As with so many health conditions, true sciatica begins with the vertebral subluxation complex, the chiropractic $20 word for spinal damage. Time, life, and gravity have acted on your spine either severely enough or long enough that inflammation generates scar tissue. This leads to loss of spinal joint motion. This causes less nutrients and water to get to the vertebral discs which lack a blood supply. They then dehydrate, degenerate, tear, bulge, and finally herniate. So true sciatica takes a long time to develop even though the symptoms may have appeared out of nowhere for no reason over night. It is years or decades in the making. And the thing that differentiates it from false sciatica is the disc. With false sciatica, the disc is not involved as a source of pain. With true sciatica, the disc is involved, making it much more complicated. So what do we do about it?
As always there are only 3 tools we use to correct subluxation; the adjustment, stretching exercises, and deep tissue massage. The purpose of these tools is to improve motion of the damaged joint, to reduce nerve stress, to reduce muscle tightness, to reduce inflammation, and to break down scar tissue. In a case where there is no disc damage, these tools work fantastic nearly every time. They work quickly and with few if any side-effects. However, when there is disc herniation, as in sciatica, this complicates things. Disc herniation is when the jelly middle of the disc (the nucleus) oozes out through the degenerated rings of the cartilage outer portion of the disc (the annulus). The bigger the herniation, the longer treatment will take, the less success they may be in pain reduction, and the worse the long term prognosis. But, with time, the adjustments can still work fantastically. But remember, it took a long time to get here. It may take a long time to get under control. But nothing can ever truly fix it!
Adult humans don’t make cartilage, so once the disc is damaged it cannot be undamaged. The herniation can be made smaller. The pain can be reduced or eliminated. The inflammation can be lessened. The rate of degeneration can be slowed. Episodes of pain can be made less frequent. But the disc will never be whole again. Impossible. This is all about spinal subluxation management.
So what happens when chiropractic cannot help the victim of true sciatica? If you are not getting better we order an MRI to assess the disc damage. And if you still don’t get better with that information we combine decompression with the adjustments. And if you still don’t get better, which is a rare few, then and only then do we consider the injections of pain management and the costs, pain, and failure rate of back surgery. Only then.