Lower back pain brings you back to your knees. All you did was bend down to pick up the pen that you dropped on the floor. Although this time is different. It is worse than it has been in the past. This time you feel a pain in the back of your leg. A red-hot dagger is stabbing him in the rear and he feels numbness and tingling in his leg, maybe even his foot. You can’t straighten up to walk and you’re limping like you’ve been shot. You lie still and pray that the pain will go away… but it doesn’t go away. In fact, it’s getting worse. His thoughts come in quick succession, “what’s wrong with me, what should I do, who should I call, should I go to the ER, 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 back pain. Swelling from inflammation or the disc itself can cause an impingement or “pinch” of the spinal nerve root. The lower lumbar nerve roots ultimately form the sciatic nerve in the leg. Inflammation of this nerve is commonly known as sciatica. “Mechanical low back pain is one of the most common patient complaints reported to emergency physicians in the United States, accounting for more than 6 million cases annually. Approximately two-thirds of adults are affected by low back pain mechanical lumbar at some point in their lives, making it the second most common complaint in ambulatory medicine and the third most costly disorder in terms of dollars spent on health care, second only to cancer and heart disease.” 1
But just because you have these symptoms doesn’t necessarily mean you should see a surgeon. 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 automatically be referred to the surgeon.” 2 If so, 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). Doctors traditionally prescribe medications, such as pain relievers, muscle relaxants, anti-inflammatories, or any combination of these. There are three problems with taking medication, if that’s all you do.
- Medications only treat the symptoms.
- The medication only provides temporary relief.
- The medication has many unhealthy side effects. Take the time to read the warning label with any of these drugs and you’ll know what I’m talking about.
In contrast, 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), they concluded that “…improvement for chiropractic patients was 5 times higher [than for medical patients]. Patients with chronic low back pain treated by chiropractors show greater improvement and satisfaction after a 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 resulting from 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 mild to moderate discogenic or sciatic pain from intervertebral disc herniation 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 aspirin, 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 with the most severe cases by 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 the patient finds it extremely difficult to move or be moved.
Lastly, not all cases of sciatica are caused by a herniated disc. A condition called piriformis syndrome can cause impingement of the sciatic nerve as it exits the pelvis. Basically, the piriformis muscle attaches to the sacrum, passes through the greater sciatic notch of the pelvis, and attaches to the top of the femur (the upper leg bone). Athletes who play seated sports, such as rowing or cycling, are particularly vulnerable to piriformis strains. Runners who overpronate are also susceptible to piriformis injuries. 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 the 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 have piriformis syndrome and should continue this stretch as part of your daily routine to help prevent further injury. However, if you continue to experience the same symptoms or if they intensify, seek professional help as soon as possible.
- Kinkade S. Evaluation and treatment of acute low back pain. Am Fam Medical. 2007 Apr 15;74(8):1181-8.
- Weber H. Lumbar disc herniation: a controlled prospective study with ten years of observation. thorns 1983;8:131-40.
- 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 2000 May; 23(4):239-245.
- Hurwitz EL, Aker PD, Adams AH, Meeker WC, Shekelle PG. Manipulation and mobilization of the cervical spine. A systematic review of the literature. thorns 1996 August 1/21 (15): 1746-59.
- Harrison DE, Cailliet R, Harrison DD, Janik TJ, Holland B. Changes in sagittal lumbar configuration with a new method of extension traction: nonrandomized controlled clinical trial. Archives of Physical Medicine and Rehabilitation 2002 November; 83(11): 1585-91.
