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.
The spine is made of bones called vertebrae, with the spinal cord running through the spinal canal in the center. The cord is made up of nerves. These nerve roots split from the cord and travel between the vertebrae into various areas of the body. When these nerve roots become pinched or damaged, the symptoms that follow are known as, radiculopathy. El Paso, TX. Chiropractor, Dr. Alexander Jimenez breaks down�radiculopathies,�along with their causes, symptoms and treatment.
The entire length of the spine, at each level, nerves exit through holes in the bone of the spine (foramen) on each side of the spinal column. These nerves are called nerve roots, or radicular nerves and�branch out from the spine and supply different parts of the body.
Nerves exiting the cervical spine travel down through the arms, hands, and fingers. This is where neck problems affecting a cervical nerve root can cause pain, as well as, other symptoms through the arms and hands, one form of (radiculopathy). Another is low back problems that affect a lumbar nerve root. This can radiate through the leg and into the foot, another form of (radiculopathy, or sciatica), which creates leg pain and/or foot pain.
The spinal cord does not go into the lumbar spine and because the spinal canal has space in the lower back, problems in the lumbosacral region often cause nerve root problems and not a spinal cord injury. Serious conditions i.e. disc herniation or fracture in the lower back are also not likely to cause permanent loss of motor function in the legs.
Cervical Spine – This nerve root is named according to the Lower spinal segment that the nerve root runs between.�
Example – The nerve at C5-C6 level is called the C6 nerve root.
It’s named like this because as it exits the spine, it passes Over the C6 pedicle (a piece of bone part of the spinal segment).
Lumbar Spine – These nerve roots are named according to the Upper spinal segment that the nerve runs between.
Example – The nerve at L4-L5 level is called the L4 nerve root.
The nerve root is named this way because as it exits the spine it passes Under the L4 pedicle.
Two Nerve Roots
Two nerves cross each disc level
Only one exits�the spine (through the foramen) at that level.
Exiting Nerve Root –�This is the nerve root exiting the spine at a certain level.
Example: L4 nerve root exits the spine at L4-L5 level.
Traversing Nerve Root –�This nerve root goes across the disc and exits the spine at the level below.
Example: L5 nerve is the traversing nerve root at L4-L5 level, and is the exiting nerve root at L5-S1 level.
There is some confusion when a nerve root is compressed by disc herniation or other cause to refer both to the intervertebral level (where the disc is) and to the nerve root that is affected. This depends on where the disc herniation or protrusion is happening. It could impinge upon either the exiting nerve�or the traversing nerve.
If The Traversing Nerve Is Affected
Lumbar Radiculopathy
In the lumbar spine, there is a weak area in the disc space right in front of the traversing nerve root, so lumbar discs tend to herniate or leak out and impinge on the traversing nerve.
If The Exiting Nerve Is Affected
Cervical Radiculopathy
The opposite is true in the neck. In the cervical spine, the disc tends to herniate to the side, rather than toward the back and the side. If the disc material herniates to the side, it will compress or impinge the exiting nerve root.
Radiculopathy & Sciatica
Nerve root goes by another name Radicular Nerve, and when a herniated or prolapsed disc presses on a radicular nerve, this is referred to as a radiculopathy. A medical physician might say there is herniated disc at L4-L5, which creates an L5 radiculopathy or an L4 radiculopathy. It all depends on where the disc herniation occurs (the side or the back of the disc) and which nerve is affected. And the term for radiculopathy in the low back is the ever famous Sciatica.
Radiculopathy
A pinched nerve can occur at different areas of the spine (cervical, thoracic or lumbar).
Common causes are narrowing of the hole where the� nerve roots exit, which can result from stenosis, bone spurs, disc herniation and other conditions.
Symptoms vary but often include pain, weakness, numbness and tingling.
Symptoms can be managed with nonsurgical treatment, but minimal surgery can also help.
Prevalence & Pathogenesis
A herniated disc can be defined as herniation of the nucleus pulposus through the fibers of the annulus fibrosus.
Most disc ruptures occur during the third and fourth decades of life while the nucleus pulposus is still gelatinous.
The most likely time of day associated with increased force on the disc is the morning.
In the lumbar region, perforations usually arise through a defect just lateral to the posterior midline, where the posterior longitudinal ligament is weakest.
Epidemology
Lumbar Spine:
Symptomatic lumbar disc herniation occurs during the lifetime of approximately 2% of the general population.
Approximately 80% of the population will experience significant back pain during the course of a herniated disc.
The groups at greatest risk for herniation of intervertebral discs are younger individuals (mean age of 35 years)
True sciatica actually develops in only 35% of patients with disc herniation.
Not infrequently, sciatica develops 6 to 10 years after the onset of low back pain.
The period of localized back pain may correspond to repeated damage to annular fibers that irritates the sinuvertebral nerve but does not result in disc herniation.
Epidemology
Cervical Spine:
The average annual incidence of cervical radiculopathies is less than 0.1 per 1000 individuals.
Pure soft disc herniations are less common than hard disc abnormalities (spondylosis) as a cause of radicular arm pain.
In a study of 395 patients with nerve root abnormalities, radiculopathies occurred in the cervical and lumbar spine in 93 (24%) and 302 (76%), respectively.
Pathogenesis
Alterations in intervertebral disc biomechanics and biochemistry over time have a detrimental effect on disc function.
The disc is less able to work as a spacer between vertebral bodies or as a universal joint.
Pathogenesis – LUMBAR SPINE
The two most common levels for disc herniation are L4-L5 and L5-S1, which account for 98% of lesions; pathology can occur at L2-L3 and L3-L4 but is relatively uncommon.
Overall, 90% of disc herniations are at the L4-L5 and L5-S1 levels.
Disc herniations at L5-S1 will usually compromise the first sacral nerve root, a lesion at the L4-L5 level will most often compress the fifth lumbar root, and herniation at L3-L4 more frequently involves the fourth lumbar root.
Disc herniation may also develop in older patients.
Disc tissue that causes compression in elderly patients is composed of the annulus fibrosus and and portions of the cartilaginous endplate (hard disc.)
The cartilage is avulsed from the vertebral body.
Resolution of some of the compressive effects on neural structures requires resorption of the nucleus pulposus.
Disc resorption is part of the natural healing process associated with disc herniation.
The enhanced ability to resorb discs has the potential for resolving clinical symptoms more rapidly.
Resorption of herniated disc material is associated with a marked increase in infiltrating macrophages and the production of matrix metalloproteinases (MMPs) 3 and 7.
Nerlich and associates identified the origins of phagocytic cells in degenerated intervertebral discs.
The investigation identified cells that are transformed local cells rather than invaded macrophages.
Degenerative discs contain the cells that add to their continued dissolution.
Pathogenesis – CERVICAL SPINE
In the early 1940s, a number of reports appeared in which cervical intervertebral disc herniation with radiculopathies was described.
There is a direct correlation between the anatomy of the cervical spine and the location and pathophysiology of disc lesion.
The eight cervical nerve roots exit via intervertebral foramina that are bordered anteromedially by the intervertebral disc and posterolaterally by the zygapophyseal joint.
The foramina are largest at C2-C3 and decrease in size until C6-C7.
The nerve root occupies 25% to 33% of the volume of the foramen.
The C1 root exits between the occiput and the atlas (C1)
All lower roots exit above their corresponding cervical vertebrae (the C6 root at the C5-C6 interspace), except C8, which exits between C7 and T1.
A differential growth rate affects the relationship of the spinal cord and nerve roots and the cervical spine.
Most acute disc herniations occur posterolaterally and in patients around the forth decade of life, when the nucleus is still gelatinous.
The most common areas of disc herniations are C6-C7 and C5-C6.
C7-T1 and C3-C4 disc herniations are infrequent ( less than 15 %).
Disc herniation of C2-C3 is rare.
Patients with upper cervical disc protrusions in the C2-C3 region have symptoms that include suboccipital pain, loss of hand dexterity, and paresthesias over the face and unilateral arm.
Unlike lumbar herniated discs, cervical herniated discs may cause myelopathy in addition to radicular pain because of the anatomy of the spinal cord in the cervical region.
The uncovertebral prominences play a role in the location of ruptured discs material.
The uncovertebral joint tends to guide extruded disc material medially, where cord compression may also occur.
Disc herniations usually affect the nerve root numbered most caudally for the given disc level; for example, the C3 � C4 disc affects the fourth cervical nerve root; C4- C5, the fifth cervical nerve root; C5 � C6, the sixth cervical nerve root; C6 � C7, the seventh cervical nerve root; and C7 � T1, the eighth cervical nerve root.
Not every herniated disc is symptomatic.
The development of symptoms depends on the reserve capacity of the spinal canal, the presence of inflammation, the size of the herniation, and the presence of concomitant disease such as osteophyte formation.
In disc rupture, protrusion of nuclear material results in tension on the annular fibers and compress?on of the dura or nerve root causing pain.
Also important is the smaller size of the sagittal diameter, the bony cervical spinal canal.
Individuals in whom a cervical herniated disc causes motor dysfunction have a complication of cervical disc herniation if the spinal canal is stenotic.
Clinical History – LUMBAR SPINE
Clinically, the patient�s major complaint is a sharp, lancinating pain.
In many cases there may be a previous history of intermittent episodes of localized low back pain.
The pain not only in the back but also radiates down the leg in the anatomic distribution of the affected nerve root.
It will usually be described as deep and sharp and progressing from above downward in the involved leg.
Its onset may be insidious or sudden and associated with a tearing or snapping sensations of the spine.
Occasionally, when sciatica develops, the back pain may resolve because once the annulus has ruptured, it may no longer be under tension.
Disc herniation occurs with sudden physical effort when the trunk is flexed or rotated.
On occasion, patients with L4-L5 disc herniation have groin pain. In a study of 512 lumbar disc patients, 4.1% had groin pain.
Finally, the sciatica may vary in intensity; it may be so severe that patients will be unable to ambulate and they will feel that their back is “locked”.
On the other hand, the pain may be limited to a dull ache that increases in intensity with ambulation.
Pain is worsened in the flexed position and relieved by extension of the lumbar spine.
Characteristically, patients with herniated discs have increased pain with sitting, driving, walking, couching, sneezing, or straining.
Clinical History – CERVICAL SPINE
Arm pain, not neck pain, is the patient� s major complaint.
The pain is often perceived as starting in the neck area and then radiating from this point down to shoulder, arm and forearm and usually into the hand.
The onset of the radicular pain is often gradual, although it can be sudden and occur in association with a tearing or snapping sensation.
As time passes, the magnitude of the arm pain clearly exceeds that of the neck or shoulder pain.
The arm pain may also be variable in intensity and preclude any use of the arm; it may range from severe pain to a dull, cramping ache in the arm muscles.
The pain is usually severe enough to awaken the patient at night.
Additionally, a patient may complain of associated headaches as well as muscle spasm, which can radiate from the cervical spine to below the scapulae.
The pain may also radiate to the chest and mimic angina (pseudoangina) or to the breast.
Symptoms such as back pain, leg pain, leg weakness, gait disturbance, or incontinence suggest compression of the spinal cord (Myelopathy).
Physical Examination – LUMBAR SPINE
Physical examination will demonstrated a decrease in range of motion of the lumbosacral spine, and patients may list to one side as they try to bend forward.
The side of the disc herniation typically corresponds to the location of the scoliotic list.
However, the specific level or degree of herniation does not correlate with the degree of list.
On ambulation, patients walk with an antalgic gait in which they hold the involved leg flexed so that they put as little weight as possible on the extremity.
Neurologic Examination:
The neurologic examination is very important and may yield objective evidence of nerve root compression (We should evaluate of reflex testing, muscle power, and sensation examination of the patient).
In addition, a nerve deficit may have little temporal relevance because it may be related to a previous attack at a different level.
Compression of individual spinal nerve roots results in alterations in motor, sensory, and reflex function.
When the first sacral root is compressed, the patient may have gastrocnemius-soleus weakness and be unable to repeatedly raise up on the toes of that foot.
Atrophy of the calf may be apperent, and the ankle (Achilles) reflex is often diminished or absent.
Sensory loss, if present, is usually confined to the posterior aspect of the calf and the lateral side of the foot.
Involvement of the fifth lumbar nerve root can lead to weakness in extension of the great toe and, in a few cases, weakness of the everters and dorsiflexors of the foot.
A sensory deficit can appear over the anterior of the leg and the dorsomedial aspect of the foot down to the big toe
With compression of the fourth lumbar nerve root, the quadriceps muscle is affected; the patient may note weakness in knee extension, which is often associated with instability.
Atrophy of the thigh musculature can be marked. Sensory loss may be apparent over the anteromedial aspect of the thigh, and the patellar tendon reflex can be diminished.
Nerve root sensitivity can be elicited by any method that creates tension.
The straight leg-raising (SLR)test is the one most commonly used.
This test is performed with the patient supine.
Physical Examination – CERVICAL SPINE
Neurologic Examination:
A neurologic examination that shows abnormalities is the most helpful aspect of the diagnostic work-up, although the examination may remain normal despite a chronic radicular pattern.
The presence of atrophy helps document the location of the lesion, as well as its chronicity.
The presence of subjective sensory changes is often difficult to interpret and requires a coherent and cooperative patient to be of clinical value.
When the third cervical root is compressed, no reflex change and motor weakness can be identified.
The pain radiates to the back of the neck and toward the mastoid process and pinna of the ear.
Involvement of the fourth cervical nerve root leads to no readily detectable reflex changes or motor weakness.
The pain radiates to the back of the neck and superior aspect of the scapula.
Occasionally, the pain radiates to the anterior chest wall.
The pain is often exacerbated by neck extension.
Unlike the third and the fourth cervical nerve roots, the fifth through eighth cervical nerve roots have motor functions.
Compression of the fifth cervical nerve root is characterized by weakness of shoulder abduction, usually above 90 degree, and weakness of shoulder extension.
The biceps reflexes are often depressed and the pain radiates from the side of the neck to the top of the shoulder.
Decreased sensation is often noted in the lateral aspect of the deltoid, which represents the autonomous area of the axillary nerve.
Involvement of the sixth cervical nerve root produces biceps muscles weakness as well as diminished brachioradial reflex.
The pain again radiates from the neck down the lateral aspect of the arm and forearm to the radial side of hand (index finger, long finger, and thumb).
Numbness occurs occasionally in the tip of the index finger, the autonomous area of the sixth cervical nerve root.
Compression of the seventh cervical nerve root produces reflex changes in the triceps jerk test with associated loss of strength in the triceps muscles, which extend the elbow.
The pain from this lesion radiates from the lateral aspect of the neck down the middle of the area to the middle finger.
Sensory changes occur often in the tip of the middle finger, the autonomous area for the seventh nerve.
Patients should also be tested for scapular winging, which may occur with C6 or C7 radiculopathies.
Finally, involvement of the eighth cervical nerve root by a herniated C7-T1 disc produces significant weakness of the intrinsic musculature of the hand.
Such involvement can lead to rapid atrophy of the interosseous muscles because of the small size of these muscles.
Loss of the interossei leads to significant loss of fine hand motion.
No reflexes are easily found, although the flexor carpi ulnaris reflex may be decreased.
The radicular pain from the eighth cervical nerve root radiates to the ulnar border the hand and the ring and little fingers.
The tip of the little finger often demonstrates diminished sensation.
Radicular pain secondary to a herniated cervical disc may be relieved by abduction of the affected arm.
Although these signs are helpful when present, their absence alone does not rule out a nerve root lesion.
Laboratory Data
Medical screening laboratory test (blood counts, chemistry panels erythrocyte sedimentation rate [ESR]) are normal in patients with a herniated disc.
Electro diagnostic Testing
Electromyography(EMG)is an electronic extension of the physical examination.
The primary use of EMG is to diagnose radiculopathies in cases of questionable neurologic origin.
EMG findings may be positive in patients with nerve root impingement.
Radiographic Evaluation – LUMBAR SPINE
Plain x-rays may be entirely normal in a patient with signs and symptoms of nerve root impingement.
Computed Tomography
Radigraphic evaluation by CT scan may demonstrate disc bulging but may not correlate with the level of nerve damage.
Magnetic Resonance Imaging
MR imaging also allows visualization of soft tissues, including discs in the lumbar spine.
Herniated discs are easily detected with MR evaluation.
MR imaging is a sensitive technique for the detection of far lateral and anterior disc herniations.
Radiographic Evaluation – CERVICAL SPINE
X-rays
Plain x-rays may be entirely normal in patients wit han acute herniated cervical disc.
Conversely,�70% of asymptomatic women and 95% of asymptomatic men between the ages of 60 and 65 years have evidence of degenerative disc disease on plain roentgenograms.
Views to be obtained include anteroposterior, lateral, flexion, and extension.
Computed Tomography
CT permits direct visualization of compression of neural structures and is therefore more precise than myelography.
Advantages of CT over myelography include better visualization of lateral abnormalities such as foraminal stenosis and abnormalities caudal to the myelographic block, less radiation exposure, and no hospitalization.
Magnetic Resonance
MRI allows excellent visualization of soft tissues, including herniated discs in the cervical spine.
The test is noninvasive.
In a study of 34 patients with cervical lesions, MRI predicted 88% of the surgically proven lesions versus 81% for myelography-CT, 58% for myelography, and 50% for CT alone.
Differential Diagnosis – LUMBAR SPINE
The initial diagnosis of a herniated disc is ordinarily made on the basis of the history and physical examination.
Plain radiographs of the lumbosacral spine will rarely add to the diagnosis but should be obtained to help rule out other causes of pain such as infection or tumor.
Other tests such as MR, CT, and myelography are confirmatory by nature and can be misleading when used as screening tests.
Spinal Stenosis
Patient with spinal stenosis may also suffer from back pain that radiates to the lower extremities.
Patients with spinal stenosis tend to be older than those in whom herniated discs develop.
Characteristically, patients with spinal stenosis experience lower extremity pain (pseudoclaudication=neurogenic claudication) after walking for an unspecified distance.
They also complain of pain that is exacerbated by standing or extending the spine.
Radiographic evaluation is usually helpful in differentiating individuals with disc herniation from those with bony hypertrophy associated with spinal stenosis.
In a study of 1,293 patients, lateral spinal stenosis and herniated intervertebral discs coexisted in 17.7% of individuals.
Radicular pain may be caused by more than one pathologic process in an individual.
Facet Syndrome
Facet syndrome is another cause of low back pain that may be associated with radiation of pain to structures outside the confines of the lumbosacral spine.
Degeneration of articular structures in the facet joint causes pain to develop.
In most circumstances, the pain is localized over the area of the affected joint and is aggravated by extension of the spine (standing).
A deep , ill-defined, aching discomfort may also be noted in the sacroiliac joint, the buttocks, and the legs.
The areas of sclerotome affected show the same embryonic origin as the degenerated facet joint.
Patients with pain secondary to facet joint disease may have relief of symptoms with apophyseal injection of a long-acting local anesthetic.
The true role of facet joint disease in the production of back and leg pain remains to be determined.
Other mechanical causes of sciatica include congentenial abnormalites of the lumbar nerve roots, external compression of the sciatic nerve (wallet in a back pants pocket), and muscular compression of the nerve (piriformis syndrome).
In rare circumstances, cervical or thoracic lesion should be considered if the lumbar spine is clear of abnormalities.
Medical causes of sciatica (neural tumors or infections, for example) are usually associated with systemic symptoms in addition to nerve pain in a sciatic distribution.
Differential Diagnosis – CERVICAL SPINE
No diagnostic criteria exist for the clinical diagnosis of a herniated cervical disc.
The provisional diagnosis of a herniated cervical disc is made by the history and physical examination.
The plain x-ray is usually nondiagnostic, although occasionally disc space narrowing at the suspected interspace or foraminal narrowing on oblique films is seen.
The value of x-rays is to exclude other causes of neck and arm pain, such as infection and tumor.
MR imaging and CT-myelography are the best confirmatory examinations for disc herniation.
Cervical disc herniations may affect structures other than nerve roots.
Disc herniation may cause vessel compression (vertebral artery) associated with vertebrobasilar artery insufficiency and be manifested as blurred vision and dizziness.
Other mechanical causes of arm pain should be excluded.
The most common is some form of compression on a peripheral nerve.
Such compression can occur at the elbow, forearm, or wrist. An example is compression of the median nerve by the carpal ligament leading to carpal tunnel syndrome.
The best diagnostic test to rule out these peripheral neuropathies is EMG.
Excessive traction on the arm secondary to heavy weights may cause radicular pain without disc compression of nerve roots.
Spinal cord abnormalities must be considered if signs of myelopathy are present in conjunction with radiculopathies.
Spinal cord lesions such as syringomyelia are identified by MRI, and motor neuron disease is identified by EMG.
Multiple sclerosis should be considered in a patient with radiculopathies if the physical signs indicate lesions above the foramen magnum (optic neuritis).
In very rare circumstances, lesions of the parietal lobe corresponding to the arm can mimic the findings of cervical radiculopathies.
Unfortunately, there are no stretches for� Root canals or Kidney stones. But there are stretches for Piriformis syndrome.
These ailments are painful and no fun! Piriformis syndrome�is especially a pain, in the butt, no pun intended.
Seriously, people suffering from Piriformis syndrome have frequent and sometimes severe pain and numbness through the buttocks and down their legs. This occurs when the Piriformis muscle spasms. When this happens, it�can end up also aggravating the sciatic nerve, which compounds the pain with tingling and numbness.
The Piriformis�is a short, small�muscle deep inside our hips, and helps rotate our legs both outward and inward. Because of its proximity to the sciatic nerve, this little body part can cause big problems, and hinder our ability to run, or even walk, through our daily activities with ease.
Fortunately, there are a variety of exercises that help stretch and relax the Piriformis muscle, giving sufferers much-needed relief from the pain and numbness it causes. If you are dealing with Piriformis syndrome, try these stretches to get yourself back on your feet and moving, pain-free.
Stretches
The “Knee Up” Stretch
Lie on the floor, use a mat or thick rug for comfort, on your back. Stretch both legs out, with your arms to your sides.�Bend one of your legs at the knee and use your hand to pull it toward the opposite shoulder Hold for ten to thirty seconds.�Straighten out that leg, and then do the same motion with the opposite leg and shoulder.
The “Cross Arm” Stretch
Arrange yourself in a sitting position. The bottoms of your feet should be touching each other, with your arms crossed and your hands resting on the opposite leg. Push both knees down toward the floor until you feel the stretch inside your thighs. Hold the position for a count of 30, then relax for a few seconds and repeat up to five more times.
The “Standing” Stretch
This is a handy exercise you can do in the bathroom at work, in a hotel, or anywhere that you would rather not lie on the floor.
Begin in a standing position with both feet flat on the floor, with your feet a shoulder-length apart.��Don’t lock your knees, and keep your back straight.�Lift one knee up and grasp it with both hands. Make sure you keep the knee parallel to the corresponding hip. Use your hands to pull your knee toward the opposite shoulder until you feel a pull along the side of your buttocks. Hold up to one minute, or as long as you can balance. Repeat the action with the other leg. Try to do it three times for each leg.
The “Sit and Bend” Stretch
This is another convenient�exercise that doesn’t require getting on the floor. Choose a solid, straight-backed chair that doesn’t roll,�sit, and bring one leg across the other, resting your ankle on your other leg. Slowly lean forward until you feel a pull along the crossed leg. Hold for up to 30 seconds. Repeat with the other leg, stretching each side 3 times.
Remember that consistency is key. Perform these exercises at least once a day, every day, until your pain and numbness is gone.
These four simple exercises�help you make great strides in recovering from Piriformis syndrome. However, if you perform these for several days and still have pain, or experience pain while attempting the stretches, it is a good idea to make an appointment with a professional chiropractor. He or she will be able to evaluate your condition and offer a comprehensive treatment plan to treat the Piriformis so it doesn’t get worse, or cause additional issues with your sciatic nerve.
Truide Torres recibi� atenci�n quiropr�ctica con la Dra. Alex Jim�nez debido al dolor que experiment� a lo largo de su espalda baja, caderas y piernas. Ella fue diagnosticada con dolor en el nervio ci�tico, com�nmente conocida como ci�tica. La ci�tica puede ocurrir cuando los discos intervertebrales, que se encuentran a lo largo de la columna vertebral, comprimen o afectan el nervio ci�tico en la parte inferior de la espalda. Truide Torres experiment� un alivio tremendo de sus s�ntomas una vez que recibi� atenci�n quiropr�ctica con la Dra. Alex Jimenez y pudo regresar a sus actividades cotidianas. Truide Torres recomienda altamente la atenci�n quiropr�ctica para el dolor del nervio ci�tico.
Tratamiento de Ci�tica
Los doctores en Quiropr�ctica (DC) regularmente tratan la ci�tica. La ci�tica se caracteriza por un dolor que se origina en la parte inferior de la espalda o las nalgas, que se desplaza hacia una o ambas piernas. El dolor del nervio ci�tico var�a en intensidad y frecuencia. La ci�tica generalmente es provocada por la compresi�n del nervio ci�tico. Los trastornos conocidos por causar ci�tica incluyen subluxaciones de la columna lumbar (cuerpos vertebrales desalineados), discos herniados o abultados (discos deslizados), embarazo y parto, tumores y dolencias no espinales como diabetes, estre�imiento o estar sentado en el bolsillo trasero. El dolor a menudo es sordo, doloroso, agudo, como un diente, alfileres y agujas o similar a las descargas el�ctricas. Otros s�ntomas relacionados con la ci�tica incluyen sensaci�n de ardor, entumecimiento y hormigueo.tor.
Tenemos la bendici�n de presentarle la Cl�nica Premier de bienestar y lesiones de El Paso.
Como Cl�nica de Rehabilitaci�n Quiropr�ctica y Centro de Medicina Integrada de El Paso, nos enfocamos apasionadamente en tratar pacientes despu�s de lesiones frustrantes y s�ndromes de dolor cr�nico. Nos enfocamos en mejorar su capacidad a trav�s de programas de flexibilidad, movilidad y agilidad dise�ados para todos los grupos de edad y discapacidades.
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Chiropractor Near Me: Due to his previous back injury history, George Lara suffered a recent back injury which he was unfortunately unable to recover from through traditional treatment. That’s when the VA recommended him to seek chiropractic care with Dr. Alex Jimenez, ultimately changing his quality of life. George Lara had degenerative disc disease, or DDD, and sciatic nerve pain before receiving treatment with Dr. Alex Jimenez. George Lara describes how much his life has improved with chiropractic care and he’s grateful of the services and care he received. George Lara recommends Dr. Alex Jimenez as the non-surgical choice for back pain, among other spine health issues.
Chiropractor Near Me
Chiropractic care is a means to diagnose and treat health problems that affect the nerves, muscles, bones, and joints of the body. A healthcare provider who supplies chiropractic care is known as a chiropractor. Adjustment of the spine, known as manipulation, is the basis of care. Chiropractors also use other kinds of treatments. Your physician will ask about your goals for your health history and therapy. It’s important to inform your physician about any physical problems you may have which make it difficult for you to do particular things.
We are blessed to present to you�El Paso�s Premier Wellness & Injury Care Clinic.
As El Paso�s Chiropractic Rehabilitation Clinic & Integrated Medicine Center,�we passionately are focused treating patients after frustrating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility and agility programs tailored for all age groups and disabilities.
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Mr. and Mrs. Dominguez first received chiropractic care with Dr. Alex Jimenez after suffering automobile accident injuries. Martha Dominguez expresses how much their quality of life has changed since receiving chiropractic treatment and physical rehabilitation with Dr. Jimenez along with the trainers and staff at Push. Mr. and Mrs. Domingues are grateful for the services they’ve received for their automobile accident injuries and their sciatica pain.
Sciatica Pain Treatment And Chiropractic Care
Chiropractic care can help alleviate automobile accident injuries. Moreover, chiropractic care is totally non-invasive and drug-free, so there are fewer dangers involved with this holistic treatment. Furthermore, chiropractic techniques concentrate on treating the pain at its source, rather than masking it with prescription painkillers. Chiropractors will begin with an evaluation and appointment. From that point, they can perform a physical evaluation and run any required diagnostics to confirm the identification of the diagnosis. The chiropractor will then work on developing a customized treatment program with the patient’s needs and lifestyle in mind.
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Low back pain occurs due to a variety of causes, which is why it is often poorly diagnosed and treated. As there are many mechanisms by which lower back pain happens, such as trauma, overuse from weight lifting for example, and repetitive motion, it’s important to mention that this article will only focus on sciatic nerve pain, or sciatica.
Sciatica refers to pain and other symptoms which radiate or travel down the leg, associated with numbness, tingling or burning sensations, and weakness in one or both lower extremities. Many patients complain of sharp, intense pain and discomfort when sitting and driving, affecting their capacity to bear weight properly when one has to walk or move. Their pain can shoot down the length of the sciatic nerve, into the buttocks, down the back of the leg, into the calf, and lastly, into the ankle and foot. The sciatic nerve, which is the longest nerve in the body, can become compressed or entrapped by certain muscles leading to sciatica.
Based on the location of this impingement, the individual will present with a variety of symptoms. If the health issue is diagnosed to originate in the low back, then the problem normally occurs around the hole in which the nerve exits the spine, resulting in symptoms surrounding the entire lower extremity. If the health issue is correctly diagnosed to originate from the buttocks, it most often includes the piriformis muscle because the sciatic nerve travels beneath it as it makes its way down the length of the leg. The source of this type of sciatica may involve different muscles just below the piriformis, otherwise known as a group of muscles called the hip rotators.
If the health issue is not in the lower back, or buttocks, then the problem is very likely to have occurred in the hamstrings, primarily at one of the muscles where the plantar nerve divides the hamstrings at the back of the thigh. The sciatic nerve may also manifest symptoms when compressed in the calf, however, these symptoms will often only be reported below the knee.
ART and PNF Treatment for Sciatic Nerve Pain
In regards to treatment, sciatica can be worked out by performing active release techniques, or ART, through the release of the entire nerve where it is being compressed. The objective when using ART for sciatic nerve pain would be to maneuver the nerve while trapping the muscle(s) in their own position. The nerve is then pulled from beneath the muscle. Also, using rehabilitation exercises through specific stretches and strengthening exercises of the muscle groups involved may allow for faster healing alongside chiropractic care to boost the communication between the spine and the positioning of the nerve entrapment/compression.
One of the most common stretching methods for sciatica is PNF or proprioceptive neuromuscular facilitation. PNF is a sort of stretch that produces a rebound relaxation of the muscle. PNF is a more advanced kind of flexibility training that involves both the contraction and stretching of the muscle group being targeted. PNF is a stretching technique utilized to increase range of motion and flexibility. PNF increases range of motion by increasing the length of the muscle and increasing neuromuscular efficiency. PNF stretching has been found to increase ROM in trained, as well as untrained, individuals. Effects can last 90 minutes or more after the stretching has been completed. PNF stretching was initially created as a form of rehabilitation, and to that effect, it is very effective. It’s also excellent for targeting specific muscle groups as well as increasing flexibility and enhancing muscle power and strength.
Four theoretical physiological mechanisms for increasing range of motion were identified using PNF stretching: autogenic inhibition, reciprocal inhibition, stress relaxation, and the gate control theory.�Autogenic Inhibition is what occurs in a contracted or stretched muscle in the form of a decrease in the excitability because of inhibitory signals sent from the same muscle.�Reciprocal inhibition is what occurs in the TM when the opposing muscle is contracted voluntarily in the form of decreased neural activity. It occurs when an opposing muscle is contracted in order to maximize its contraction force, and it relaxes.�Stress relaxation is what occurs when the musculotendinous unit (MTU), which involves the muscles and the connected tendons, is under a constant stress.�The gate control theory is what occurs when two kinds of stimuli, such as pain and pressure, activate their respective receptors at the same time.
How to Perform a PNF Stretch
The practice of doing a PNF stretch involves the next steps. The muscle group to be stretched is first placed so that the muscles are stretched and under pressure. The individual then contracts the muscle, using a band for 5 to 6 seconds while a partner, or immovable object, applies sufficient resistance to inhibit motion. Please be aware, the effort of contraction ought to be relevant to the individual’s amount of conditioning. The contracted muscle group is then relaxed and a controlled stretch is used for approximately 20 to 30 seconds. The muscle band is then allowed 30 seconds to recover and the process is repeated 2 to 4 more times.
Information differs marginally regarding time recommendations for PNF stretching, determined by which healthcare professional you’re speaking to. Although there are conflicting responses to the question of how long should a patient contract the specific muscle group for and how long should they rest for between each stretch, it’s been found through a study of research and patient experience, that the above timing recommendations offer the most advantages from proprioceptive neuromuscular facilitation stretching.
Furthermore, certain precautions will need to be taken when performing PNF stretches because they may put additional stress on the targeted muscle group, which can boost the possibility of soft tissue injury. To reduce this risk, it’s essential for the patient to include a conditioning phase before a maximum, or intense effort is utilized.
About the Active Release Technique or ART
The active release technique, or ART, is among the newest treatments in the world of chiropractic. ART is used to target muscle, nerve, and tendon problems. It is also used to treat blood vessel problems. Quite a few studies have been conducted and these have generated positive results which reveal that ART is really an effective treatment method. A lot of individuals nowadays try ART since so many are experiencing muscle problems.
Oftentimes, individuals, particularly the older ones, wake up and they feel that their body is quite hard to move. There are also those who start to feel their range of motion getting more and more limited with time. A number of the most common body parts that suffer from limited selection of motion include the neck, the arms, and the back. For many individuals, there is also restricted range of motion. There are numerous factors that cause restricted range of movement. The active release technique can be used to improve limited mobility as well as improve sciatica symptoms associated with a variety of health issues.
How ART Affects Limited Range of Motion
ART therapists initial assess the muscles that they are supposed to take care of. They check the texture, the stiffness, and needless to say, their freedom. Since the groundwork is conducted, the therapists would then attempt to elongate the muscles so as to break the adhesions. The stretching is usually conducted with the management of vein in consideration. Also, the practitioner would need to ask the patient to move the affected body parts in ways prescribed by the practitioner. So essentially, ART is a joint-venture. Practitioner and patients work together in order to generate great medical outcomes.
Dr. Alex Jimenez’s Insight
The active release techniques, or ART, and the proprioceptive neuromuscular facilitator, or PNF, stretches are therapeutic procedures commonly utilized for the common practice of releasing tension in the soft tissues as well as increasing the range of motion of the human body. Although a variety of treatment options are available to help treat sciatica, ART and PNF can be used by qualified and experienced healthcare professionals to safely and effectively improve and manage sciatic nerve pain. Moreover, alternative treatment options, such as chiropractic care, and strengthening exercises can also be used in combination with these therapeutic methods to help speed up the recovery process.
The Future of ART and PNF
It’s important to remember that both ART and PNF should only be run by accredited practitioners. Healthcare professionals are not just expected to find basic instruction and permit but they are also expected to have attended numerous workshops and seminars about the subject. In some countries, credential tests even must be passed. In addition, it ought to be noted that ART and PNF must be conducted on muscle stiffness not due to blunt trauma. The condition should also not involve inflammation.
There are many healthcare professionals who focus on ART and PNF. A few of these include chiropractors, physical therapists, massage therapists, medical physicians, and even athlete trainers. The active release technique and the proprioceptive neuromuscular facilitation stretches helps people do things that they used to do. It helps them become more efficient at work as well as be practical in their daily lives. Due to the health benefits of ART and PNF, more and more people from the medical and therapeutic world are learning how to concentrate on it. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Sciatica
Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.
It has been compared to the worst possible type of pain anyone can imagine. Other people say it’s even worse than labor because the pain doesn’t seem to have an end to it. These are some of the most common descriptions of sciatica, where a severe case of this excruciating nerve pain can bring anyone to their knees. That’s why lots of patients don’t simply say they have sciatica, they’re victims of its symptoms.
Sciatic nerve pain, or sciatica, is associated with many well-known symptoms, however, is sciatica really that common? What type of treatments are available to help alleviate sciatic nerve pain?And does a person’s everyday activities play a part in whether they will develop sciatica in the first place? Dwight Tyndall, MD, FAAOS answers several of the most commonly asked questions patients need to know regarding their sciatica.�Dr. Tyndall is a pioneer in the area of outpatient spine surgery, however, he is also a strong proponent of non-surgical treatment methods, including chiropractic care, to manage back pain and sciatica. Dr. Tyndall shares his perspectives on sciatic nerve pain and discusses what may indicate a need for surgery in severe cases of sciatica.
What is Sciatica?
According to Dr. Tyndall, sciatica is both a spinal disorder and a catch-all term for a group of symptoms. Sciatic nerve pain, best referred to as sciatica, is a spinal condition characterized by nerve pain which radiates down the length of the sciatic nerve. The sciatic nerve is the largest nerve in the entire human body, and it’s made up of spinal nerves from the vertebrae level L4 in the lumbar spine down to the vertebrae level S1 in the sacrum. Anything which impacts those nerves can lead to sciatica. Moreover, sciatica’s symptoms may be grouped under the medical term dysesthesia, meaning any sort of abnormal sensation. Most patients describe sciatica as an odd feeling radiating out of their lower back into their buttocks and down to their thigh and calf, often radiating as far down into the foot.
What are the Symptoms of Sciatica?
Dr. Tyndall explains that sciatica’s hallmark symptom include pain in the low back or buttocks which radiates down one or both legs. Signs and symptoms which shouldn’t be ignored include pain which doesn’t respond to non-surgical treatment options and/or pain which greatly restricts an individuals activity level and quality of life. Some red flags which may signal the need for surgical interventions associated with sciatic nerve pain include: reduced motor function in one part of the leg, usually a drop foot at which the patient can’t lift thei foot off the ground, weakness in one or both legs and bladder or bowel changes.
Is Sciatica the Same as Lumbar Radiculopathy?
“Most people see sciatica to be more severe than lumbar radiculopathy, but radiculopathy, which comes from the Latin radix significance origin, is a condition that affects the nerve during its origin as it exits the spinal cord. Sciatica and lumbar radiculopathy can be brought on by a pinched nerve from the spinal column due to a disc herniation or stenosis, but kidney problems or a sinus issue, like endometriosis, may also pose sciatica-like symptoms,” states Dr. Dwight Tyndall.
Who’s at Risk of Developing Sciatica?
“By my clinical experience, men and women have exactly the same identical risk of developing sciatica. Obesity also doesn’t play a role, either. Concerning age classes, however, sciatica has been estimated to peak during the ages of 30 and 40, and the risk usually declines as people begin reach their 50’s,” added Dr. Tyndall.
How Common is Sciatica?
As mentioned by Dr. Dwight Tyndall, sciatica and low back pain frequently occur together, but sciatica is much less common. While 80 percent of individuals experience low back pain at any point in their lives, just 2 to 3 percent will actually develop sciatica.
When Should a Person with Sciatica See a Healthcare Professional?
According to Dr. Tyndall, an individual with symptoms of sciatic nerve pain will need to see a healthcare professional if their pain is not reacting to over-the-counter (OTC) medications, or if these create weakness in the leg. Also, a person ought to see a doctor if their pain is so severe that their well-being is affected. Should the sciatica include bladder or bowel changes, the individual must seek immediate medical attention for their health issues. Furthermore, it’s important for a person with sciatica to seek the help of a healthcare professional to rule out any possible underlying causes which may be responsible for their symptoms.
What Type of Healthcare Professional Can Help Treat Sciatica?
According to Dr. Tyndall, any healthcare professional qualified and experienced in spine health issues, such as a chiropractor, can help diagnose, treat and even prevent sciatica. A doctor of chiropractic, or chiropractor, is a healthcare professional who utilizes spinal adjustments and manual manipulations, among other non-invasive treatment methods, to help correct any spinal misalignments, or subluxations, which may be causing sciatic nerve pain. A chiropractor may also recommend a series of stretches and exercises, as well as lifestyle modifications, to help speed up the patient’s recovery process. Chiropractic care is often the preferred alternative treatment option to help alleviate sciatica without the need for drugs and/or medications or surgery. However, if a patient is experiencing any of the red flag symptoms mentioned above, it may be necessary to visit a spine surgeon in order to discuss the treatment options. Always make sure to consider surgical interventions as a final alternative if your sciatica doesn’t respond to non-surgical treatment methods.
What are the Causes of Sciatica?
“There are many external factors, but among the greatest is your occupation. Someone who operates in a manual labor industry, like construction, has a higher likelihood of developing sciatica since they put more wear and tear on their back. Tiger Woods is an example of this. He acquired sciatica because his career as a golfer placed significant stress on his spine. There is a genetic element as well, as a few young men and women who do not operate in a strenuous job develop sciatica, however, the genetic tie is not clearly defined. Lastly, pregnancy may also result in sciatica. As the infant develops, it can put pressure on the lumbar spine, pelvis, and sciatic nerve. However, delivering the infant is usually enough to eliminate sciatica caused by pregnancy,” says Dr. Tyndall.
How Often is Sciatica Likely to Re-Occur?
“This question isn’t easy to answer because many factors contribute to whether a person will develop sciatica more than once. Sciatica is likely to re-occur if the spinal disc that led to sciatica the very first time is severely damaged. The more damaged the disk, the more likely it is to re-herniate and lead to sciatica again. Also, if the patient continues to work in a high-physical stress environment, the risk of re-ocurrence increases.
How is Sciatica Diagnosed?
“The physical examination is essential to a sciatica diagnosis. The straight-leg raise test is the traditional diagnostic tool during a physical examination. In this test, a patient be asked to lift up their leg when lying down. If that induces pain down their leg, the patient could have sciatica. Other physical tests healthcare professionals frequently utilize are knee extension tests, where the patient expands their knee to a straight position, like a straight-leg lift. Additionally, healthcare professionals will as patients to walk on their tip toes or on their heel to measure their potency. Other healthcare professionals will also observe how strong they are going down stairs or simply walking. Many doctors can determine a sciatica analysis from a physical examination, but if imaging studies are needed to learn more, the physician may recommend a magnetic resonance imaging (MRI) scan.
What Treatments are Effective for Sciatica?
As mentioned before by Dr. Dwight Tyndall, there is a variety of treatment options available to help alleviate the symptoms of sciatica. Approximately 80 percent of patients will improve with non-surgical treatment options. Several OTC medications, such as NSAIDs (eg, ibuprofen), are also effective in the management of sciatic nerve pain. If the sciatica does not subside, the doctor may prescribe a low-dose steroid pack (to be obtained over one week). If this doesn’t manage the sciatic nerve pain, then the patient may receive an epidural steroid injection (you will first need an MRI to pin-point the injection region).
Other non-surgical treatment options which are commonly utilized to help alleviate the symptoms of sciatica, include, acupuncture, chiropractic care and physical therapy, and needless to say, time normally works wonders such as pain. Chiropractic care is the most commonly used alternative treatment option for the treatment of sciatica. Chiropractic care focuses on the diagnosis, treatment and prevention of a variety of injuries and/or conditions associated with the musculoskeletal and nervous system. Through spinal adjustments and manual manipulations, a doctor of chiropractic, or chiropractor, can help reduce unnecessary pressure in the structures surrounding the spine, improving strength, mobility and flexibility. Chiropractic care and physical therapy alike, can also help improve a patient’s overall health and wellness, aside from improving their sciatica, through physical activities and nutritional advice.
Is Surgery Ever Necessary to Treat Sciatica?
“It may certainly be so, however, the good thing is that the vast majority of people with sciatica don’t need surgery. And, your doctor may ask you to explore non-surgical treatment options, however, your tolerance for pain is the real predictor as to when you have to consider another option for treatment. Surgery may be necessary if symptoms worsen despite trying non-surgical alternatives, if you have weakness in your leg, or if you experience bladder and/or bowel changes,” explained Dr. Dwight Tyndall.
“The surgical procedure to treat sciatica is also called a lumbar microdiscectomy. It is a normal procedure with very positive individual outcomes when used accordingly. A lumbar microdiscectomy is similar to a traditional lumbar discectomy. Technological advances, like the advent of surgical microscopes, allow surgeons to create smaller incisions that are minimally traumatic to the body and result in a much quicker recovery for the patient”, added Dr. Tyndall.
Can Surgery be Performed in an Outpatient Setting?
“Yes, lumbar microdiscectomy can surely be carried out in an outpatient setting. Many patients like the cozy environment and are able to go home the exact same day of operation,” concluded�Dwight Tyndall, MD, FAAOS.
Is Sciatica Preventable?
As thoroughly explained by Dr. Dwight Tyndall, sciatica can be preventable if the individual doesn’t put significant and repeated stress in their back, which will reduce the chance of damaging or injuring a nerve. Nonetheless, in the present society, through our tasks and daily stresses of modern life, it’s difficult to accomplish that. Fortunately, with the abundance of treatment choices available, people can get relief from sciatic nerve pain with the appropriate healthcare professional’s help.
Dr. Alex Jimenez’s Insight
Many people will experience symptoms of low back pain at least once throughout their lifetime, however, only a few individuals will develop true sciatica symptoms. Sciatica is medically referred to as a collection of symptoms, rather than a single condition, and it’s generally characterized by pain and discomfort, followed by tingling or burning sensations and numbness along the length of the sciatic nerve. The sciatic nerve is the largest nerve in the human body and it travels from the lower back down the buttocks and thighs into the legs and feet. Sciatic nerve pain, or sciatica, has become a common health issue for many people, therefore, its important to be educated regarding this prevalent complaint in order to follow up with the most appropriate treatment.
The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Sciatica
Sciatica is medically referred to as a collection of symptoms, rather than a single injury and/or condition. Symptoms of sciatic nerve pain, or sciatica, can vary in frequency and intensity, however, it is most commonly described as a sudden, sharp (knife-like) or electrical pain that radiates from the low back down the buttocks, hips, thighs and legs into the foot. Other symptoms of sciatica may include, tingling or burning sensations, numbness and weakness along the length of the sciatic nerve. Sciatica most frequently affects individuals between the ages of 30 and 50 years. It may often develop as a result of the degeneration of the spine due to age, however, the compression and irritation of the sciatic nerve caused by a bulging or herniated disc, among other spinal health issues, may also cause sciatic nerve pain.
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Lumbar Spine:
