to exclude other conditions such as tumors, infections, and fractures.

In myelography, there may be deformity or displacement of the extradural contrast-filled thecal sac seen in herniation of the disc. There may also be features in the affected nerve such as edema, elevation, deviation, and amputation of the nerve root seen in the myelography image.


In this imaging modality, the contrast medium is injected into the disc in order to assess the disc morphology. If pain occurs following injection that is similar to the discogenic pain, it suggests that that disc is the source of the pain. When a CT scan is also performed immediately after discography, it is helpful to differentiate the anatomy and pathological changes. However, since it is an invasive procedure, it is indicated only in special circumstances when MRI and CT have failed to reveal the etiology of back pain. It has several side effects such as headache, meningitis, damage to the disc, discitis, intrathecal hemorrhage, and increased pain.

Treatment of Herniated Disc

The treatment should be individualized according to the patient-guided through history, physical examination, and diagnostic investigation findings. In most cases, the patient gradually improves without needing further intervention in about 3 – 4 months. Therefore, the patient only needs conservative therapy during this time period. Because of this reason, there are many ineffective therapies that have emerged by attributing the natural resolution of symptoms to that therapy. Therefore, conservative therapy needs to be evidence-based.

Conservative Therapy

Since the herniation of the disc has a benign course, the aim of treatment is to stimulate the recovery of neurological function, reduce pain, and facilitate early return to work and activities of daily living. The most benefits of the conservative treatment are for younger patients with hernias that are sequestered and in patients with mild neurological deficits due to small disc hernias.

Bed rest has long been considered a treatment option in herniation of the disc. However, it has been shown that bed rest has no effect beyond the first 1 or 2 days. The bed rest is regarded as counterproductive after this period of time.

In order to reduce the pain, oral non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen can be used. This can relieve the pain by reducing inflammation associated with the inflamed nerve. Analgesics such as acetaminophen can also be used although they lack the anti-inflammatory effect seen in NSAIDs. The doses and the drugs should be appropriate for the age and severity of the pain in the patient. If pain is not controlled by the current medication, the clinician has to go one step up on the WHO analgesics ladder. However, the long-term use of NSAIDs and analgesics can lead to gastric ulcers, liver, and kidney problems.

In order to reduce the inflammation, other alternative methods such as applying ice in the initial period and then switching to using heat, gels, and rubs may help with the pain as well as muscle spasms. Oral muscle relaxants can also be used in relieving muscle spasms. Some of the drugs include methocarbamol, carisoprodol, and cyclobenzaprine.

However, they act centrally and cause drowsiness and sedation in patients and it does not act directly to reduce muscle spasm. A short course of oral steroids such as prednisolone for a period of 5 days in a tapering regime can be given to reduce the swelling and inflammation in the nerves. It can provide immediate pain relief within a period of 24 hours.

When the pain is not resolved adequately with maximum effective doses, the patient can be considered for giving steroid injections into the epidural space. The major indication for the steroid injection into periradicular space is discal compression causing radicular pain that is resistant to conventional medical treatment. A careful evaluation with CT or MRI scanning is required to carefully exclude extra discal causes for pain. The contraindications for this therapy include patients with diabetes, pregnancy, and gastric ulcers. Epidural puncture is contraindicated in patients with coagulation disorders and therefore the foraminal approach is used carefully if needed.

This procedure is performed under the guidance of fluoroscopy and involves injecting steroids and an analgesic into the epidural space adjacent to the affected intervertebral disc to reduce the swelling and inflammation of the nerves directly in an outpatient setting. As much as 50% of the patients experience relief after the injection although it is temporary and they might need repeat injections at 2 weekly intervals to achieve the best results. If this treatment modality becomes successful, up to 3 epidural steroidal injections can be given per year.

Physical therapy can help the patient return to his previous life easily although it does not improve the herniated disc. The physical therapist can instruct the patient on how to maintain the correct posture, walking, and lifting techniques depending on the patient’s ability to work, mobility, and flexibility.

Stretching exercises can improve the flexibility of the spine while strengthening exercises can increase the strength of the back muscles. The activities which can aggravate the condition of the herniated disc are instructed to be avoided. Physical therapy makes the transition from intervertebral disc herniation to an active lifestyle smooth. The exercise regimes can be maintained for life to improve general well-being.

The most effective conservative treatment option that is evidence-based is observation and epidural steroid injection for the relief of pain in the short-term duration. However, if the patients so desire they can use holistic therapies of their choice with acupuncture, acupressure, nutritional supplements, and biofeedback although they are not evidence-based. There is also no evidence to justify the use of trans electrical nerve stimulation (TENS) as a pain relief method.

If there is no improvement in the pain after a few months, surgery can be contemplated and the patient must be selected carefully for the best possible outcome.

Surgical Therapy

The aim of surgical therapy is to decompress the nerve roots and relieve the tension. There are several indications for surgical treatment which are as follows.

Absolute indications include cauda equina syndrome or significant paresis. Other relative indications include motor deficits that are greater than grade 3, sciatica that is not responding to at least six months of conservative treatment, sciatica for more than six weeks, or nerve root pain due to foraminal bone stenosis.

There have been many discussions over the past few years regarding whether to treat herniation of intervertebral disc disease with prolonged conservative treatment or early surgical treatment. Much research has been conducted in this regard and most of them show that the final clinical outcome after 2 years is the same although the recovery is faster with early surgery. Therefore, it is suggested that early surgery may be appropriate as it enables the patient to return to work early and thereby is economically feasible.

Some surgeons may still use traditional discectomy although many are using minimally invasive surgical techniques over recent years. Microdiscectomy is considered to be the halfway between the two ends. There are two surgical approaches that are being used. Minimally invasive surgery and percutaneous procedures are the ones that are being used due to their relative advantage. There is no place for the traditional surgical procedure known as a laminectomy.

However, there are some studies suggesting microdiscectomy is more favorable because of its both short-term and long-term advantages. In the short term, there is a reduced length of operation, reduced bleeding, relief of symptoms, and reduced complication rate. This technique has been effective even after 10 years of follow-up and therefore is the most preferred technique even now. The studies that have been performed to compare the minimally invasive technique and microdiscectomy have resulted in different results. Some have failed to establish a significant difference while one randomized control study was able to determine that microdiscectomy was more favorable.

In microdiscectomy, only a small incision is made aided by an operating microscope and the part of the herniated intervertebral disc fragment which is impinging on the nerve is removed by hemilaminectomy. Some part of the bone is also removed to facilitate access to the nerve root and the intervertebral disc. The duration of the hospital stay is minimal with only an overnight stay and observation because the patient can be discharged with minimal soreness and complete relief of the symptoms.

However, some unstable patients may need more prolonged admission and sometimes they may need fusion and arthroplasty. It is estimated that about 80 – 85 % of the patients who undergo microdiscectomy recover successfully and many of them are able to return to their normal occupation in about 6 weeks.

There is a discussion on whether to remove a large portion of the disc fragment and curetting the disc space or to remove only the herniated fragment with minimal invasion of the intervertebral disc space. Many studies have suggested that the aggressive removal of large chunks of the disc could lead to more pain than when conservative therapy is used with 28% versus 11.5 %. It may lead to degenerative disc disease in the long term. However, with conservative therapy, there is a greater risk of recurrence of around 7 % in herniation of the disc. This may require additional surgery such as arthrodesis and arthroplasty to be performed in the future leading to significant distress and economic burden.

In the minimally invasive surgery, the surgeon usually makes a tiny incision in the back to put the dilators with increasing diameter to enlarge the tunnel until it reaches the vertebra. This technique causes lesser trauma to the muscles than when seen in traditional microdiscectomy. Only a small portion of the disc is removed in order to expose the nerve root and the intervertebral disc. Then the surgeon can remove the herniated disc by the use of an endoscope or a microscope.

These minimally invasive surgical techniques have a higher advantage of lower surgical site infections and shorter hospital stays. The disc is centrally decompressed either chemically or enzymatically with the use of chymopapain, laser, or plasma (ionized gas) ablation and vaporization. It can also be decompressed mechanically by using percutaneous lateral decompression or by aspirating and sucking with a shaver such as a nucleosome. Chemopapin was shown to have adverse effects and was eventually withdrawn. Most of the above techniques have shown to be less effective than a placebo. Directed segmentectomy is the one that has shown some promise in being effective similar to microdiscectomy.

In the cervical spine, the herniated intervertebral discs are treated anteriorly. This is because the herniation occurs anteriorly and the manipulation of the cervical cord is not tolerated by the patient. The disc herniation that is due to foraminal stenosis and that is confined to the foramen are the only instances where a posterior approach is contemplated.

The minimal disc excision is an alternative to the anterior cervical spine approach. However, the intervertebral disc stability after the procedure is dependent on the residual disc. The neck pain can be significantly reduced following the procedure due to the removal of neuronal compression although significant impairment can occur with residual axial neck pain. Another intervention for cervical disc herniation includes anterior cervical interbody fusion. It is more suitable for patients with severe myelopathy with degenerative disc disease.

Complications of the Surgery

Although the risk of surgery is very low, complications can still occur. Post-operative infection is one of the commonest complications and therefore needs more vigorous infection control procedures in the theatre and in the ward. During the surgery, due to poor surgical technique, nerve damage can occur. A dural leak may occur when an opening in the lining of the nerve root causes leakage of cerebrospinal fluid which is bathing the nerve roots. The lining can be repaired during the surgery. However, headache can occur due to loss of cerebrospinal fluid but it usually improves with time without any residual damage. If blood around the nerve roots clots after the surgery, that blood clot may lead to compression of the nerve root leading to radicular pain which was experienced by the patient previously. Recurrent herniation of the intervertebral disc due to herniation of disc material at the same site is a devastating complication that can occur long term. This can be managed conservatively but surgery may be necessary ultimately.

Outcomes of the Surgery

There has been extensive research done regarding the outcome of lumbar disc herniation surgery. Generally, the results from the microdiscectomy surgery are good. There is more improvement of leg pain than back pain and therefore this surgery is not recommended for those who have only back pain. Many patients improve clinically over the first week but they may improve over the following several months. Typically, the pain disappears in the initial recovery period and it is followed by an improvement in the strength of the leg. Finally, the improvement of the sensation occurs. However, patients may complain of feeling numbness although there is no pain. The normal activities and work can be resumed over a few weeks after the surgery.

Novel Therapies

Although conservative therapy is the most appropriate therapy in treating patients, the current standard of care does not address the underlying pathology of herniation of the intervertebral discs. There are various pathways that are involved in the pathogenesis such as inflammatory, immune-mediated, and proteolytic pathways.

The role of inflammatory mediators is currently under research and it has led to the development of new therapies that are directed at these inflammatory mediators causing damage to the nerve roots. The cytokines such as TNF ? are mainly involved in regulating these processes. The pain sensitivity is mediated by serotonin receptor antagonists and ?2 adrenergic receptor antagonists.

Therefore, pharmacological therapies that target these receptors and mediators may influence the disease process and lead to a reduction in symptoms. Currently, cytokine antagonists against TNF ? and IL 1? have been tested. Neuronal receptor blockers such as sarpogrelate hydrochloride etc have been tested in both animal models and in clinical studies for the treatment of sciatica. Cell cycle modifiers that target the microglia that are thought to initiate the inflammatory cascade have been tested with the neuroprotective antibiotic minocycline.

There is also research on inhibiting the NF- kB or protein kinase pathway recently. In the future, the treatment of herniation of the intervertebral disc will be much more improved thanks to the ongoing research. (Haro, Hirotaka)


El Paso Chiropractor Near Me

Dr. Alex Jimenez DC, MSACP, RN, CCST


A disc bulge and/or a herniated disc is a health issue that affects the intervertebral discs found in between each vertebra of the spine. Although these can occur as a natural part of degeneration with age, trauma or injury as well as repetitive overuse can also cause a disc bulge or a herniated disc. According to healthcare professionals, a disc bulge and/or a herniated disc is one of the most common health issues affecting the spine. A disc bulge is when the outer fibers of the annulus fibrosus are displaced from the margins of the adjacent vertebral bodies. A herniated disc is when a part of or the whole nucleus pulposus is protruded through the torn or weakened outer annulus fibrosus of the intervertebral disc. Treatment of these health issues focuses on reducing symptoms. Alternative treatment options, such as chiropractic care and/or physical therapy, can help relieve symptoms. Surgery may be utilized in cases of severe symptoms. – Dr. Alex Jimenez D.C., C.C.S.T. Insight

Curated by Dr. Alex Jimenez D.C., C.C.S.T.



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