The “Psychotic Nerve”
[originally published in KCN, May 1999]
No, you won’t find this in any anatomy book, and the treatment of mentally deranged nerves was never brought up during my years in chiropractic college. However, ask anyone who has had the unfortunate displeasure of suffering from the intense leg pain that this “nerve” generates, and they will emphatically stand by this tongue-and-cheek, layman’s designation. After some quick thinking , the astute diagnostician will realize that the nerve they are referring to, is not the “psychotic”, but the sciatic, and the painful condition that can afflict this nerve is a term more appropriately recognized in health care circles as sciatica (but who knows, “psychotica” has a nice ring to it).
All kidding aside, the sciatic nerves hold the rank as being the largest and longest nerves of the body. Reaching about the size of your thumb in diameter, the sciatic nerves venture forth from the spine as five nerves sprouting from the lumbar and sacral regions on either side, bundling together like telephone cables, and running the length of each leg to the toes. When these nerves become inflamed or irritated anywhere along their course, the painful leg condition of sciatica results.
Sciatica can take on many different faces, and thus can be very frustrating for both patients and doctors alike. The pain, as a general rule, is in the back of the leg and can sometimes go all the way into the foot and toes. The pain can range from a sharp, shooting pain, to one that feels burning or tingling. Oddly enough, sometimes sufferers will actually describe their pain more as a numbness! The pain may ache or act more like a knife. It may be constant or may decide to come and go. Certain movements or positions may affect the pain and sometimes they won’t. In severe cases, significant weakness and wasting of the leg muscles results. The patient may or may not have accompanying lower back pain. And if all this were not enough, the effects that this can have on one’s life can be devastating. Simple things that we all too often take for granted like walking, bending, twisting, sitting, and standing, not to mention, sleeping, can become difficult, if not impossible in some cases.
So how does all of this occur? Good question. This is where we doctors find the condition frustrating. But before we get too far ahead of ourselves, I need to point out that not all leg pain is sciatica. All too often the sciatic nerve becomes the scapegoat of leg pain. Leg pain can generate from many different sources: some locally in the leg and some far removed. This is where a good comprehensive history and examination are invaluable at helping the doctor to locate the source of the problem. Having said this, the causes of sciatica can be many. Causes can run the gamut from advancing stages of diabetes to tumors; arthritis to constipation; endometriosis to vitamin deficiencies. In the vast majority of cases, however, the cause of sciatica can be traced back to the spine. Again, this is where the invaluableness of a good history and examination come into play — helping your doctor to distinguish the “hoof beats” he hears: “Is it a horse, or possibly a zebra?”
One of the very common causes of sciatica is the Vertebral Subluxation Complex. This complex is a condition in which the segmented bones of the spine lose their normal motion or position, often triggering factors which can compromise the spinal nerves that exit the spine to become the sciatic nerve. One of several factors that may contribute to this process is the bulging or herniation of the soft, pulpy discs which separate each of the spinal bones. This condition can chemically irritate or physically put pressure on these nerve roots, and BINGO the “Psychotic Nerve” rears its ugly head.
So how can one combat this ugly beast. The problem, which may seem like a mere technicality at first, is that sciatica is not a pathological disease, but rather a symptom — an indicator that an underlying problem exists. So while a quick breeze through the medical journals will indicate that most cases of sciatica are “benign, self-limiting disorders” (ie. they won’t kill you and they will eventually go away on their own), one has to wonder, if it has truly has “ gone away” or if the problem that spurned it on in the first place is still present. Those that have dubbed this nerve the “Psychotic” will probably side with the latter.
As you may recall in my November 1998 article, “My Doctor Said It Would Go Away,” I highlighted a research project published in the British Medical Journal which debunked the medical myth that the majority of low back pain patients will get better in six weeks regardless of the treatment they receive or don’t receive. What the researchers ended up finding out was that this line of thinking was based on medical doctor’s consultation records, where a patient not returning for more treatment was an automatic assumption that they were “cured”. However, follow-up telephone interviews revealed that the majority of these patients were still suffering from pain and/or disability (75% to be exact). The bottom line in this study was that back pain does not just magically “go away.” Instead, it is like an unwelcome visitor who decides to unexpectedly show up on a semi-regular basis.
Chiropractors have been aware of the cyclical nature of spinal pain for over 100 years. Pain emanating from the spine is merely a symptom that an underlying problem exists. Unless the root of the problem is addressed, the symptoms will continue to come and go. In most cases, sciatica is no different.
The medical approach to calming sciatica is symptom-oriented. Combinations of bed rest, pain medications, muscle relaxers, antiinflammatories, and physical therapy interventions are often prescribed. Unfortunately, because sciatica can be so difficult to get a handle on, even the strongest medications don’t offer any relief for some patients. Direct injection of pain medication into the nerve itself will sometimes do the trick, while for other patients surgery is resorted to.
The chiropractic approach, on the other hand, is is really not about “curing” sciatica at all, but rather, centered around finding the cause of the problem. If it is determined that the cause of the patient’s sciatica is stemming from the spine and the Vertebral Subluxation Complex is involved, chiropractic may very well be able to help. Chiropractors correct poor spinal alignment and function by delivering carefully directed and controlled pressures, known as “adjustments,” to the problematic areas of the spine. By utilizing spinal adjustments in the lower back, excessive pressure on the spinal nerves, joints, and discs, that may be a contributing factor, if not the sole source of sciatic pain, can be removed. Several studies out of both medical and chiropractic journals report that adjustments to the spine are often beneficial in helping sufferers of sciatica. As one study in the British Journal of Rheumatology so aptly stated, “…the beneficial effect of manipulation [adjustments] in hastening pain relief [in patients with sciatica] was highly significant.”
Unfortunately, there’s no “magic bullet” for sciatica. Both chiropractic and conventional medical approaches have their place. At the very least, however, chiropractic adjustments should be utilized as one of the first lines of treatment in the health care arsenal for sciatica sufferers. Considering chiropractic’s relatively good outcome with sciatica, coupled with its excellent safety record, it makes sense that this form of treatment be tried first. It’s hard to make a case, with some obvious clinical exceptions aside, why the typical sciatica patient should be subjected to chemical and surgical interventions that often only carry modest positive outcomes with a much greater risk.
As I stated before, sciatica can be a very frustrating condition for both the patient and the doctor. And while it may be tempting to name-call the sciatic nerve, we need to remember that it is rarely the sciatic nerve itself that is the problem. The old adage “Don’t shoot the messenger” seems appropriate here. If we think of the sciatic nerve as a messenger and listen closely, we may be able to find out who the sender is, and thus be able to address the cause. If we kill the messenger, by eliminating or suppressing symptoms, the sender remains at large.
Sources used for this article:
Barge. The chiropractic vertebral subluxation and its relationship to vertebrogenic lumbar pain, cruralgia, and sciatica syndromes. Chiropractic Research Journal. 3(2). pp. 25-39. 1996.
Bell and Rothman. The conservative treatment of sciatica. Spine. 9(1):54-6. 1984.
Bergmann and Jongeward. Manipulative therapy in lower back pain with leg pain and neurological deficit. Journal of Manipulative and Physiological Therapeutics. 21(4), pp. 288-94. 1998.
Coxhead, Inskip, Meade, et. al. Multicentre trial of physiotherapy in the management of sciatic symptoms. Lancet. 1(8229): 1065-8. 1981.
Croft, et al. Outcomes of low back pain in general practice: a prospective study. BMJ 1998. 316: 1356-9.
Dudeney, O’Farrell, Boucheier-Hayes, and Byrne. Extraspinal causes of sciatica. A case report. Spine. 23(4). pp. 494-6. 1998.
Dhote, et. al. Cyclic sciatica: a manifestation of compression of the sciatic nerve by endometriosis. A case report. Spine. 21(19). pp. 2277-9. 1996.
Gatterman. Chiropractic Management of Spine Related Disorders. William & Wilkins. Baltimore. 1990.
Koren, Tedd. Sciatica and leg pain. Koren Publications Inc. 1997.
Mathews, Mills, et. al. Back pain and sciatica: controlled trials of manipulation, traction, sclerosant, and epidural injections. British Journal of Rheumatology. 26(6): 416–23. 1987.
Mazanec. Back pain: medical evaluation and therapy. Clev Clin J Med. 62(3): 163-8. 1995.
Sciatica and the chiropractic lifestyle. Back Talk Systems, Inc. 1996
Stern, Cote, and Cassidy. A series of consecutive cases of low back pain with radiating leg pain treated by chiropractors. Journal of Manipulative and Physiological Therapeutics. 18(6): 355-42. 1995.
Wheeler. Diagnosis and management of low back pain and sciatica. American Family Physician. 52(5): 1347-8. 1995.
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