To help! My back pain and sciatica are killing me!

The pain in your lower back brings you to your knees again. All he did was bend down to pick up the pen that he dropped on the floor. However, this time is different. It is worse than it has been in the past. This time he feels pain running down the back of his leg. A hot dagger is stabbing you in the butt and you feel numbness and tingling down your leg, maybe even your foot. He is unable to straighten up to walk and is limping as if shot. You stand still and pray that the pain goes away … but it doesn’t go away. In fact, it is getting worse. His thoughts come in quick succession, “what is happening to me, what should I do, who do I call, should I go to the emergency room, will I need surgery?” Good question.

If you experience any combination of these symptoms, you likely have a herniated disc in your lower back, one of the causes of mechanical low back pain. Swelling of the inflammation or of the disc itself can cause a pinch or “pinch” of the spinal nerve root. The lower lumbar nerve roots eventually form the sciatic nerve in your leg. Inflammation of this nerve is commonly known as sciatica. “Mechanical low back pain is one of the most common complaints that patients express to emergency physicians in the United States, accounting for more than 6 million cases a year. Approximately two-thirds of adults are affected by mechanical low back pain. at some point in their lives for what is the second most common complaint in outpatient medicine and the third most expensive disorder in terms of health care dollars, second only to cancer and heart disease. ” 1

But just because you have these symptoms doesn’t necessarily mean that you need to see a surgeon quickly. According to a landmark study published in the medical journal Spine, “An operation should not be performed if another treatment will give equivalent results within an acceptable period of time … the patient with low back pain and sciatica should not be automatically referred to the surgeon.” 2 If that’s the case, what are some of your other options? If you’re like most people, the first place you’ll think to visit is your family doctor’s office (or an emergency room, if you’re really panicking). Traditionally, doctors prescribe medications, such as pain relievers, muscle relaxants, anti-inflammatories, or any combination of these. There are three problems with taking medication, if this is all that is done.

1. Medication only treats symptoms.
2. Medication only provides temporary relief.
3. Medications have many unhealthy side effects. Take the time to read the warning leaflet with any of these medications and you will know what I am talking about.

On the contrary, chiropractic care has been shown to be more effective in treating chronic low back pain than traditional medical care. In a study published in the Journal of Manipulative Physiological Therapeutics (JMPT), he concluded that “… the improvement for chiropractic patients was 5 times greater [than for medical patients]. Patients with chronic low back pain treated by chiropractors show greater improvement and satisfaction per month than patients treated by family doctors “3.

Are there times when surgery is necessary? The answer is definitely yes. The absolute signs for surgical intervention are those patients with cauda equina syndrome (which is rare), in the presence of severe motor deficits as a result of a large extruded or migrated disc fragment, and in patients with intractable pain. Unless one of these conditions is present, chiropractic care for the treatment of discogenic or mild to moderate sciatic pain from a herniated intervertebral disc has been shown to be safe and effective. A study shows that chiropractic treatment (in this case in the cervical spine) is 100 times safer than the use of non-steroidal anti-inflammatory drugs such as asprin, ibuprofen, naproxen, etc. 4 Another study shows that patients had an 86% improvement in chronic low back pain after a course of chiropractic care. 5

As a side note, let me also say that medical care and chiropractic care are not mutually exclusive ways of treating mechanical low back pain and sciatica. In my experience, I have seen great results in the most severe cases when managing these conditions in cooperation with the patient’s primary care physician or pain management specialist. In these cases, medication is useful or necessary for the patient to tolerate conservative care; for example, when it is extremely difficult for the patient to move or be moved.

Lastly, not all cases of sciatica are caused by a herniated disc. A condition called piriformis syndrome can cause a sciatic nerve to impinge when it exits the pelvis. Basically, the piriformis muscle inserts into the sacrum, passes through the greater sciatic notch in the pelvis, and inserts into the upper part of the femur (the bone in the upper leg). Athletes who play seated sports, such as rowing or cycling, are particularly vulnerable to piriformis stresses. Runners who overpronate are also susceptible to piriformis injury. When the muscle is injured, it causes swelling due to inflammation, which can then irritate or compress the sciatic nerve as it exits the pelvis. It is important to rule out a spinal injury as a cause of sciatica, but the following video will demonstrate a stretch of the piriformis muscle. If your symptoms resolve after stretching for a week or two, then you probably had piriformis syndrome and should continue this stretch as part of your daily routine to help prevent future injury. However, if you continue to experience the same symptoms or if they intensify, seek professional help as soon as possible.

1. Kinkade S. Evaluation and treatment of acute low back pain. I am Fam Physician. 2007 Apr 15; 74 (8): 1181-8.
2. Weber H. Lumbar disc herniation: a prospective controlled study with ten years of observation. Spine 1983; 8: 131-40.
3. Nyiendo J, Haas M, Goodwin P. Patient Characteristics, Practice Activities, and One-Month Outcomes for Chronic and Recurrent Low Back Pain Treated by Chiropractors and Family Medicine Physicians: A Practice-Based Feasibility Study. JMPT May 2000; 23 (4): 239-245.
4. Hurwitz EL, Aker PD, Adams AH, Meeker WC, Shekelle PG. Manipulation and mobilization of the cervical spine. A systematic review of the literature. Spine 1996 Jan 1 (15): 1746-59.
5. Harrison DE, Cailliet R, Harrison DD, Janik TJ, Holland B. Sagittal lumbar configuration changes with a new extension traction method: a non-randomized controlled clinical trial. Archives of Physical Medicine and Rehabilitation 2002 November; 83 (11): 1585-91.