Question: I have sciatica which is quite painful. I went to a chiropractor and the result is that now my feet frequently go numb. I no longer go to the chiropractor. What alternative approaches have you found to be successful?

Dr. Hibberd's Answer:

Sciatica is a term used to describe irritation of the sciatic nerve which runs down the back of your thigh and supplies the hamstring muscles of each thigh. When irritated, tension on the sciatic nerve will induce pain.

The sciatic nerve is supplied by the fifth Lumbar nerve root, and the first and second sacral nerve roots, any of which may be affected by disc disease or herniation.

Most sciatica is caused by nerve root irritation, bone spur formation associated with degenerative disease, or arthritic change, disc disease, inflammation, or dislodgement affecting the corresponding nerve root adjacent to the problematic disc.

Vascular disorders and tumors may cause sciatica-like symptoms and should be considered when you are initially evaluated.

Since most sciatica is caused by pressure on a corresponding nerve root, it is little surprise that manipulation made your symptoms worse. You would be well advised to have your recurrent and persistent sciatica properly evaluated and appropriately imaged, especially since you have numbness involved and it has worsened.

An X-ray is not sufficient here since it does not have sufficient resolution to evaluate your nerve roots adequately. Avoid manipulation for now. A proper evaluation will also involve a muscle strength, sensory, and reflex assessment. The presence of sensory and motor findings or reflex changes will usually lead to a recommendation to image your nerve roots preferably by MRI of your lumbo-sacral spine.

Most cases of sciatica can be managed quite well medically (medication and sometimes graduated physical therapy modalities that include diathermy, ultrasound, and other heat generating treatments).

Fortunately, most cases self resolve. The medications used are usually anti-inflammatories and short course oral corticosteroids. More resistant cases require imaging to assist in planning the most appropriate treatment be it more aggressive medical treatment such as epidural block or less commonly but occasionally necessary surgical management.

Manipulation of your spine will not prevent or safely treat the initial onset of sciatica. Properly supervised treatment once the condition has been stabilized may include manipulation later for comfort only, however only under professional supervision. Manipulation is generally not to be used in acute disc disease treatment.

In fact, there is no role for spinal manipulation in the prevention of any disorder that affects the spine or spinal cord.