Can Chiropractic Help with Sciatica?

"I’ve tried everything for my sciatica but nothing’s worked.” Maybe it's because your sciatica isn’t actually coming from your low back. How long have you been dealing with sciatica? How many different treatments have you tried to find relief from your sciatica? And how many of them have been focusing on your low back?

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I mean, it makes sense because the sciatic nerve does come from your lower back. And for many people, they do get great relief from back therapies, stretches, exercises, etc. For other people, however, no matter what they seem to do it doesn’t make any difference in helping their sciatica. If this describes you, and if you are open to learning just a little bit more about sciatica - about how your sciatica may actually be caused by something else and not just a problem in your lower back - we may be able to offer a solution to help you.

Is sciatica just a low back problem?

Where is the sciatic nerve? If you look in an anatomy book (or online), you will read that the sciatic nerve is formed by nerve roots from the L4, L5, S1, and S2 levels of your low back. In neurology terms, this is what is called an apparent origin. To make an analogy, let’s say that you are swimming in the ocean, and you see a triangular dorsal fin sticking out of the water. What do you think of now? Shark, of course! But all you are actually seeing is the part that is above the surface.

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Similarly, with sciatica and the sciatic nerve, the part that emerges from your low back is only part of the nerve. The actual fibers of the sciatic nerve actually go something like this: The sensory nerve endings are located on the bottom of your foot. These nerve endings unite to form nerve fibers and bundles that form one continual line - like a single piece of string that goes up behind the back of your knee, up the back of your thigh along the inside of your buttocks, and then in through the openings of your sacrum and lumbar spine.

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BUT THIS SAME NERVE FIBRE DOESN’T STOP HERE!! It continues up through your spinal cord all the way through your upper neck and into a part of your midbrain called the thalamus, which processes the primary sensory information from all the way down in your toes. That is one continual nerve fiber! A single piece of string from all the way in your toes up to your brain.

So what does this have to do with sciatica?

I want you to consider the possibility that sciatica does not always have to come from a problem affecting the sciatic nerve where it is located in the low back. It is possible that the sensation of sciatica could instead be the result of interruption of the nerve signals at any point along with the entire transmission of the nerve! In other words, your low back - even if you do have bulging discs and arthritis may not be the origin of the problem.

Where is your sciatica coming from?

In our experience, we see a combination of different types of sciatica: all wit similar effects, but with completely different causes: 

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1. Piriformis syndrome. This is the type of sciatica that usually responds best with physiotherapy, general chiropractic, massage, stretching, and exercising. It occurs when the piriformis muscle along the inside bottom of your glues tightens, putting pressure on the sciatic nerve. Now, the question may still be asked, “Why does the pirifirmis muscle get tight in the first place?” And how is possible to prevent the muscle from tightening and causing sciatica? To address this question, keep reading about the other types of sciatica for an important clue.

2. Lumbosacral nerve issues. If something is physically pushing on the nerve fibers where they exit the spine, they can also cause sciatica. Again, here is where targeted therapies for the low back are often able to help with the sciatica symptoms. But what if that doesn’t work either?

3. Pelvic sclerotogenous referral. A sclerotome referral is where there is referred pain from pressure on a joint. Commonly, the pelvic or sacroiliac joints are commonly implicated. One of the major predisposing factors that we have found in our practice is that pelvic and low back issues are often the effects of some type of problem in the foot or ankle! In other words, you tweaked your ankle or knee a little, and the result is that it has destabilized your low back, which, over time, has lead to the development of sciatica.

4. Upper neck problem. Remember that we said how the sciatica nerve fibers are actually continuous all the way to your brain through your neck? Your upper neck - the atlas and axis especially - are major sources of mechanical irritation that can cause a physical tugging on the nerve fibers as they enter your skull. Therefore, it is not uncommon for people who experience low back pain issues to actually have the problem originating in the upper neck.

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Picture that piece of string again running from your little toe up to your brain. If you pull the string from the top end, where will the tension be? Exactly! You will feel it at the bottom!! Add to it if you have an ankle issue, could you also imagine how that tension could also pull things from the bottom upwards? If this makes sense, let me ask you: HAS ANYONE CHECKED YOUR ANKLES OR YOUR UPPER NECK TO SEE IF THEY MAY BE RELATED TO YOUR SCIATICA? If the answer is, “No,” then there may be an option that you have not yet explored that may be able to help you find the sciatica answers you have been looking for.

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Why hasn’t anyone told me about this for sciatica before?

This connection between the upper neck and the low back and sciatica is not a new discovery! The connection does back at least 100 years! But even as long as 25 years ago, 1993, a study into the effects of the upper neck and sciatica went relatively unreported where specific care to the upper neck exclusively - not the low back! - showed substantial improvements in orthopedic tests for what was traditionally thought of low back issues:

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• 50-60% improvement in signs of direct nerve tension on sciatica (Straight Leg Raiser, Braggard)

• 70-80% improvement for signs of pelvic or sacroiliac joint dysfunction (Advancement, Yeoman)

• 83% improvement for signs of lumbosacral joint dysfunction (Kemp)

These are not small numbers!

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The challenge is that it is easy to focus on where the pain is versus where the pain is coming from. I think you would agree with me that what we're describing here about sciatica makes sense.

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The simple question now is, What do you do about it? Well, let me ask you the question again first: HAS ANYONE CHECKED YOUR ANKLES OR YOUR UPPER NECK TO SEE IF THEY MAY BE RELATED TO YOUR SCIATICA? If not, here is where ether work we do at Atlas Health Australia may be able to help you.

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Our practice is located in the north Brisbane suburb of North Lakes where we practice a special division of chiropractic known as Upper Cervical Care. Upper cervical care refers to the top bones in the neck - the atlas and the axis - and the unique relationship that they have on your spine and nervous system.

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If these bones are misaligned in any number of degrees (270 combinations according to some authors!), they may interfere with the normal function of your body, leading to health challenges down the track. Therefore, our approach works to get these bones properly alignment and moving the way that they are designed so that your body is able to do what it is supposed to do: i.e., repair and heal itself.

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In this way, the work that we do isn’t a treatment of the effects of sciatica. Instead, it is a natural approach to address the underlying causes of body dysfunction that allow for your own nerve system to fix itself.

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The tests that we perform in the office include detailed physical and muscle tone testing to identify the locations of pressure in your body that could be contributing towards sciatica; neurological testing that assesses the normal function of your body (whether you feel pain or not), and advanced 3D imaging, which helps us see the act degree and direction of misalignment in your spine.

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Although our focus is on the upper neck, it is also our personal experience that we cannot ignore what is happening with the ankles as they relate to sciatica. Therefore, we look to ensure that you are working properly as a whole person, and if there are any additional issues elsewhere, either looking to help you in-house or referring you out to find the right care for what you need.

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References

Brieg A. Adverse Mechanical Tension in the Central Nervous System. Almqvist and Wiksell. 1974

Chan CK, Lee HY, Choi WC, Cho JY, Lee SH. Cervical cord compression presenting with sciatica-like leg pain. Eur Spine J. 2011 Jul;20 Suppl 2:S217-21. doi: 10.1007/s00586-010-1585-5. Epub 2010 Oct 13. https://www.ncbi.nlm.nih.gov/pubmed/20938789

Charlton K. Commentary: does chronic axial non-disease musculoskeletal pain exist outside the neuraxis? Speculations of a privately practicing chiropractic clinician. Chiropr J Austr. 2011;41:1:18-22.

Herman CA. Resolution of Low Back Pain in an 8-year-old Following Blair Upper Cervical Chiropractic Care: A Case Report. Journal of Upper Cervical Chiropractic Research; Jul 2016:24-30.

Ito T, Homma T, Uchiyama S. Sciatica caused by cervical and thoracic spinal cord compression. Spine (Phila Pa 1976). 1999 Jun 15;24(12):1265-7. https://www.ncbi.nlm.nih.gov/pubmed/10382257

Overley SC, Kim JS, Gogel BA, Merrill RK, Hecht AC. Tandem Spinal Stenosis: A Systematic Review. JBJS Rev. 2017 Sep;5(9):e2. doi: 10.2106/JBJS.RVW.17.00007. https://www.ncbi.nlm.nih.gov/pubmed/28872572

Patel EA, Perloff MD. Radicular Pain Syndromes: Cervical, Lumbar, and Spinal Stenosis.

Semin Neurol. 2018 Dec;38(6):634-639. doi: 10.1055/s-0038-1673680. Epub 2018 Dec 6. https://www.ncbi.nlm.nih.gov/pubmed/30522138

Robinson SS, Collins KF, Grostic JD. A retrospective study; patients with chronic low back pain managed with specific upper cervical adjustments. Chiropr Res J. 1993;2(4):10-6.

Thimineur M, Kitaj M, Kravitz E, Kalizewski T, Sood P. Functional abnormalities of the cervical cord and lower medulla and their effect on pain: observations in chronic pain patients with incidental mild Chiari I malformation and moderate to severe cervical cord compression.

Clin J Pain. 2002 May-Jun;18(3):171-9. https://www.ncbi.nlm.nih.gov/pubmed/12048419