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 spinal cord is the information pathway that transmits signals from the brain to the rest of the body. The body’s limbs and organs cannot function properly without regular communication flowing through the spinal cord. Understanding how the sciatic nerve responds to the other parts of the body can clarify how a doctor of chiropractic heals sciatica. When severe pain presents normal communications are overridden for the sake of body and health preservation. The sciatic nerve is an important part of the spinal cord and requires a trained professional to aid in proper and effective healing.
Basics On Sciatica
Sciatica happens when the nerves are compressed/pinched in some form. Lower back conditions can be the cause of such compression. Sciatica can be reduced and healed. Conditions that can lead to sciatic pain include:
Herniated discs
Subluxations
Disc Degeneration
Spinal Stenosis
Lower back disc bulge
Piriformis syndrome
Symptoms
Sciatica often includes:
Sharp pain
Numbness
Burning
Tingling sensation
Individuals can also experience weakness down the leg.
Normal activities can become strained as individuals experience these symptoms. Pressure on the nerve can be decreased and healed with professional chiropractic care. The human spine consists of 31 pairs of nerves. Five of these pairs are in the lumbar/lower back region and five are right below that area in the sacral region. The sciatic nerve starts in the lower back. It goes down through the hips, buttocks, thighs, knees, calves, and ends in the foot.
Causes could be something as simple as sitting on a bulging wallet or sitting for extended lengths of time can result in a decreased blood flow to the area. Also, direct trauma to the gluteal muscles from automobile accidents, sports, and work injuries can lead to sciatic nerve issues and pain.
Treatment Options
Tests and examinations will be conducted to figure out the origin of the pain to develop a personalized treatment plan to expedite the healing process. Treatment can include:
Chiropractic treatment
Decreasing muscle tension
Core stabilization
Spinal decompression
Rehabilitation therapy
Chiropractic treatment is designed to help the body activate its own healing system. It is non-invasive and drug-free providing an organic alternative. Advanced cases of sciatica can result in muscle weakness or a loss of sensation in the legs, if not properly treated. Individual treatment plans vary depending on an individual’s specific needs.
Prevention
Prevention is important once the condition is healing to not cause flare-ups. Sciatica symptoms can return, especially if proper and continued care to the spine is not maintained. Preventative care and maintenance are essential for ensuring a healthy spine and body. These tips can help avoid back injuries that can lead to sciatica and help with reoccurrences:
Practice proper posture
Regular exercise/physical activity with safe movements
Bend at the knees, especially when lifting heavy objects
Follow specific instructions given by a chiropractor
Body Composition
Healthy Snacks
Eggs
Eggs make a great snack that will keep the body full and help to eat less. They are a great source of protein and fat and have a healthy variety of vitamins and minerals. Hard-boiled eggs are easy to make ahead of time and are portable.
Cheese
Cheese is a great snack for protein and fat. But it is important to watch the serving size if watching/limiting calories. Cottage cheese is highest in protein but cream cheese and cheese sticks are also good options. Cheese can be paired with a serving of fruit or vegetables like grape tomatoes, bell peppers, celery, apples, or pears.
Jerky
Jerky is convenient and portable and is a great way to pack in extra protein throughout the day. The best option is grass-fed. Remember that some jerky is high in sodium if limiting sodium.
Greek Yogurt
Natural Greek yogurt is a great option for a high-protein snack. However, many yogurts are high in sugar. Therefore choose yogurt with less than 10 grams of sugar per serving, or opt for plain yogurt to avoid the sugar altogether. The yogurt can be sweetened with honey, fresh fruit, or mixed into a smoothie.
Hummus and Guacamole Dips
Hummus is a great source of plant-based protein and is balanced with carbohydrates, fat, and fiber. It is the olive oil in the hummus that provides a healthy dose of heart-healthy polyunsaturated fats. Guacamole is a delicious source of healthy fats.Both dips are calorie-dense, therefore it is important to be aware of portion sizes. These can be paired with carrot sticks, bell peppers, or celery.
Disclaimer
The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the musculoskeletal system’s injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.
Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, CTG*
email: coach@elpasofunctionalmedicine.com
phone: 915-850-0900
Licensed in Texas & New Mexico
References
National Institutes of Health. (2019.) “Sciatica.” medlineplus.gov/sciatica.html.
North American Spine Society. (2012.) “Clinical Guidelines for Diagnosis and Treatment of Lumbar Disc Herniation with Radiculopathy.” www.spine.org/Portals/0/assets/downloads/ResearchClinicalCare/Guidelines/LumbarDiscHerniation.pdf
Sciatica is a very common and painful issue. Keeping it in check can be difficult especially with various causes that can generate flare-ups. Individuals managing sciatica need to pay attention and be vigilant of the negative activities/movements that could cause symptoms to reappear. A few common causes include:
Excessively tight-fitting pants
Improperly lifting heavy objects
Poor posture
Weight gain
Not stretching out
Wearing the wrong shoes
Knowing what not to do is just as effective for helping sciatica flare-ups as knowing what is best.
Sciatica Causes
The sciatic nerve is the longest nerve. It comes out the spine through the pelvis, down the leg to the foot. There is one sciatic nerve on each side of the body, and either can become irritated, injured, and inflamed. However, it�s rare that both are irritated at the same time. The underlying causes can vary. Most of the time the cause is a herniated disc that presses against the nerve, causing the pain. Even though this happens in the lower back, an individual might only feel pain in the buttocks and the back of the leg. Other causes of sciatic nerve pain include:
What makes sciatica worse depends on the underlying cause. For most, this is a herniated or bulging disc that presses against the nerve. With this type of case, any increase in pressure on the discs can worsen the symptoms. Sitting down in fact puts more pressure on the spinal discs, worsening the pain. Lying down can also worsen symptoms. When the pain is peaking, lying down for a little while can help, but for too long can worsen symptoms. Standing with a neutral spine, and walking around a bit, can help with nerve pain relief and the healing process.
Improper/Poor Posture
Poor posture, especially the rounding of the lower back. This usually happens when sitting. The rounded low back becomes a bad habit that individuals think will help with the pain. This can cause a flare-up. The spine has a natural S-curve and the more an individual can maintain that natural curve, the better off they will be.
Weight Gain
Too much weight can cause flare-ups with added stress/pressure on the spine, especially the low back. Maintaining a healthy weight will help relieve the added pressure, however, many who experience sciatica have trouble exercising. This is where a physical therapist and chiropractor can assist an individual with customized exercise and diet programs to overcome this obstacle. Eating is a way that individuals deal with pain, anxiety, and depression. But weight gain and poor health can worsen sciatica. Individuals that are overweight tend to experience more inflammation throughout the body, making sciatica even worse.
Stretching
Not stretching, especially as the body gets older tightens the muscles, ligaments, and tendons. And stretching improperly can injure these areas. There are recommended and non-recommended stretches for individuals dealing/managing sciatica. Stretches that require bending the low back can place added pressure on the lumbar spine, causing sciatica flare-ups.
Lifting Heavy Things
Lifting and improperly lifting heavy objects can worsen sciatica. This has to do with the rounding of the low back. Any time the spine is taken out of its natural S-curve, there is undue pressure on the joints and discs. When lifting heavy objects in this position the problem is worsened. When possible avoid lifting anything heavy while dealing with sciatica. It�s healthy to stay active, but there is no need to do intense workouts at home or the gym, especially heavy lifting.
Tight Pants
Tight pants can contribute to sciatica. Whether shorts, jeans, or skirts, wearing overly-tight, form-fitting pants should be avoided until the sciatica is gone. And even after it is not recommended to wear overly tight-fitting clothing, as this can cause blood and nerve circulation problems.
Shoes
Like tight pants, the wrong shoes without adequate support can cause flare-ups. For example, high heels force weight distribution to the front of the feet. For the body to compensate, it�s normal to push the pelvis and hips forward. When the body is in this position for a long time it starts to place stress on the hamstrings, which will exacerbate sciatica. Shoes without adequate support place added stress on the feet, which gets transferred up the leg to the hamstrings. Customized shoe inserts designed especially for individuals with sciatica can help in preventing symptoms.
Improvement
Sciatica takes time to heal. Avoiding making it worse and taking all the steps to help it heal, can bring the body back to normal within 2 weeks. For most, it takes around 4 weeks for the pain to go away. This depends on various factors. For example, if sciatica develops during pregnancy, it could take longer to get rid of the pain. One sign that shows improvement is called centralization meaning the pain is moving out of the leg and into the spine. This is a good sign that the individual is on the right track.
Body Composition
Meal Planning
The convenience of food delivery is wonderful, but remember that frequently eating food prepared away from home increases the risk of weight gain and obesity. Restaurants tend to serve oversized portions and prepare meals with excessive calories, sodium, and sugar. The benefit of eating from home is that individuals have more control over the ingredients and cooking methods used to prepare the food. It helps to plan meals and snacks in advance to make sure they are balanced. Here are the types of foods that should be included in a balanced meal plan:
A variety of whole fruits
Non-starchy vegetables – leafy greens, red and orange veggies
Starchy vegetables – potatoes, green peas, legumes, winter squash
Grains, with the goal to make at least � from whole-grain sources
Low-fat or fat-free dairy milk, yogurt, cheese
Protein from various sources – lean meats, seafood, eggs, nuts & seeds, and soy products
Healthy cooking oils – olive oil or canola oil
Nuts and nut butter
Fresh or frozen fruits
Dried herbs and spices
Dr. Alex Jimenez�s Blog Post Disclaimer
The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*
Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
Back pain combined with sciatica is the number one cause of temporary disability all over the world. The spine is a complex interconnected system that supports the entire body. Being overweight does not help. Losing weight can help relieve sciatica and prevent future episodes. It can be done through chiropractic health coaching. According to research, overweight individuals have a higher risk of developing sciatica. The more weight the body carries the more stress is placed on the spine and joints, which can irritate/inflame the sciatic nerve.
Causes and Symptoms
To understand how sciatica is affected by the weight of the body one needs to understand how it works. A breakdown of the causes and symptoms.
The sciatic nerve runs from the lower spine, through the glutes, down the back of the thigh, and is attached under the foot.
The nerve becomes compressed or irritated where it exits the lower spine. This can be caused by a bulging or herniated disc, narrowing of the spinal canal, or bone spurs.
Symptoms include a sharp pain that spreads out from the low back and down the back of the leg. It also causes tingling, numbness, and weakness.
Indirect Cause Being Overweight
Being overweight can indirectly cause sciatica. When the body has to support added/extra weight it can cause problems. That extra weight also places tremendous stress on the joints, especially those in the spine. The lower back takes most of the force from this stress, which is how sciatica develops. The stress slowly pulls the spine out of alignment and compresses the discs between the vertebrae, which then compresses the sciatic nerve, causing pain and discomfort.
Sciatica and Weight Loss
Keep in mind that weight loss is not a cure for sciatica. Weight loss will surely help relieve sciatica pain but there are other issues at work that are combined with excess weight and are causing sciatica. Weight loss is only a step in the right direction. The most recommended and effective ways to lose weight and relieve sciatica pain is having a healthy diet, exercise, and chiropractic health coaching. Other things that can be done to relieve sciatic nerve pain include:
Regular exercise will help reduce the symptoms and strengthen the body’s core and leg muscles. There are a variety of things that make sciatica worse like:
Sitting too much
Sedentary lifestyle
Wearing shoes with no support
Lifting, bending, twisting, reaching, overuse
Exercise is the best antidote to sitting too much and living a sedentary. Exercising with sciatica does not mean a full gym routine but doing the right exercises that will not worsen the condition. The important thing is staying active. Avoiding exercise will only make sciatica worse. For example, yoga is great for sciatica and health in general. A 30-minute session of yoga 3 times a week combined with another form of exercise twice a week can produce optimal results.
Weight Training
Weight training will work with sciatica with certain adjustments and avoiding specific exercises that can cause pain and should be discussed with a doctor, chiropractor, physical therapist depending on the individual’s sciatic condition.
Form and Posture
Weight training form is essential. Practice slow repetitions with special attention to physical form. Proper posture, maintaining a neutral spine, and avoiding rounding the lower back will help avoid worsening sciatica, and prevent further injury/s.
Avoid Overhead and Straight Leg Exercises
Not until the sciatica pain reduces avoid overhead lifting exercises and straight leg exercises, as these can cause flare-ups. Also, avoid intensive abdominal exercises that require doing crunches.
Know The Limits
When sciatica is present, the body is in healing mode, the key is to not overdo it. This exercise is minimal, to help in the recovery process, and strengthen the muscles. Too much exercise can prolong the recovery.
Losing Belly Fat
Losing belly fat with sciatica is possible. But it will take a sustained effort that will be well worth it when sciatica. Losing the fat needs concentration on three things:
Nutrition
Eating whole nutritious foods with plenty of vegetables, and staying away from processed and sugary foods. This is where a health coach and nutritionist can offer the greatest recommendations and develop a customized diet/health plan.
Exercise
Weight training, yoga, cardio, or a combination of all is probably best. Whatever regimen is chosen the objective to stick with it.
Lifestyle adjustments
This includes improving posture, workstation set up, adjusting sitting routines, and limiting activities that cause back pain/sciatica.
Chiropractic Health Coaching
The full-body approach outlined is how chiropractic treats sciatica. Chiropractic can relieve the pain quickly with massage, spinal adjustments, and physical therapies. This is why chiropractic health coaching is ideal for those who have a hard time making nutrition, exercise, and lifestyle changes on their own. Numerous studies show that chiropractic promotes weight loss, reduced pain, improved posture, and increased well being. And it is done in a safe, non-invasive, medication-free way.
Body Composition
Eating Out A Significant Contributor For Weight Gain
When eating out, there is a tendency to consume excess empty calories and increase fat storage. This is why preparing food is so important. It gives the individual direct control over what is being consumed and allows trying out different dietary approaches to see which one works best for improving body composition and gut health. Even for those that don�t enjoy cooking, consult a chiropractic health coach to see what options are available.
Dr. Alex Jimenez�s Blog Post Disclaimer
The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*
Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
Trying to get a proper night’s rest and healthy sleep with sciatica can be difficult. Here we discuss how to combat sciatica discomfort for a better night�s rest. The sciatic nerves are the two largest nerves in the body. They run from the low back through the:
Hips
Buttocks
Down each leg into the feet
When the nerve gets:
Irritated
Inflamed
Pinched
Compressed
Sciatica can cause pain, tingling, numbness in the butt, lower back, leg, calf, and foot. It is a common condition that affects many individuals.
Is It Sciatica
Sciatica happens when the nerve becomes pinched from a bulging or herniated disc. In rare cases, the pain can result from a tumor putting pressure on the nerve or damage to the nerve caused by disease. The location and intensity of the pain depend on where the injury or damage occurred and how bad it is. Sciatica pain can be described as:
Dull
Sore
Numbing
Jolting
Throbbing
Hot
Stabbing
Radiating
For many sciatica usually resolves within a matter of weeks. However, once sciatica has presented future episodes are almost guaranteed to resurface and if not treated properly can lead to more serious problems.
Symptoms
The sciatic nerve/s can affect several areas of the body, making symptoms vary. The most common include:
Lower back pain starts at the low back, runs along the hips and buttocks down each leg.
Pain radiates/spreads down the butt/leg area sometimes described as a shooting pain and usually occurs on just one side.
Pain while sitting for long periods of time places pressure on the gluteal muscles, lower back, and nerves. This can cause or worsen the condition. When having to sit for a while, it is recommended to get up every hour or so and walk/move around. This gets the blood flowing and stretches out the tightened muscles.
Hip pain, as the sciatic nerves run through the hip joint and in some cases can cause pain to settle in the hip. Injuries in the hip can mimic the symptoms of sciatica. If there is hip pain that does not improve with time get checked by a doctor to rule out other causes like osteoarthritis, bursitis.
Numbness, some experience weakness in the legs and an altered sensation of numbness. This is caused by a herniated disc in the lower lumbar region.
Burning/tingling like a pins and needles sensation, especially in the feet and toes.
Conditions/Causes
There are several conditions that can cause sciatica:
Degenerative Disc Disease is where the discs of the spine deteriorate and become susceptible to painful herniation.
Spondylolisthesis is a painful condition where the lower vertebrae slip forward onto the bone directly below impinging the sciatic nerve.
Muscle Spasms and involuntary contractions of the muscles can cause sciatica if they compress the nerve.
Pregnancy sciatica is not uncommon. As the baby grows it places pressure on the nerve causing aches and pains.
Lumbar spinal stenosis is when the spaces in the low back begin to narrow compressing and irritating the nerve.
Risk factors include:
Age, as the spine gets older it becomes more susceptible to herniated discs and bone spurs, which are leading causes of sciatica.
Obesity and excess weight create added stress on the spine, which can inflame the nerves.
Occupation/work that requires standing/sitting for long periods or if a lot of heavy lifting is involved there is added pressure on the back increasing the risk for back problems.
Individuals with diabetes have an increased risk for nerve damage. When nerves are damaged, they can cause radiating pain.
Night Time
Sleeping at night can be a challenge, especially not being able to get into a comfortable position. Sleep deficits and insufficient sleep can reduce the body�s tolerance to pain and worsen inflammation. Many wake up with increased symptoms.
This is likely due to the fact that when the body is laying down the discs draw in and absorb fluid, which results in increased pressure within the disc, creating more pressure on the nerve. But there are some things to do to lessen pain and get a good night�s sleep. This includes changing sleep position, stretching, and practicing healthy sleep hygiene.
Sleeping Positions
Sleeping on the back is considered the best sleeping position for sciatica because it eases pressure on the low back and discs where the nerves are located.
Sleeping on the side can be more comfortable and is a good position because it doesn�t place direct pressure on the muscles, discs, or sciatic nerve. But, it is important that the mattress is supportive enough to keep the spine aligned. If more support is needed place a pillow between the legs.
Sleeping with the knees elevated can help take the pressure off the low back. To achieve this place a pillow under the knees or, with an adjustable bed, use it to elevate the foot of the bed.
Sleeping with a body pillow provides extra comfort and helps the body remain in a certain position throughout the night. These pillows come in a variety of shapes, sizes.
Stretches
Stretching can provide relief. It�s important to stretch to keep the body flexible and to prevent pain. Gentle stretches before bed, and after waking up will loosen the muscles and ligaments surrounding the spine and joints.
Stand and place one heel on an elevated surface, like a chair.
Fully extend the knee and flex the ankle by pointing the toes toward the ceiling.
Bend forward at the hips keeping the spine in a neutral position. Hold for 15 to 30 seconds.
Repeat with the other leg.
Sleep Hygiene
Proper sleep hygiene helps prepare for a good night�s sleep. Here are some tips to help improve sleep hygiene.
A nighttime routine will help unwind the body before bedtime. Start the routine 30 minutes before planning to go to sleep. Some things to do to help unwind:
Take a warm bath
Listen to relaxing/soothing music
Meditation
Reading
Get a new mattress. An old, sagging mattress can worsen sciatica and strain the back. The best mattresses for sciatica pain combines contour comfort to ease pressure points at the hips and shoulders with the proper support to keep the spine aligned.
Eye masks can help with artificial light which can fool the mind along with the circadian clock into thinking it�s daylight. Keeping out unwanted light all night can help.
Avoid blue light too close to bedtime like lamps and device screens. These are great for the day, as they help boost attention, reaction time, and mood. But at night it can be disruptive. Turn off electronics at least 30 minutes before bed to help the body adjust.
Room temperature control has found that most sleep better in a cool room. The optimal temperature is between 60 and 67 degrees.
Avoid exercise close to bedtime. Working out before bed can interfere with sleep. This is because exercise releases adrenaline keeping the mind and body alert.
Avoid stimulants before bedtime like caffeine, sugar, etc. which will keep the body up.
Medical Intervention
Sciatica pain can be mild or severe. Stretching or changing up sleeping position can help ease discomfort. But if the pain is severe or chronic, and if it prevents getting a good night�s sleep, consult a chiropractic professional.
InBody Spotlight
Sleep And Body Composition
A lack of sleep makes it harder to gain muscle and harder to lose fat.
Sleeping less means fewer opportunities to secrete growth hormone and develop muscle
Testosterone is negatively affected by lack of sleep
Sleeping less can increase cortisol levels, impairing muscle development
Irregular sleep throws off the body’s cycles, making the body feel hungrier
Sleeping less is linked to eating more snacks, increasing energy levels
Lack of sleep can cause reductions in Basal Metabolic Rate by 20%, reducing total energy output
Being tired reduces spontaneous movements, reducing total energy output
If trying to get into shape and change body composition, sufficient sleep is vital. Any positive changes to get more sleep are going to have positive changes in efforts to change body composition.
Dr. Alex Jimenez�s Blog Post Disclaimer
The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*
Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
References
Siengsukon, Catherine F et al. �Sleep Health Promotion: Practical Information for Physical Therapists.��Physical therapy�vol. 97,8 (2017): 826-836. doi:10.1093/ptj/pzx057
After all of these years, I am happy to announce that the Texas Supreme Court has finally made a decision regarding the Texas Board of Chiropractic Examiners et al v. Texas Medical Association case on January 29th, 2021. With great honor and gratitude, I’d like to continue to extend sincere thanks to everyone who worked hard on this case and whose tremendous efforts resulted in the decision. Thanks to the Supreme Court’s decision, chiropractors in Texas can now carry on their jobs accordingly. Below, I have provided a letter from Board President, Mark R. Bronson, D.C., F.I.A.N.M. on behalf of the Texas Board of Chiropractic Examiners stating the Texas Supreme Court’s decision in the Texas Board of Chiropractic Examiners et al v. Texas Medical Association case on January 29th, 2021. – Dr. Alex Jimenez D.C., C.C.S.T.
February 1, 2021
On behalf of the Texas Board of Chiropractic Examiners, I extend our sincere thanks and appreciation to everyone whose efforts resulted in the Texas Supreme Court’s decision in Texas Board of Chiropractic Examiners et al v. Texas Medical Association on January 29, 2021. Special thanks are due to all the attorneys at the Office of the Attorney General who worked on this case over these years.
The decision properly affirmed the validity of the Board’s scope of practice rule, which the court clearly said does not exceed our statutory scope of chiropractic practice. The court unequivocally held that the Board�s rules do not violate Occupations Code Chapter 201 or run counter to the chapter’s objectives set by the Texas Legislature, and in fact, carefully observe the statutory boundary between the medical and chiropractic professions. This decision, which recognizes the common sense and long-standing inclusion of associated nerves in chiropractic diagnosis and treatment, preserves and strengthens the essence of chiropractic.
Thanks to the court’s decision, our licensees can now fulfill their duties as vital portal-of-entry healthcare providers in Texas without fear. The court’s decision reaffirms the principles of economic freedom that have made Texas the best state in the nation to be a chiropractor.
Sincerely,
Mark R. Bronson, D.C., F.I.A.N.M. Board President
Texas Board of Chiropractic Examiners
The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*
Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas & New Mexico*
Identification of piriformis syndrome or sciatica requires proper testingand examination. The piriformis muscle begins at the sacrum near the sacroiliac joint and is attached to the femur/thigh bone at the outer area of the hip. The sciatic nerve passes typically under or through the muscle before going down the back of the thigh.
The piriformis helps turn the hip outward and bring the thigh outward to one side while the hip is bent. This could be when raising the knee and bringing the leg out. An example is stepping out of a car. The muscle also helps to stabilize when walking, running, and standing. Individuals with the sciatic nerve passing through the piriformis have an increased chance of developing piriformis syndrome. It can also be called piriformis sciatica since it is not true sciatica.
Symptoms
Piriformis syndrome does not always present the same way. Common symptoms include pain, tingling, and numbness in the buttocks that becomes worse when sitting. Other symptoms can include:
Pain when sitting, standing, or walking.
Pain when getting up from a seated/squatting position
Pain in the sacroiliac joint
Pain and/or pins and needles, burning, tingling, or itching sensation
Movement helps to reduce pain symptoms
Numbness in the foot
Many of these symptoms can be mistaken for sciatica. This is why proper testing is necessary to provide the appropriate treatment; otherwise, the condition could worsen or create new injuries.
Causes
Primary piriformis syndrome happens when splitting the piriformis muscle, the sciatic nerve, and/or the sciatic nerve does not run along the normal path.
Secondary piriformis syndrome is more common and is caused by inflammation of the soft tissues, muscle spasms, etc. And the result is nerve compression.
Direct trauma to the buttock area can definitely cause inflammation, scarring, and contraction of the piriformis muscle. This could be the result of an automobile accident or a fall.
The most common cause is a progressive tightening of the muscle brought on from a weakened piriformis muscle.
Testing
Because of the close relation between piriformis syndrome and sciatica, a chiropractic medical professional will perform various tests to determine if symptoms are spinal disc-related or caused by the sciatic nerve getting pinched or impinged piriformis muscle. A chiropractor will examine the low back, hip, pelvis, sacroiliac joint, walking gait, posture, and leg length. They will test various body reflexes as well. Other tests can include:
Palpation/manipulation of the piriformis muscle
A Straight leg raise will be done to see if there is localized pain when pressure is applied to the piriformis muscle and the tendon. The chiropractor will flex the hip at a 90-degree angle and extend/straighten the knee.
A Freiberg test will be done to see if pain presents around the piriformis or reproduces symptoms.
The Pace maneuver test looks for pain and/or weakness during rotation of the hip when sitting.
The F.A.I.R test stands for flexion, adduction, and internal rotation. This test has the individual lie on the non-affected side while the chiropractor guides the painful leg into hip flexion, turns it in toward the body, and gently turns the lower leg outward.
The Beatty maneuver tests for pain while lying on the non-affected side, and the chiropractor elevates the flexed symptomatic leg.
Testing for pain or weakness in specific positions is usually conducted for one minute or when the individual experiences symptoms.
In addition to a physical exam, a chiropractor will utilize imaging scans to rule out any other causes. This can include X-rays, MRIs, or CT scans. Once the source has been diagnosed, treatment can begin. Many individuals choose to wait and see what happens, hoping the problem will go away. But the sooner the root issue is dealt with, the sooner an individual can get back to living pain-free.
Sciatica Pain Rehabilitation
References
The Journal of the Osteopathic Medical Association. (November 2008) Diagnosis and Management of Piriformis Syndrome: An Osteopathic Approach jaoa.org/article.aspx?articleid=2093614
There are other causes of sciatica that are not spine-related. It is sometimes called non-spinal pathology, which means not related to the spine. The most common cause of sciatic pain is a herniated disc. Non-spine-related causes of sciatica can imitate/copy the symptoms of a herniated disc in the low back. When a lumbar herniated disc causes sciatica, people typically report a sudden onset of pain with leg pain worse than any back pain that might be present. In addition to pain in the leg, there are also reports of leg weakness, numbness, and tingling. Leg pain becomes worse after:
Long periods of sitting/standing
Forward bending
Body maneuvers that increase pressure in intervertebral discs
Coughing
Sneezing
Individuals also report when lying down and the spine is extended the back pain reduces and alleviates the pain. Determining the source of sciatica pain correctly means that it is important to:
Characterize the activities leading up to when the symptoms first presented
Location of the pain
Associated factors that reduce and worsen the pain
Medical history
Because there are quite a few non-spine-related causes, it can be helpful to keep in mind:
The way the sciatic nerve runs through the lower body. It starts in the lower lumbar and upper sacral nerve roots. It exits through the pelvis and runs down the back of the thigh to the knee where it branches out into nerves that provide the motor and sensory functions to the legs and feet.
Non-spinal sciatica causes. Non-spinal causes usually are the result of irritation of the nerve itself. The most common ways to irritate the nerve is compression, traction, or injury.
Symptoms perceived as sciatica may not be related to the nerve at all. Injury/s to structures close to the nerve, like the hip, can copy symptoms caused by irritation of the nerve.
Hip joint disorders can emulate sciatica symptoms
Because the sciatic nerve is close to the hip joint, an injury to the hip could resemble symptoms of sciatica. Whatever the cause of the hip injury, those with hip pathology often report pain in the groin, upper thigh, and buttocks. The pain gets worse with activity, specifically bending, and rotation of the hip.
Leg pain that turns into a limp when walking means that more likely the hip, and not the lower back, is the cause of the leg pain. X-rays and if necessary MRIs of the hip can help in determining if the hip is the cause of leg pain. An example of hip pathology that mimics spine-related sciatica:
Hip Osteoarthritis
This is characterized by the loss of cartilage. This results in the narrowing of the ball and socket joint. Individuals with arthritis of the spine and hip, a doctor could use a steroid injection as a therapeutic providing pain relief and a diagnostic to help identify the root cause/pain generator.
Osteonecrosis
The femoral head can collapse from a lack of blood flow. Risk factors include:
Alcohol abuse
Sickle cell disease
Chronic steroid use
Femoral neck fracture
Hip dislocation
Femoroacetabular Impingement
This can stem from constant abnormal rubbing between the femoral neck and acetabulum from a bone deformity of the femur, or the acetabulum. Hip impingement at the joint can start the onset of arthritis along with tears of the labrum. This is cartilage that surrounds the hip joint and provides stability.
Trochanteric Bursitis
There are fluid-filled sacs called bursas/bursae that help decrease friction between the bones, surrounding tendons, and muscles. They are at multiple locations on the body. Bursitis means that the bursa is inflamed and can be quite painful. The greater trochanter is a bony outward bump that extends from the femur. Trochanteric bursitis refers to inflammation of the bursa that separates the greater trochanter with the muscles and tendons of the thigh. Common symptoms are pain on the outside of the thigh that worsens by pressing on the area and can interfere with proper sleep when lying on the affected side.
Femoral Neck Stress Fracture
Incomplete fracture/s of the femoral neck typically occur in individuals that walk or run long distances regularly like runners and soldiers. The pain is usually focused around the groin and can be subtle when it presents. Walking or running makes the pain worse.
Sacroiliac joints and fractures
The sacroiliac joints connect the spine to the pelvis. There are two joints, one on either side of the sacrum. While they are relatively immobile, they go through tremendous force doing routine daily activities. Sacroiliac joint pathology that can mimic spine-related sciatica include:
Sacroiliitis
This is inflammation of the sacroiliac joints. The pain presents in a slow fashion with no obvious injury or cause. The pain is usually localized to the buttocks and can radiate down the back of the thigh. It is believed to be caused by irritation of the sciatic nerve by the inflammatory molecules in the sacroiliac joint or could present as referred pain from the joint. This is pain that is detected in a location other than the area of the pain generator. The pain reduces with light walking.
Sacral Fracture
A fracture of the sacrum can occur in those with a weakened bone after a minor injury and without trauma. Risk factors include:
Advanced age
Osteoporosis
Chronic steroid use
Rheumatoid arthritis
Vitamin D deficiency.
The pain usually localizes in the low back that radiates to the buttocks, or groin, and worsens with activity.
Trauma-related
Trauma to the pelvis or thigh can definitely cause sciatica pain and symptoms. With high-energy injuries, it is possible for the nerve roots of the sciatic nerve to get pulled or torn. More common causes include:
Posterior hip dislocation
Pelvic fracture
The hamstring muscles are in close proximity to the sciatic nerve. A torn hamstring can irritate the sciatic nerve either through direct compression from the localized bleeding known as a hematoma or from an inflammatory response triggered when the injury happened.
Penetrating trauma
If some sharp object like a tool or shrapnel penetrates any area where the sciatic nerve is, it could cause sciatica by cutting the nerve. Or the object tears the nerve, known as a laceration. Most cases of trauma-induced sciatica result from a mild form of nerve injury known as neuropraxia. This is an injury that temporarily blocks nerve function. Neuropraxia can develop from the shock waves that surround the object as it travels through the tissue.
Benign tumors and metastatic cancer
Discovering cancer during diagnosis for sciatica is rare. Symptoms that increase the possibility of cancer being the cause include:
Cancer in medical history
50 years and older
Leg pain that goes on through the night
No relief from lying on the back
Night sweats
Unexplained weight loss
When back pain presents in a subtle fashion without a history of trauma or injury and is not affected by activity or changes in position can also suggest cancer as the cause. Tumors usually cause sciatica by applying direct compression on the nerve. They can be benign or malignant. Tumor/s can arise from the sciatic nerve itself:
Shingles is a painful rash that occurs on one side of the body. It is caused by the varicella-zoster virus, which is the virus that causes chickenpox. The virus can lie dormant in nerve cells for years without causing any symptoms. Older individuals and individuals with underlying conditions in an immunocompromised state can cause the virus to activate. If the virus reactivates around the buttock and thigh, it can feel like sciatica. The presence of a red rash with blisters around the painful area is consistent with shingles.
Childbirth and endometriosis
During pregnancy, the pelvis can become compressed between the growing baby and the bones in the pelvis. Also, having the hips and knees flexed and supported in stirrups too long can also cause sciatica. However, pregnancy-related sciatica is often temporary.
A less common cause that occurs in women is endometriosis. Endometriosis is the growth of tissue somewhere other than the uterus, usually the ovaries and fallopian tubes. In some cases, this tissue can accumulate around the sciatic nerve or the nerve itself. As the tissue responds to the changes taking place during a normal menstrual cycle, recurrent sciatica pain can present.
Vascular diagnoses
Arteries and veins in the pelvis and lower extremities that have become abnormal can cause sciatica. Either through compression or lack of oxygen from poor blood flow. An aneurysm can happen when the wall of the artery weakens and cannot withstand the pressure of the blood flowing through. This enlarges the artery and in some cases, the artery grows large enough to compress the nerve.
Peripheral artery disease can cause sciatica when not enough blood is circulated from the heart to the muscles in the legs. If not enough oxygen is delivered to the muscles, leg pain and numbness can occur. It’s called claudication and is characterized by pain that is aggravated when walking and relieved when standing still. Risk factors for peripheral artery disease include:
Smokers both current and those who have quit
High blood pressure
High cholesterol
Diabetic
Diabetes/high blood sugar
Diabetic peripheral neuropathy happens from nerve damage caused by high blood sugar. Nerves that are exposed to chronic high blood sugar can get damaged from the disruption of proper blood flow or from an alteration of the cellular structure of the nerve.
Prescription meds
Nerve and muscle damage can happen as a side effect from prescription meds. Neuropathy and myopathy can cause symptoms that mimic sciatica brought on by disc herniation. Sometimes, if the medication is no longer taken the symptoms go away. The list of medications include:
Chemotherapy agents
Antibiotics
Statins medication to help lower cholesterol
Piriformis syndrome and back pocket wallets
The piriformis muscle originates on the sacrum, runs through the sciatic notch, shown above, and attaches the top of the femur. The sciatic notch also includes the sciatic nerve. Piriformis syndrome is caused when the piriformis muscle compresses the sciatic nerve. Individuals typically report pain in the buttocks that shoots down the same leg and is made worse when sitting. Piriformis syndrome can be difficult to diagnose, but physical exam maneuvers have been developed in aiding the diagnosis of the syndrome. They involve some form of hip abduction resistance and external rotation to cause a contraction of the piriformis muscle.
Back pocket wallet
Also known as wallet neuritis, and wallet sciatica are terms that have been used to describe compression of the sciatic nerve by a heavy/bulky wallet in a back pocket. It is similar to symptoms of piriformis syndrome and presents in the buttocks and the same leg that can get aggravated from sitting. Usually, if the wallet is the sole cause, taking the wallet from the back pocket to another pocket or other storage option often brings pain relief.
Conclusion non-spine related causes
While the majority of sciatica cases are caused by a back problem, injury, etc. There are various causes outside of the spinal column. Being able to describe the:
Location
Pain severity
Associated symptoms
Factors that aggravate and alleviate the pain
These can absolutely help your doctor, chiropractor, specialist accurately diagnose and generate an optimal customized treatment plan for spine-related or non-spine-related sciatica.
Chiropractors & Sciatica Syndrome Expose
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