Sciatica is one of the most common injuries, with as many as 40% of individuals experiencing the condition, and it becomes more frequent as the body ages. The pain originates with the sciatic nerves and can go on for several weeks, months, or years. Staying active is a major recommendation to relieve the pain and prevent future flare-ups. Injury Medical Chiropractic and Functional Medicine Clinic can decompress and release the nerve and educate individuals on an anti-inflammatory diet and staying active to expedite healing.
Staying Active
Sciatica is most commonly caused by a slipped disc, which puts pressure or irritates the sciatic nerve, and causes discomfort and painful sensations. The most common factors for developing sciatica include the following:
As the body ages, the spinal discs wear out and break down, leading to the spine shifting out of alignment.
Job occupations that place added strain on the back, like sitting or standing for extended periods, repetitive heavy lifting, or bending, reaching, and twisting movements.
Doctors and chiropractors have found that only resting with sciatica can worsen the injury.
This is because if it is a slipped/bulging/herniated disc, the disc remains in this state, the nerve stays compressed or irritated, and the muscles that control the low back become weak and unable to provide support.
Recommendations
Don’t Sit For Too Long
Prolonged periods of sitting place added pressure on the discs and ligaments in the low back.
Even when sitting doesn’t make it worse, the muscles can develop unhealthy muscle memory that causes partial contracting when there shouldn’t be any that tightens the gluteal muscles causing added strain.
Individuals with a job requiring a lot of sitting or standing are recommended to take frequent breaks to stretch out their muscles or use a standing desk to change positions.
Posture Adjustments
Slouching, hunching, and continuing to practice unhealthy postures will exacerbate sciatica.
Pay attention to the body’s position when standing or sitting.
To prevent slouching, pull the shoulders down and back.
Imagine the shoulder blades touching.
Individuals working at a desk or workstation should take frequent breaks.
Position the screen to see it without tilting the head down.
Increase Physical Activity and Exercise
Exercise is highly recommended to keep the muscles and nerves moving and circulation flowing.
Aerobics
Walking, light jogging, swimming, cycling, and dancing, increase heart rate without causing added strain or pain.
Strength Training
Exercises using free weights, weight machines, or isometric exercises strengthen the muscles and can help restore their position.
Stretching and Flexibility Training
Yoga, tai chi, and Pilates increase flexibility and strength.
The stretching will keep the nerves and muscles from spasms that can worsen the injury.
Strengthen The Core
A stronger core will improve spinal health. Actively engaging the abdominal muscles protects sciatic nerve roots by minimizing spinal pressure.
The back muscles can become increasingly stressed and tired when they have to do all the work without core muscle support.
A weak core can cause additional back pain and worsen sciatica symptoms.
Stand Up Straight
Keep the head and shoulders straight.
Focus On Breathing
Rhythmic breathing helps keep the mind focused and alert while engaged in an activity.
Core Muscles
The back, side, pelvis, and buttock muscles are also part of the core.
Strengthening all of these muscles helps to support the spine.
Exercises for core strengthening include yoga and Pilates, planks, and bridges.
Nerve Recovery
As the nerve recovers, the area the nerve supplies could experience tingling discomfort.
This could be accompanied by an electric sensation at the level of the healing nerve fibers.
The location of this sensation should move as the nerve heals.
With time the sensations should subside, and the area should begin to feel more normal.
Spinal Decompression Demonstration
References
Jensen, Rikke K et al. “Diagnosis and treatment of sciatica.” BMJ (Clinical research ed.) vol. 367 l6273. 19 Nov. 2019, doi:10.1136/bmj.l6273
Kuai, Shengzheng, et al. “Influences of lumbar disc herniation on the kinematics in multi-segmental spine, pelvis, and lower extremities during five activities of daily living.” BMC musculoskeletal disorders vol. 18,1 216. 25 May. 2017, doi:10.1186/s12891-017-1572-7
Ma, Xiao, et al. “The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults.” Frontiers in psychology vol. 8 874. 6 Jun. 2017, doi:10.3389/fps.2017.00874
Ramaswami, Ramya, et al. “Management of Sciatica.” The New England journal of medicine vol. 376,12 (2017): 1175-1177. doi:10.1056/NEJMclde1701008
Spondyloarthritis is a group of inflammatory, immune-mediated diseases that cause chronic low back pain, inflammation, irritating aches, and pains. The conditions mostly affect the spine but can affect joints in the arms, legs, hips, skin, eyes, and intestines. Spondylitis types can significantly affect daily function, physical activity and compromise bone health.
Spondylitis Types
The main types include:
Ankylosing spondylitis
Psoriatic arthritis
Enteropathic arthritis
Reactive arthritis
Juvenile spondylitis
Undifferentiated spondylitis
Axial Spondylitis vs. Peripheral Spondylitis Types
Axial means relating to the body’s central region, as in the trunk and head.
Axial spondyloarthritis is arthritis and inflammation in the hips and spine.
The condition starts before age 45.
The pain typically starts in the low back but can begin in the neck or other regions.
Characterized by back pain, usually in the lower back and/or buttocks.
Morning back stiffness lasting 30 minutes or longer.
Sacroiliac joint inflammation can also present.
The back pain gradually progresses.
Lasts longer than three months.
Improves with physical movement, not with rest.
Peripheral spondyloarthritis is arthritis and inflammatory pain in the peripheral joints and tendons and does not include the spine.
Individuals can have peripheral and axial spondylitis symptoms simultaneously.
Diagnosis depends on whether symptoms are primarily peripheral or axial.
Spondylitis and Spondylosis
Spondylosis and spondylitis are similar in they cause pain and inflammation in the back and hips. The difference is in each condition’s triggers.
Spondylitis is a disease in which the body’s immune system degrades joints, causes inflammation, overproduces bone formation, and causes bone fusion.
Spondylosis is a category of arthritis that presents as the spine ages from normal wear and tear.
It happens during the degeneration of the spine’s discs and joints.
It also presents when bone spurs develop on the spine’s vertebrae.
Ankylosing Spondylitis
Ankylosing spondylitis is the most common form of arthritis affecting the spine, other joints, and body regions. The condition causes spinal joint inflammation causing extreme discomfort and chronic pain. In some cases, the inflammation progresses to ankylosis, where spine sections fuse and become immobile. Other body areas that can trigger inflammation include:
The ribs
Heels
Shoulders
Hips
Small joints of the feet and hands.
Ankylosing spondylitis symptoms vary from person to person. Common early symptoms include:
There is general discomfort, appetite loss, and mild fever early in the condition.
Persistent stiffness and pain in the buttocks and low back, gradually progressing over a couple of weeks or months.
The pain and stiffness can travel into the neck and spine within months or years.
The pain is usually spread out and dull.
The stiffness and pain are worse in the morning and night and improve with light exercise or a warm shower.
The pain typically becomes chronic, lasts for a minimum of 3 months, and can be felt on both sides.
Tenderness and pain in the hips, thighs, shoulder blades, heels, and ribs may also occur.
Treatment approaches include applications of ice and heat to reduce swelling, increase circulation, and decrease joint pain, posture exercises, stretches, physical therapy, and medication.
Psoriatic Arthritis
Psoriatic arthritis causes swelling, pain, and inflammation in the small joints of the hands and feet; however, the joints of the knees, ankles, and wrists can also be affected. Psoriasis is a rash that causes scaly skin patches.
Individuals can develop dactylitis when a finger or toe swells between the surrounding joints.
Spinal stiffness and pain can present.
Typically the ends of the finger joints are most affected and experience pain and inflammation.
Medications frequently utilized to treat ankylosing spondylitis can be used.
Exercise helps preserve the range of motion and maintain strength.
Isometric exercises work muscles without joint motion reducing the risk of further injury to inflamed joints.
Occupational and physical therapy can significantly assist in optimizing arthritic joint function.
Enteropathic Spondylitis
Enteropathic Arthritis is chronic inflammatory arthritis linked to inflammatory bowel disease. The most recognized are Crohn’s and ulcerative colitis.
The peripheral limb joints and sometimes the whole spine are the most prevalent body areas afflicted with enteropathic spondylitis.
The main symptom is intestine inflammation, including bowel and joint pain and/or inflammatory back pain.
Other symptoms can include weight loss, blood in the stool, abdominal pain, and/or chronic diarrhea.
Managing enteropathic arthritis typically means managing the underlying bowel disease.
Juvenile Spondyloarthritis
Juvenile spondyloarthritis is a group of childhood rheumatic diseases that cause arthritis before age 16 and can continue through adulthood. Juvenile spondyloarthritis encompasses:
Enteropathic arthritis
Enthesitis-related arthritis
Undifferentiated spondyloarthritis
Psoriatic arthritis
Reactive arthritis
Juvenile ankylosing spondylitis
Juvenile spondyloarthritis causes inflammation and pain in joints in the lower body, like the ankles, hips, knees, and pelvis. Other body areas that could be affected include:
The bowels
Eyes
Skin
Spine
Lethargy and fatigue can also present. The symptoms can be unpredictable and episodic, appearing and disappearing without a specific cause. The condition cycles between flare-ups and remission. Common treatment approaches include:
Medication
Exercise
Posture training
Physical therapy, medication
Ice and heat to decrease joint pain and relax muscles.
In severe cases, surgery could be recommended.
Reactive Arthritis or Reiter’s Syndrome
Reactive arthritis is arthritis that causes pain and inflammation in the mucous membranes, bladder, skin, joints, eyes, and genitals.
Reactive arthritis is believed to be a reaction to an infection, usually in the gastrointestinal or urinary tract.
Reactive arthritis does not affect the sacroiliac joints and spine in most cases.
Reactive arthritis is typically treated with nonsteroidal anti-inflammatory medications, steroids, and rheumatoid arthritis medications.
A physician could prescribe antibiotics if a bacterial infection brought on reactive arthritis.
Undifferentiated Spondyloarthritis
Undifferentiated spondyloarthritis is where the signs and symptoms of spondylitis don’t meet the criteria for a specific rheumatoid disorder. Individuals diagnosed with undifferentiated spondyloarthritis will have one or more of the symptoms that include:
Fatigue
Back inflammation
Back pain
Buttock pain that alternates or presents on both sides.
Swollen toes or fingers
Heel pain
Arthritis in the small joints.
Arthritis in the large limb joints.
Enthesitis or inflammation where the ligament or tendon connects to the bone.
Eye inflammation
Individuals can also present symptoms of other spondylitis types, like psoriatic or ankylosing.
Treatment approaches include:
Exercise
Physical therapy
Posture training
Ice and heat to decrease joint pain and loosen up muscles.
Spondylitis Types Diagnosis of Spondyloarthritis
References
Carron, Philippe, et al. “Peripheral spondyloarthritis: a neglected entity-state of the art.” RMD open vol. 6,1 (2020): e001136. doi:10.1136/rmdopen-2019-001136
Gill, Tejpal, et al. “The intestinal microbiome in spondyloarthritis.” Current opinion in rheumatology vol. 27,4 (2015): 319-25. doi:10.1097/BOR.0000000000000187
Rosenbaum, James T. “The eye in spondyloarthritis✰.” Seminars in arthritis and rheumatism vol. 49,3S (2019): S29-S31. doi:10.1016/j.semarthrit.2019.09.014
Seo, Mi Ryoung et al. “Delayed diagnosis is linked to worse outcomes and unfavorable treatment responses in patients with axial spondyloarthritis.” Clinical rheumatology vol. 34,8 (2015): 1397-405. doi:10.1007/s10067-014-2768-y
Sharip, Aigul, and Jeannette Kunz. “Understanding the Pathogenesis of Spondyloarthritis.” Biomolecules vol. 10,10 1461. 20 Oct. 2020, doi:10.3390/biom10101461
Tendons and Ligaments: A tendon is a fibrous flexible, strong tissue similar to a rope that attaches the muscles to the bones. Tendons allow for the movement of the body’s limbs and help prevent muscle injury by absorbing muscles’ impact when running, jumping, or performing other actions. Ligaments are bands of solid elastic tissue that connect bone to bone, hold structures together and keep them stable, support the joints and limit their movement.
Tendons and Ligaments
Tendons are strong and non-flexible.
Ligaments are flexible and elastic.
Both comprise collagen and living cells, essential in joints and bones and integral to locomotion.
Tendons allow body movement by transmitting force from muscle to bone, allowing the body to stand, walk, and jump.
Ligaments work by allowing for the full range of motion.
Ligaments are around the knees, ankles, elbows, shoulders, and other joints.
Connective Tissue
The collagen connective tissue that makes up tendons and ligaments is the same; their patterns are different.
Tendon fibers are laid out in a parallel pattern.
Tendon connective tissue needs to have more elasticity to help move the muscles.
Ligament fibers are laid out in a crisscross pattern.
Ligament connective tissue stabilizes and strengthens the bones’ joint structure.
Tendon Injury
A tendon that gets overstretched or torn is known as a strain. Common areas affected by strains are the:
Leg
Foot
Back
Strains often result from repetitive work movements, intense physical activity, and sports. Individuals who overuse their bodies without proper rest and muscle repair recovery have an increased risk of injury. Symptoms include:
Inflammation
Swelling
Pain
Cramping
Weakness
Ligament Injury
A ligament that gets overstretched or torn results in a sprain. Sprains can happen suddenly from a fall, awkward movement, or trauma. Sprains commonly occur in the:
Ankle
Knee
Wrist
Examples include:
Misstep causing the ankle to twist in an awkward position, snapping a ligament and causing unstableness or wobbliness.
There could be a popping sensation or the feeling of a tear when the injury occurs.
Wrist sprains often happen when reaching out and extending the hands to break a fall, and the wrist hyperextending back.
The hyperextension overstretches the ligament.
Symptoms of a sprained ligament include:
Inflammation
Swelling
Bruising
Pain
The joint may feel loose or weak and unable to take on weight.
The intensity of symptoms varies depending on whether the ligament is overextended or torn. Sprains are classified by grade:
Grade 1 – a mild sprain with slight stretching of the ligament.
Grade 2 – a moderate ligament tear, but not a complete tear.
Grade 3 – a complete ligament tear, making the joint unstable.
Chiropractic Care
Tendons and ligaments do not receive full blood circulation like other soft tissues. Depending on the severity of the injury, and the slower transfer of oxygen and nutrients, ligament and tendon injuries can take six to twelve weeks to heal, and repeatedly stressing the injured area from overuse can extend recovery. Chiropractic adjustments, and massage therapy, combined with corrective exercises and stretches, will reduce inflammation, decrease pain, improve the range of motion, increase nerve and muscle function, and strengthen the muscles. Chiropractic treatment involves:
Childress, Marc A, and Anthony Beutler. “Management of chronic tendon injuries.” American family physician vol. 87,7 (2013): 486-90.
Fenwick, Steven A et al. “The vasculature and its role in the damaged and healing tendon.” Arthritis research vol. 4,4 (2002): 252-60. doi:10.1186/ar416
Leong, Natalie L et al. “Tendon and Ligament Healing and Current Approaches to Tendon and Ligament Regeneration.” Journal of orthopedic research: official publication of the Orthopaedic Research Society vol. 38,1 (2020): 7-12. doi:10.1002/jor.24475
Scalcione, Luke R et al. “The athlete’s hand: ligament and tendon injury.” Seminars in musculoskeletal radiology vol. 16,4 (2012): 338-49. doi:10.1055/s-0032-1327007
Forklifts, also known as lift trucks, are used for loading, unloading, and transporting various goods and materials in construction, shipping, and retail industries. They are heavy-duty equipment and require extensive training to operate safely. Forklifts are involved in many serious workplace accidents causing thousands of injuries annually. Chiropractors specialize in injury care and rehabilitation from vehicle accidents and collisions. They can help restore optimal musculoskeletal function and health through adjustments, massage, decompression, and traction therapies.
Forklift Operation
The forklift is one of the most widely used pieces of equipment to raise, lower, or remove pallets, boxes, crates, or other containers and transport and stock goods and materials. There are a variety of lift trucks that include:
The weight, speed, and operation difficulty increase the risk of an accident, increasing the risk of injuries. Other factors include:
They can reach up to 20 miles per hour or more.
They have front braking systems making it harder to stop.
The weight distribution is in the back.
The rear wheels turn instead of the front, causing tip-overs.
Most carry their loads in front and can obstruct an operator’s view.
Lifting too heavy a load can destabilize a forklift and cause it to turn over.
Accident and Injury Causes
Federal work safety regulations require individuals to complete a training program to operate a forklift safely. The most common causes of accidents include:
Lack of training and experience.
Lack of safety equipment – helmets, seatbelts, grab handles, roll cages, cage guards, warning lights, and sirens.
Lack of maintenance – bent forks, no load backrest, unbalanced wheels, etc.
Improper loading – off center, damaged goods, loose loads.
Lifting, moving or tilting the mast too fast.
Riding with a raised load.
Speeding.
Improper backing-up techniques.
Poor communication.
Horseplay.
Giving rides.
Failing to immobilize the machine when the operator leaves.
Failing to pay attention to the position of the forks.
Failing to yield to pedestrians.
Traveling up or down unsafe inclines.
Driving off the side of a ramp.
Design or manufacturing defects.
Common Accidents
The most common type of accidents involve:
Tip-overs and Rollovers.
Falling off the lift.
Getting struck by falling materials or objects.
Pedestrian injuries like getting hit by the vehicle or tripping over the forks.
Getting caught in or compressed/crushed by the vehicle or objects.
Injuries
The most common injuries that result from lift accidents include:
Chiropractic therapy can help heal and rehabilitate musculoskeletal injuries. A chiropractic team will relieve pain symptoms and restore the body’s alignment and function. Treatment includes:
Adjustments
To gently realign joints.
Decrease pain.
Increase range of motion.
Improves posture.
Soft-tissue massage
To relax tight muscles.
Relieve spasms.
Release tension in the connective tissue surrounding the muscles.
Reduces pain.
Improves the range of motion of the spine and joints.
Exercises and stretches
To restore and maintain flexibility, joint stability, and mobility.
Joint bracing and taping
To support sprained joints or muscles during healing.
Health Coaching
Guides diet and nutrition to reduce inflammation and promote healthy eating to manage weight.
Forklift Fails
References
Bage, T et al. “Forklift-related lower limb injuries: a retrospective case series study with patient-reported outcome measures (PROMs).” Annals of the Royal College of Surgeons of England vol. 103,10 (2021): 730-733. doi:10.1308/rcsann.2020.7124
Born, C T et al. “Patterns of injury and disability caused by forklift trucks.” The Journal of trauma vol. 40,4 (1996): 636-9. doi:10.1097/00005373-199604000-00020
Hong, Choon Chiet, et al. “Forklift-Related Crush Injuries of the Foot and Ankle.” Foot & ankle international vol. 36,7 (2015): 806-11. doi:10.1177/1071100715576486
Ull, Christopher et al. “Injuries after Forklift Trucks Accidents – Injury Patterns, Therapy and Outcome in the Context of the Statutory Accident Insurance.” “Gabelstaplerunfälle – Verletzungsmuster, Therapie und Outcome im berufsgenossenschaftlichen Kontext.” Zeitschrift fur Orthopadie und Unfallchirurgie, 10.1055/a-1402-1649. 19 Apr. 2021, doi:10.1055/a-1402-1649
Waters, Thomas et al. “Lower back disorders among forklift operators: an emerging occupational health problem?.” American journal of industrial medicine vol. 47,4 (2005): 333-40. doi:10.1002/ajim.20146
The low back is a common source of discomfort and soreness among volleyball players because of repetitive jumping, bending, and rotating of the trunk. Adolescents have an increased risk of this injury because their vertebral bones are still developing, which increases the risk for stress fractures. Chiropractic care, massage therapy, decompression, rest, and athletic training can help expedite pain relief and heal the injury.
Volley Back Pain
Muscle or ligament strains are the most common injury from repetitive jumping, bending, rotating movements, and hyperextension during serving, hitting and setting. This can lead to excessive compression forces on the discs and joints, causing reduced blood circulation, increasing the risk of overload injuries. One study reported that low back pain is experienced in 63% of players. However, if low-back pain is accompanied by pain that runs down the leg along with numbness or weakness in the foot or ankle, the issue could be a herniated disc.
Causes
One common reason is endurance imbalances in the muscles that stabilize the low back. The core muscles provide stability to the low back and spine for all movements. If imbalances are present, a player may spike or serve the ball with intense turning and arching. The added actions cause increased pressure in the joints and hip, gluteal, and leg muscles, affecting the spine’s stability.
The gluteals run from the back of the pelvis/hip bones down to the outside of the thigh.
The gluteal muscles prevent the trunk and hips from overbending forward when landing.
If the gluteal muscles do not have the strength and endurance to perform this motion, the upper body will bend too far forward, causing poor landing posture and decreased spine stability.
Anterior Pelvic Tilt
Studies have shown that players with low back pain tend to stand and land with an anterior pelvic tilt. This is an unhealthy posture when the front of the pelvis tilts forward, and the back of the pelvis raises. Landing hard with an anterior pelvic tilt causes increased arching and increases the pressure in the joints.
Chronic back pain
Warning signs of a more serious back problem include:
Pain that has lasted for more than 1 week and is not improving or getting worse.
Pain that prevents sleep or causes the individual to constantly wake up.
Difficulty sitting.
Back soreness when performing basic tasks and chores.
Significant pain on the court when jumping, landing, or rotating.
Chronic pain ranges from aches to shooting or throbbing pain that can run down the buttocks and legs.
Chiropractic Care
A chiropractor can alleviate volleyball back pain, rule out a more severe injury, such as a stress fracture or herniated disc, and provide a healthier and faster recovery. According to a study, athletes who received chiropractic care showed better speed and mobility. Quick reflexes and hand-eye coordination depend on an optimal functioning nervous system. 90% of the central nervous system travels through the spine. When one or more spinal segments are misaligned, the effect on the nervous system can seriously impact and disrupt nerve circulation, affecting speed, mobility, reflexes, and hand-eye coordination. Chiropractic adjustments will:
Relax and reset the back muscles.
Realign and decompress the spine.
Remove the pressure around the nerve roots.
Strengthen the core.
Improve and increase range of motion, strength, and overall endurance.
Anterior Pelvic Tilt
References
Haddas R, Sawyer SF, Sizer PS, Brooks T, Chyu MC, James CR. “Effects of Volitional Spine Stabilization and Lower-Extremity Fatigue on the Knee and Ankle During Landing Performance in a Population With Recurrent Low Back Pain.” J Sport Rehabil. 2017 Sep;26(5):329-338. doi: 10.1123/jsr.2015-0171.
Hangai M. et al., Relationship Between Low Back Pain and Competitive Sports Activities During Youth, Am J Sports Med 2010; 38: 791-796; published online before print January 5, 2010, doi:10.1177/0363546509350297.
Jadhav, K.G., Deshmukh, P.N., Tuppekar, R.P., Sinku, S.K.. A Survey of Injuries Prevalence in Varsity Volleyball Players. Journal of Exercise Science and Physiotherapy, Vol. 6, No. 2: 102-105, 2010 102
Mizoguchi, Yasuaki, et al. “Factors associated with low back pain in elite high school volleyball players.” Journal of physical therapy science vol. 31,8 (2019): 675-681. doi:10.1589/jpts.31.675
Movahed,Marziehet al. (2019). “Single leg landing kinematics in volleyball athletes: A comparison between athletes with and without active extension low back pain.”
Sheikhhoseiniet al. (2018). “Altered Lower Limb Kinematics during Jumping among Athletes with Persistent Low Back Pain”
Sciatica is common and affects up to 40% of the general population. Different types include acute, chronic, alternating, and bilateral sciatica. The sciatic nerve comprises three specific nerve roots in the lower back. The three nerves originate in the L4 and L5 vertebrae and the sacrum, just below the vertebrae. The nerve then branches off and runs through the back of each thigh. Injury, compression, or irritation of these nerves can cause various symptoms, including numbness, tingling, electrical shooting pain, and muscle spasms in the low back, the leg, and the foot. Chiropractic care can realign the spine, relax the muscles, release compression and relieve sciatica.
Acute, Chronic, Alternating, and Bilateral Sciatica
Acute
Acute pain can be brought on by sudden irritation to the nerves that have become pinched, compressed, or a combination.
Causes a constant burning or shooting sensation through the low back, buttocks, down the leg, and possible hip discomfort.
It becomes worse when sitting.
It can cause immediate and short-term pain lasting for 1-2 weeks.
Chronic
Chronic sciatica can last for months or years on and off or continuously.
It can be caused or worsened by inflammatory conditions like rheumatoid arthritis, injuries, infections, and spinal misalignment issues.
It can resolve but will come back without treatment or lifestyle and activity adjustments.
Bilateral
Sciatica typically takes place in one leg; it has been known to be bilateral and experienced in both legs.
This type of sciatica is rare but can occur from degenerative changes in the vertebrae and/or the discs at several spinal levels.
If there is pain in both legs, it is likely not a herniation but degenerative changes like spinal stenosis.
The symptoms can range from infrequent to irritating to severe and debilitating.
Weakness may be felt in the leg and foot, or a feeling of heaviness, making it difficult to lift the foot off the floor.
Alternating
Alternating sciatica affects both legs alternately. It is usually connected to bilateral sciatica that switches sides.
This type is rare and can result from degenerative problems in the sacroiliac joint, the joint connecting the spine to the hips, or sacroiliac arthritis.
Spinal Sources
Sciatica occurs when L4, L5, and/or S1 nerve roots are affected.
L4 Nerve Root
Pain in the hip, thigh, inner medial areas or the knee, and the calf.
Weakness in the thigh and hip muscles.
Reduced knee-jerk reflex.
Loss of sensation around the calf.
L5 Nerve Root
Pain in the buttock and the outer area of the thigh.
Weakness in the buttock and leg muscles.
Difficulty moving the ankle and lifting the big toe upward.
Loss of sensation between the big toe and the second toe.
S1 Nerve Root
Known as classic sciatica.
Pain in the buttock, back of the calf, and side of the foot.
Fatigue in the buttock and foot muscles.
Difficulty and discomfort raising the heel off the ground or walking on tiptoes.
Loss of sensation in the foot’s outer side, including the third, fourth, and fifth toes.
Chiropractic care can directly address the root cause of the problem, treat the cause, and alleviate the symptoms. Chiropractic manipulation is recommended by the American College of Physiciansas a first line of treatment for back pain before medication, muscle relaxants, injections, and surgery. Treatments to address sciatic nerve impingement:
Ice/Cold Therapy
Reduces inflammation and swelling.
Prepares the patient for massage and adjustments.
Therapeutic Tissue Massage
This therapy promotes muscle relaxation and lessens the muscle spasm/recoil response.
Ultrasound
Soothing heat created by sound waves penetrates the muscles, increases circulation, and relaxes the muscles to alleviate spasms, stiffness, and pain.
Transcutaneous Electrical Nerve Stimulation/Tens Unit
A muscle stimulation machine applies electrical impulses to relax the muscles and untangle muscle knots.
Spinal Manipulation
This process realigns the spine to move properly and restores vertebral health.
Stretches and Exercises
This ensures treatment will last once treatment has or is coming to an end.
Spinal Decompression
Pulls and stretches the body to release any compression on the nerve roots and infuse circulation back into the discs.
The pressure is taken off the sciatic nerve, and routine adjustments will retrain the muscles to maintain their re-alignment. The duration of treatment will vary based on the root cause of sciatica. Each treatment plan is tailored to the individual patient’s situation.
Severe and Complex Sciatica Syndromes
References
Davis D, Maini K, Vasudevan A. Sciatica. [Updated 2022 May 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507908/
Hernández C.P., Sanchez N., Navarro-Siguero A., Saldaña M.T. (2013) What is Sciatica and Radicular Pain?. In: Laroche F., Perrot S. (eds) Managing Sciatica and Radicular Pain in Primary Care Practice. Springer Healthcare, Tarporley. https://doi.org/10.1007/978-1-907673-56-6_1
Kumar, M. Epidemiology, pathophysiology and symptomatic treatment of sciatica: A review. nt. J. Pharm. Bio. Arch. 2011, 2.
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Witenko, Corey, et al. “Considerations for the appropriate use of skeletal muscle relaxants for the management of acute low-back pain.” P & T : a peer-reviewed journal for formulary management vol. 39,6 (2014): 427-35.
Wright R, Inbody SB. Radiculopathy and Degenerative Spine Disease. In: Neurology Secrets. Elsevier; 2010:121-130. doi:10.1016/b978-0-323-05712-7.00007-6
When the body is correctly aligned, the shoulders are the same height, and face forward. Uneven shoulders are when one shoulder begins to raise higher than the other. It usually starts with a slight difference but can turn into a more severe imbalance causing discomfort, tightness, and pain in the neck, shoulders, hips, and back. Chiropractic treatment can bring the body back into balance and alignment through various techniques and therapy modalities.
Misaligned Uneven Shoulders
Several factors can lead to uneven shoulders. Misalignments can be caused by:
Often the shoulder on the dominant side tends to be slightly lower.
Constantly using one hand or side for everything.
Carrying a heavy bag on the dominant shoulder.
Structural issues or muscular skeletal imbalances in other areas of the body.
For example, if the ankle or hip gets injured, it can cause an individual to bring their body out of alignment to adjust to how they position themselves and move. Other common causes include:
Overuse of the shoulders
Tight upper back muscles
Unhealthy posture
Uneven hips
Pinched nerve
Weak muscles
Flat feet
Sedentary lifestyle
Varying leg length
Osteoporosis
Scoliosis
Shoulder injuries
Incorrect sleeping position or sleeping on one side
Sports like tennis, golf, and baseball have an increased risk of causing misaligned, uneven shoulders and posture imbalances.
Symptoms
Uneven shoulders can result in discomfort, tightness, and stiffness in the neck, shoulders, and lower back.
Continued tightness and pulling in the higher shoulder.
A chiropractic massage and functional medicine team will bring the shoulders back into normal alignment.
Therapeutic myofascial release massage will release tension, relax the muscles, and increase flexibility.
Chiropractic adjustments
Spinal decompression therapy
Stretches and muscle-building exercises to balance the shoulders.
Lifestyle adjustment instructions for switching shoulders when carrying bags, using armrests, using the phone, using a mouse, and using ergonomic chairs.
Posture training includes learning to stay aware of one’s posture throughout the day when standing or sitting and completing regular activities.
Learning to use the non-dominant arm to balance the workload.
Incorporating relaxation, meditation, and breathing techniques to relieve stress, tension, and tightness.
Shoulder Pain Treatment
References
Burbank, Kelton M et al. “Chronic shoulder pain: part I. Evaluation and diagnosis.” American family physician vol. 77,4 (2008): 453-60.
Foroozan Mahmoodi et al. The effect of corrective exercises on the pain and degree of uneven shoulder deformity https://rsr.basu.ac.ir/article_625_en.html
Mayo Clinic Staff. (2017). Stress management. mayoclinic.org/healthy-lifestyle/stress-management/in-depth/relaxation-technique/art-20045368
Mitchell, Caroline, et al. “Shoulder pain: diagnosis and management in primary care.” BMJ (Clinical research ed.) vol. 331,7525 (2005): 1124-8. doi:10.1136/bmj.331.7525.1124
Pu Chu, Eric Chun, and Kevin Hsu Kai Huang. “Bridging the gap between observation and brace treatment for adolescent idiopathic scoliosis.” Journal of family medicine and primary care vol. 6,2 (2017): 447-449. doi:10.4103/jfmpc.jfmpc_52_17
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