Role of Chiropractic Treatment for Sciatica

Sciatica or lumbar radiculopathy is a common disabling condition that may affect people in all age groups. Sciatica symptoms usually include radiating pain in the buttocks down to the legs, feet, or toes. The symptoms may begin insidiously or after a traumatic injury or fall.

Sciatica is mainly diagnosed based on clinical examination. Radiological investigations may be needed if the initial symptoms get worse or if there is a neurological deficit.

MRI image in axial section showing lumbar spine at the level of L5-S1.

MRI image in axial section showing lumbar spine at the level of L5-S1.

Conservative measures are primarily used to treat sciatica without neurological deficits. The neurological deficits may include loss of sensation or numbness in the lower extremities or the saddle area (around the anus and genitals). There may be a weakness in the legs’ muscles, and patients may face difficulty walking or climbing stairs. Rarely there may be loss of control of bladder or bowel movements.

The conservative treatment may include activity modification, heat and cold therapy, physical therapy, pain medications, and alternative medicines such as chiropractic manipulation and acupuncture. Patients with neurological deficits may require surgical intervention in the form of lumbar decompression surgery, sometimes combined with lumbar fusion surgery.

The sciatic nerve is the largest nerve in the human body, formed by the L4, L5, S1, S2, and S3 nerve roots in the lower spine. The nerve roots may get compressed or irritated as they exit the vertebral column. The compression of the roots or the nerve may lead to the symptoms of sciatica.

A chiropractor utilizes spinal manipulation along with exercise techniques to relieve the symptoms of sciatica. Spinal manipulative therapy works under the principle to reduce the irritation of the nerves. The methods utilized by the chiropractic practitioner may involve the use of high-velocity thrusts to remove trigger points. They may also use gentle pressure to relax the muscles and thereby reduce the spasm.

MRI image in sagittal section showing lumbar spine.

MRI image in sagittal section showing lumbar spine.

The mechanism of action of chiropractic spinal manipulation therapy has been hypothesized to be both mechanical and neurological. The biomechanical action of chiropractic manipulation reduces the mechanical stress on the nerve roots that may be irritated between the muscle fibers. The reduction in irritation leads to decreased inflammation and alleviation of symptoms.

The neurophysiological mechanism is hypothesized to act by affecting the nerve signals from the muscles surrounding the vertebral column (paraspinal muscles). Spinal manipulation therapy is also hypothesized to act via changing the perception of the pain.

The chiropractic practitioners’ deep pressure and manipulation are hypothesized to reduce inflammation-causing cells near the irritated nerve roots. The muscle fibers around the vertebral column go into spasm following irritating, and manipulation helps ease the spasm.

Besides the manipulation techniques, the chiropractors also utilize various exercises to increase flexibility and strengthen the vertebral column’s muscles. Other methods such as heat and cold therapy, massage, and TENS (transcutaneous electrical nerve stimulation) may be combined with the manipulation.

Chiropractic treatment is one of the various conservative management options. Many patients may benefit from chiropractic techniques; however, the evidence of chiropractic techniques in sciatica treatment is limited. Many recent studies have indicated that chiropractic manipulation is no more beneficial than other forms of alternative medicine.

The majority of patients get better over some weeks after the onset of sciatica. Although the evidence of chiropractic techniques’ therapeutic value may be limited, patients may benefit from manipulation therapy. Studies have indicated very few adverse effects of chiropractic manipulation compared to the use of medications. However, a physician’s visit may be necessary to diagnose the condition causing sciatica and to learn if any manipulation may not be recommended.

Sciatica most commonly occurs due to a prolapsed intervertebral disc and spinal canal stenosis. Both the conditions may not be reversed by chiropractic manipulation, and chiropractor therapy only aids in the reduction of the symptoms with doubtful benefits.

My name is Dr. Suhirad Khokhar, and am an orthopaedic surgeon. I completed my MBBS (Bachelor of Medicine & Bachelor of Surgery) at Govt. Medical College, Patiala, India.

I specialize in musculoskeletal disorders and their management, and have personally approved of and written this content.

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