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Sciatica Guide

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ask: what kind of doctor should i see to heal sciatic nerve

By Anonymous
 
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four broken ribs and a split bleeding spleen i still have pain on my whole left side still hurts and now my sciatic nerves are hurting i tried chiropractic it got worse do not use aggressive of any kind water therapy is helping the most

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drtchiro

I cannot stress highly enough that all chiropractors are NOT the same (most people are not aware of this). As a chiropractor, there are several ways to conservatively treat sciatica, however, the treatment must be based on what the cause is, and there are multiple causes of sciatica.

Sciatica as a diagnosis only describes pain going down the leg, therefore further investigation by examination and possibly diagnostic testing (x-ray or MRI) may be necessary. I have an article on my website about sciatica here Dr. T on Sciatica.

In cases where the sciatica is severe, I will usually co-treat with an MD, so medication and chiropractic care is used at the same time to control the symptoms.

The cause could be a disc herniation, disc bulge, inflammation, irritation of the nerve itself (multiple causes), piriformis syndrome, just to name a few and can only be found by exam and confirmed by diagnostic testing. It's possible that you gave up on your chiropractor too quickly, or maybe the technique used was not treating the cause.

If one way is not working, because there are multiple ways of treating sciatica, tell your chiropractor it’s not working, and a good chiropractor has an arsenal of things to use. Unfortunately some chiropractors are “stuck” in their ways of diagnosing and treating, which may not resolve the condition, another way all chiropractors are not the same. If he/she is not listening to you, find another chiropractor. Most chiropractors have multiple techniques from low force to aggressive to deal with sciatica, but not all chiropractors do. Some are philosophically opposed to therapy, others are not. Some use one technique only, others use multiple.

Traditional chiropractic will treat "subluxation", and depending on what that doctor of chiropractic believes subluxation is, will determine the course of treatment. Modern chiropractic deals with function and the body's ability to distribute stress. Here is something about chiropractic techniques. I personally use several.

I have many things on my website in the health topics section on chiropractic and chiropractors that you may not see on another chiropractic website, as my take on subluxation is the modern version of it. http://www.DrTChiro.com

Based on what is causing the sciatica, some of the treatments a chiropractor will do is myofascial release--if it's at the piriformis, or somewhere in the lower back or leg-- which is like massage. Mobilization, depending on what you can handle, which can be as much as an adjustment where it "cracks" or adjusts, sometimes a table or instrument is used to induce motion—restoration of normal motion is the key. Sometimes we use therapies like electrical muscle stimulation, or intersegmental traction also depending on the cause.

We may also use a flexion-distraction, which is a form of decompression by taking pressure off of the disc by literally pulling your back apart lightly, which is to tolerance and begins gently until the patient and doctor believe you can tolerate more. If it feels like someone just needs to pull your back or stretch you, this is exactly what flexion-distraction does.

Again, this all depends on what we find after examination--which is likely the same as what an orthopedic surgeon or a neurologist would evaluate, by the way. Sometimes our exam is more than an MD would do as many patients tell me that their doctor didn’t even touch them or even ask them to bend forward. After the evaluation, we can begin to address the problem. Also, not all chiropractors will approach it this way, but many, if not most, will.

Treatment may be a quick fix, or a few treatments, again depending on the cause. Sometimes x-rays are taken--when necessary, but I prefer not to radiate someone as I believe that the fewer x-rays you have in your lifetime, the better. Unless I believe it will result in a significant gain of information because the treatment may be the same, or until I believe further investigation is necessary I may not do x-rays, initially-- sometimes an MRI is warranted if we believe it to be a disc problem.

When conservative treatment is not completely effective, sending to pain management for injections is in order, again depending on the cause which we find by examination. Based on x-rays and other examination findings, if conservative treatment is not effective, depending on the severity, we may refer to an orthopedic surgeon for a surgical consult.

The surgeon may elect to do injections or medication at that time—which is common. Usually, that is not the preferred course by most patients, which is why most patients seek out a chiropractor. Some surgeons are quick to recommend surgery, which may be necessary after everything else fails, but not the first choice of most patients.

Most MD’s will usually prescribe anti-inflammatory medication, and/or muscle relaxants, and/or pain killers. For symptomatic relief, medications may be effective, however, will not likely fix your problem, but may deal with the symptoms. If your body can return itself to normal function while taking meds, it may “self correct” adequately, but not always. If medication alone is not effective; I highly recommend seeking out a competent chiropractor. Again, not all chiropractors are the same.

MD’s may also refer to a physical therapist—usually because they don’t know of a good chiropractor--which also may be helpful, but chiropractic treatment will also significantly overlap what a PT would do. PT’s focus primarily on weakness of muscles and exercise, and utilize therapy as well, which may be effective. If PT it is not effective, it is because the cause, which is dysfunction of the area, usually movement and the adaptive response to that dysfunction, is not addressed. This is exactly what chiropractic addresses.

As mentioned in the other comment, acupuncture has also been found to be effective, and I have recommended acupuncture in the past, as well has had referrals from acupuncturists to me when their patients have not responded completely. Some states have chiropractors who also are allowed to do acupuncture, and may also be licensed acupuncturists.

Sometimes treating sciatica is a team effort, depending on the cause and severity, and the specialists that treat those given causes.

Chiropractic may not work for everyone, but chiropractors have a pretty good success rate with sciatica usually. If you haven't already gathered, this is a modern chiropractic treatment methodology that some chiropractors may not embrace, and in fact would say it's "chiropractic heresy". However, most modern chiropractors would utilize a similar protocol, and know when a problem is within or out of their scope.

I hope that helps,

William M. Thomas, D.C.
Dr. T.
http://www.drtchiro.com

February 4, 2012 - 1:46pm
Rosa Cabrera RN

Hi Anonymous,

Thank you for posting! The Sciatic nerve is the largest nerve running through your body-- this explains why Sciatica pain radiates and is extremely painful. I am so sorry you are suffering with this to no avail. 

Sometimes when all possible comfort measures have been exhausted some patients turn to an Acupuncturist, who can sometimes greatly improve the amount of discomfort felt due to the "pinched" nerve. 

Here's some more information on Sciatica and other treatments: http://www.empowher.com/condition/sciatica/treatments

Best of luck!

Rosa

February 3, 2012 - 1:27pm
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